SavedAdd your journal

Journals / International Journal of Science Letters / 2026 / Volume: 8 Issue: 1

The effects of water immersion and water birth on maternal and neonatal outcomes: a systematic review

Aleyna Yıldız(Üsküdar Üniversitesi)0000-0003-0151-3636
Tuğba Yılmaz Esencan(Üsküdar Üniversitesi)0000-0002-8748-0793
Pages
—
Publication Date
2026-09-30
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

When appropriate candidate selection is ensured and evidence-based midwifery care is provided, water birth may be considered a safe birth option for both mothers and neonates.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: The aim of this systematic review is to evaluate the effects of water birth on maternal and neonatal outcomes in the light of current evidence.
📊
Key Findings & Data:The systematic review included randomized controlled trials and prospective and retrospective cohort studies published in English or Turkish between 2012 and 2026.
💡
Conclusion & Impact:When appropriate candidate selection is ensured and evidence-based midwifery care is provided, water birth may be considered a safe birth option for both mothers and neonates.
🔬Design:Review & Systematic Survey
📍Scope:2012 Verileri
⚙️Variables:Maternal-Fetal Relations · Delivery · Obstetric

Abstract

Aim: The aim of this systematic review is to evaluate the effects of water birth on maternal and neonatal outcomes in the light of current evidence. Methods: This systematic review examines the current literature on maternal and neonatal outcomes of immersionband water birth. The literature search was conducted using Google Scholar, PubMed, Cochrane Library, and ScienceDirect databases. The systematic review included randomized controlled trials and prospective and retrospective cohort studies published in English or Turkish between 2012 and 2026. A total of 11 studies met the inclusion criteria and were included in the review. Results: The reviewed studies indicate that water birth enhances maternal relaxation through the effects of buoyancy and hydrostatic pressure, reduces pain perception, and supports the elasticity of perineal tissues, thereby contributing to the physiological progression of labour. This method has been reported to reduce the need for pharmacological analgesia, increase maternal satisfaction with childbirth, and encourage women’s active participation in the birth process. With regard to maternal outcomes, water birth appears to be associated with lower rates of third- and fourth-degree perineal tears, anal sphincter injuries, episiotomy, and postpartum haemorrhage. In terms of neonatal outcomes, no significant adverse differences have been identified between water birth and conventional birth methods with respect to Apgar scores, neonatal intensive care unit admissions, or the incidence of neonatal infections. However, the risk of umbilical cord avulsion during water birth remains controversial in the literature. Although rare cases have been reported, this complication is considered to have a low incidence. Conclusion: The available evidence suggests that there is no strong indication that water birth has adverse effects on maternal or neonatal outcomes. When appropriate candidate selection is ensured and evidence-based midwifery care is provided, water birth may be considered a safe birth option for both mothers and neonates.

🔖

Cite This Article

Yıldız, A., Esencan, T. Y. (2026). The effects of water immersion and water birth on maternal and neonatal outcomes: a systematic review. International Journal of Science Letters, Volume: 8 Issue: 1. https://doi.org/10.38058/ijsl.1941274

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (37)

