The therapeutic properties of warm water immersion have been known for centuries. Baths, showers and whirlpools have been used for comfort during labor for many years. Over the past two decades the use of warm water immersion for the birth of the baby has aroused interest in many countries and an increase in the number of women requesting this option for both hospital and out-of-hospital births is occurring.
Waterbirth International has reviewed the best available evidence and has developed guidelines and protocols to assist midwives, physicians, nurse managers and women in their decision making process around the use of water immersion for labor and birth. The body of evidence is relatively small but growing.  Demand for this low-risk non-medicated labor tool increases every day as popular press publishes stories of successful waterbirths.  Our history as an organization includes consultations with over 7000 pregnant women in the past 20 years. 

There have been a few highly controversial reports in the literature, especially in the journal Pediatrics on the negative effects of water immersion for babies.  "Water Birth: a near drowning experience" (Nuygen et al, 2002)  suggests that every case of waterbirth should be evaluated as a possible fresh water drowning. The authors' conclusions that the use of water for labor and birth may contribute to adverse outcomes should be viewed with considerable caution. There are several methodological problems with this case study and these results are not congruent with the findings of many large trials.  It is clear more research is needed into this form of care. But opinion pieces should be viewed at just that, opinion and not referred to as scientific or medical evaluation of the evidence. 

Maternal and neonatal outcomes after water immersion for labor and birth have been assessed in a number of large surveys and retrospective analysis.  Researchers reviewed 4693 and 4032 births (Gilbert & Tookey, 1999), respectively, where water immersion was used and found no difference in outcomes for women and their newborns compared to a cohort group of low risk women who did not use water.

The perinatal mortality rate for these births was comparable to other low risk births in the UK. 

The obstetric nurse needs to be aware of not only the controversies but the actual evidence and the protocols that are in place in over 300 US hospitals.