  1. Amerikan Kadın Doğum ve Jinekologlar Koleji. (2016). Committee opinion no. 679: Immersion in water during labor and delivery.
  2. Akbaş, P., Şat, S. Ö., Mine, İ. Ş., & Yaman, Ş. (2021). Doğum ağrısı ile başlama skalası’nın Türkçe geçerlilik-güvenilirlik çalışması. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi, 7(3), 235–241.
  3. Bovbjerg, M. L., Cheyney, M., & Caughey, A. B. (2022). Maternal and newborn outcomes following waterbirth: The MANA Stats study. BJOG: An International Journal of Obstetrics & Gynaecology, 129(6), 950–958. https://doi.org/10.1111/1471-0528.17009
  4. Burns, E., Feeley, C., Hall, P. J., & Vanderlaan, J. (2022). Systematic review and meta-analysis to examine intrapartum interventions, and maternal and neonatal outcomes following immersion in water during labour and waterbirth. BMJ Open, 12, e056517. https://doi.org/10.1136/bmjopen-2021-056517
  5. Carlsson, T., & Ulfsdottir, H. (2020). Waterbirth in low-risk pregnancy: An exploration of women’s experiences. Journal of Advanced Nursing, 76(5), 1221–1231. https://doi.org/10.1111/jan.14336
  6. Carreguí-Vilar, S., Rocca-Ihenacho, L., Moya-Artuñedo, E. M., Collado-Boira, E. J., & Chalmeta, R. (2025). Epidural or water immersion? A prospective cohort study on maternal and neonatal outcomes in a tertiary hospital. Midwifery, 104392. https://doi.org/10.1016/j.midw.2025.104392
  7. Cluett, E. R., Burns, E., & Cuthbert, A. (2018). Immersion in water during labour and birth. Cochrane Database of Systematic Reviews, 2018(5), CD000111. https://doi.org/10.1002/14651858.CD000111.pub4
  8. Dahlen, H. G., Dowling, H., Tracy, M., Schmied, V., & Tracy, S. (2012). Maternal and perinatal outcomes amongst low-risk women giving birth in water compared to six birth positions on land: A descriptive cross-sectional study in a birth centre over 12 years. Midwifery, 29(7), 759–764. https://doi.org/10.1016/j.midw.2012.07.002
  9. Edwards, S., Angarita, A. M., Talasila, S., & Berghella, V. (2024). Waterbirth: A systematic review and meta-analysis. American Journal of Perinatology, 41(9), 1134–1142. https://doi.org/10.1055/s-0043-1764145
  10. Ergin, B., & Taşkın, L. (2022). The effect of warm shower application in the first stage of labor on pain, anxiety, and comfort: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research, 48(7), 1442–1450. https://doi.org/10.1111/jog.15266
  11. Esencan, T. Y., & Daştan, K. (2023). Doğum eylemine yönelik girişimlerde ebelerin rolü. Kırşehir Ahi Evran Üniversitesi Sağlık Bilimleri Dergisi, 7(2), 126–135.
  12. Feeley, C., Cooper, M., & Burns, E. (2021). A systematic meta-thematic synthesis to examine women’s views and experiences of immersion in water for labor and birth. Journal of Advanced Nursing, 77(7), 2942–2956. https://doi.org/10.1111/jan.14720
  13. Halfdansdottir, B., Ellinger-Kaya, K., Fjøsne, K., Lindgren, H., Hegaard, H. K., & Blix, E. (2024). Association between waterbirth in physiological birth and perineal trauma or other adverse outcomes among low-risk women. Women and Birth, 37(4), 101625. https://doi.org/10.1016/j.wombi.2024.101625
  14. Herrero-Orenga, C., Galiana, L., Sansó, N., Molas Martín, M., Castro Romero, A., & Fernández-Domínguez, J. C. (2024). Effects of water immersion as an analgesic method during labor compared with epidural in low-risk women: A 10-year retrospective cohort study. Healthcare, 12(19), 1919. https://doi.org/10.3390/healthcare12191919
  15. Huang, J., Zang, Y., Ren, L.-H., Li, F.-J., & Lu, H. (2019). A review and comparison of common maternal positions during the second-stage of labor. International Journal of Nursing Sciences, 6(4), 460–467. https://doi.org/10.1016/j.ijnss.2019.06.007
  16. International Confederation of Midwives. (2024). Essential competencies for midwifery practice. https://internationalmidwives.org/resources/essential-competencies-for-midwifery-practice/
  17. Kartikasari, M., & Aktovianta, L. (2021). Meta-analysis: The effect of waterbirth method on perineal rupture risk. Journal of Epidemiology and Public Health, 6(4), 505–520.
  18. Lathrop, A., Bonsack, C. F., & Haas, D. M. (2018). Women’s experiences with water birth: A matched groups prospective study. Birth, 45, 416–423. https://doi.org/10.1111/birt.12362
  19. McKinney, J. A., Vilchez, G., Jowers, A., Atchoo, A., Lin, L., Kaunitz, A. M., Lewis, K. E., & Sanchez-Ramos, L. (2024). Water birth: A systematic review and meta-analysis of maternal and neonatal outcomes. American Journal of Obstetrics & Gynecology, 230(3), 961–980. https://doi.org/10.1016/j.ajog.2023.08.034
  20. Mitchell, L., & Khan, E. (2022). Guideline for use of water during labour and birth. Milton Keynes University Hospital NHS Foundation Trust. https://www.mkuh.nhs.uk/wp-content/uploads/2022/10/Water-birth-guideline.pdf
  21. Nakazone, P. V., Leister, N., Teixeira, T. T., Silva, C. M., McCourt, C., & Riesco, M. L. G. (2026). Maternal and neonatal waterbirth outcomes in a freestanding birth center in Brazil: A cross-sectional study. Midwifery, 153, 104691. https://doi.org/10.1016/j.midw.2025.104691
  22. National Institute for Health and Care Excellence. (2023). Intrapartum care for healthy women and babies (NG235). https://www.nice.org.uk/guidance/ng235
  23. National Institute for Health and Care Excellence. (2025). Intrapartum care: Evidence review on the effects and safety of water immersion during the second stage of labour (NG235).
  24. Neiman, E., Austin, E., Tan, A., Anderson, C. M., & Chipps, E. (2019). Outcomes of waterbirth in a US hospital-based midwifery practice. Journal of Midwifery & Women’s Health, 65(2), 216–223. https://doi.org/10.1111/jmwh.13033
  25. NHS Scotland. (2024). Waterbirth standard operating procedure (SOP). Right Decisions Service. https://www.rightdecisions.scot.nhs.uk/media/sprhpb1e/waterbirth-sop-2024docx.pdf
  26. Nikodem, V. C., Edwards, S. E., Krzyzanski, A. M., Berghella, V., & Hofmeyr, G. J. (2022). Immersion in water in the second stage of labor: A randomized controlled trial. American Journal of Obstetrics & Gynecology MFM, 4(6), 100721. https://doi.org/10.1016/j.ajogmf.2022.100721
  27. Reviriego-Rodrigo, E., Ibargoyen-Roteta, N., Carreguí-Vilar, S., Mediavilla-Serrano, L., Uceira-Rey, S., Iglesias-Casás, S., Martín-Casado, A., Toledo-Chávarri, A., Ares-Mateos, G., Montero-Carcaboso, S., Castelló-Zamora, B., Burgos-Alonso, N., Moreno-Rodríguez, A., Hernández-Tejada, N., & Koetsenruyter, C. (2023). Experiences of water immersion during labor: A qualitative thematic synthesis. BMC Pregnancy and Childbirth, 23(1), 395. https://doi.org/10.1186/s12884-023-05690-7
  28. Royal College of Obstetricians and Gynaecologists, & Royal College of Midwives. (2006). Immersion in water during labour and birth. RCOG Press.
  29. Russell, K., Walsh, D., Scott, I., & McIntosh, T. (2014). Changing midwives’ behaviour in the labour ward to increase water birth rates. Midwifery, 30(3), e96–e101. https://doi.org/10.1016/j.midw.2013.11.001
  30. Sanders, J., Barlow, C., Brocklehurst, P., Cannings-John, R., Channon, S., Cutter, J., Hunter, B., Jokinen, M., Lugg-Widger, F., Milosevic, S., Gale, C., Milton, R., Morantz, L., Paranjothy, S., Plachcinski, R., & Robling, M. (2024). Maternal and neonatal outcomes in spontaneous vaginal births in or out of water following water immersion during labour: The POOL cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 131(12), 1650–1659. https://doi.org/10.1111/1471-0528.17878
  31. Snapp, C., Stapleton, S. R., Wright, J., Niemczyk, N. A., & Jolles, D. (2020). Experience of land and water birth within the American Association of Birth Centers Perinatal Data Registry, 2012–2017. The Journal of Perinatal & Neonatal Nursing, 34(1), 16–26. https://doi.org/10.1097/JPN.0000000000000450
  32. Seed, E., Kearney, L., Weaver, E., Ryan, E. G., & Nugent, R. (2023). A prospective cohort study comparing neonatal outcomes between waterbirth and land birth in an Australian tertiary maternity unit. Australian and New Zealand Journal of Obstetrics and Gynaecology, 63(1), 59–65. https://doi.org/10.1111/ajo.13555
  33. Vidiri, A., Zaami, S., Straface, G., Gullo, G., Turrini, I., Matarrese, D., Signore, F., Cavaliere, A. F., Perelli, F., & Marchi, L. (2022). Waterbirth: Current knowledge and medico-legal issues. Acta Bio Medica, 93(1), e2022077. https://doi.org/10.23750/abm.v93i1.12617
  34. Winata, I. G. S., Harrista, D. V., & Setiawan, W. A. (2024). Various childbirth techniques: Home birth, water birth, lotus birth, hypnobirth, and birthing position. Indonesian Journal of Perinatology, 5(1), 19–28. https://doi.org/10.51559/inajperinatol.v5i1.52
  35. World Health Organization. (2013). Midwifery skills guidelines: A guide for midwifery skills (Issue 1). https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/MLT-MN-48-01-GUIDELINE-2013-eng-01-MIDWIFERY-SKILLS-GUIDELINES-A-Guide-for-Midwifery-Skills-Issue-1-May-2013.pdf
  36. World Health Organization. (2018). WHO recommendations: Intrapartum care for a positive childbirth experience.
  37. Yurtsal, Z. B., & Eroğlu, V. (2022). Doğum gününe uyumlamada kullanılan farmakolojik olmayan taklit. Sağlık & Bilim, 95.