As a doula, you know that many families wonder about water birth. With conflicting information and opinions, many families wonder, is water birth safe?
Many parents hear about the benefits of water birth. They hear it helps with comfort and pain relief, and even possibly reduces the risk of tearing. However, providers and institutions worry about the safety of baby, and even the parent, during a water birth.
A 2023 meta-analysis published in the American Journal of Obstetrics & Gynecology (AJOG) examined maternal and neonatal outcomes associated with planned water birth. This report offers important insights for doulas who support, educate, and advocate for birthing families.
Overview of the AJOG Water Birth Study
The AJOG study analyzed outcomes of planned water births in hospital and community settings and compared them with land births among low-risk pregnancies. Researchers focused on both neonatal outcomes (such as respiratory complications and NICU admission) and maternal outcomes (including perineal trauma).
Importantly, this was a large, contemporary, peer-reviewed analysis designed to address long-standing safety concerns related to underwater birth—particularly for newborns.
Key Findings Relevant to Doulas
No Increase in Serious Neonatal Complications
The study found no increased risk of serious neonatal morbidity or mortality among infants born in water when births were:
- Planned
- Attended by trained professionals
- Limited to low-risk pregnancies
- Conducted under established eligibility criteria
This challenges the assumption that water birth is inherently dangerous for newborns when appropriate safeguards are in place. Is water birth safe? Per this study, it does seem it is safe for low risk pregnancies.
However, it is important to remember that only low-risk pregnancies were included in this study. If you are working with moderate or high-risk pregnancies, providers may still deem water birth as risky.
Respiratory Outcomes Were Not Worse With Water Birth
One of the most common concerns about water birth is the risk of neonatal aspiration or respiratory distress. The AJOG study did not find a higher rate of adverse respiratory outcomes in water-born infants compared with those born on land, under proper clinical protocols.
This reinforces current understanding that healthy term newborns have protective reflexes that prevent breathing underwater at birth.
Slightly Increased Risk of Umbilical Cord Avulsion — But Still Rare
The study did identify a slightly higher incidence of umbilical cord avulsion (cord snapping) in water births compared with land births. However:
- These events were still rare
- Most cases were managed without long-term neonatal harm
- Risk is mitigated by gentle, controlled birth techniques
This finding underscores the importance of skilled attendants and thoughtful handling during the birth itself—something doulas should be mindful of when discussing water birth logistics with clients. As doulas, we are non-medical. However, we can assist clients in finding providers familiar and experienced with water birth. Is water birth safe? When there’s skilled attendants, even with some risk, overall, water birth appears to be a safe option.
Is Water Birth Safe For Moms? Maternal Outcomes Were Favorable
Water birth was associated with:
- Lower rates of severe perineal trauma
- High maternal satisfaction
- Reduced need for pharmacologic pain management
While doulas do not provide medical care, these outcomes align with what many families report anecdotally when choosing water immersion for birth.
What This Means for Doulas
Supporting Informed Decision-Making
Doulas can use this study to help clients understand that:
- Planned, properly attended water birth is supported by emerging evidence
- Risks and benefits should be discussed with their midwife or doctor
- Their pregnancy risk level might impact their midwife or doctor’s recommendations
A scope-appropriate approach might sound like:
“Recent peer-reviewed research shows that planned water birth, when attended by trained providers and for low-risk pregnancies, does not appear to increase serious newborn risks. This would be a great topic to explore with your midwife or OB to see if it’s an option for you.”
Staying Within Scope
Doulas do not recommend or medically screen for water birth, but we:
- Provide evidence-based information
- Encourage discussions with their maternity care providers
- Support clients emotionally and physically regardless of birth setting
It’s essential to avoid framing water birth as universally “safe” or “unsafe” and point families to evidence and their midwife or OB to make informed decisions about their options. We can say that evidence supports water birth as a safe option for many and it is important they make an informed decision with their providers.
Understanding Why Policies Vary
Despite growing evidence, many hospitals still restrict water birth. This study helps doulas understand that:
- Institutional policies often lag behind emerging research
- Liability concerns and staff training influence availability
- Ongoing research is shaping policy discussions
This context helps us as doulas to better support clients who feel confused or frustrated by differing recommendations.
Important Limitations to Acknowledge
As with any study, there are important caveats:
- The research focused on planned water births, not accidental deliveries in water
- Results apply to low-risk pregnancies only
- Outcomes depend heavily on trained attendants and clear protocols
Doulas should always emphasize that water birth safety depends on appropriate candidate selection and professional oversight. Planned water birth with a qualified attendant (midwife or OB) is not the same as a planned water birth without an attendant (e.g., freebirthing).
This AJOG study adds peer-reviewed evidence to ongoing conversations about water birth. For doulas, it reinforces the importance of:
- Evidence-based education
- Clear scope boundaries
- Collaborative communication with care providers
Is water birth safe? Water birth is not appropriate for every family or setting — but when planned carefully and attended by qualified professionals, current research suggests it can be a safe option for some low-risk pregnancies.
As doulas, our role remains the same: educate honestly, support continuously, and refer appropriately — grounded in the best available evidence. Not already a doula? Get started today and you’ll be ready to support families however they choose to birth, including having a safe water birth.
Author: Aliza Juliette Bancoff
Aliza Juliette Bancoff is a well-known doula and doula trainer who has been providing doula services to families for over a decade. She is the founder of Main Line Doulas, a doula group providing doula support in the great Philadelphia area for the last decade, the International Doula Institute, which provides online doula training and lactation training and certification programs and the International Breastfeeding Institute which provides lactation training and certification. She is the co-founder of United Birth, a company devoted to increasing access to doulas across the country to make the perinatal time safer both physically and emotionally. “Every birthing person deserves access to quality doula support. And we are working to make that a reality across the country. The work we are doing to get doulas to every birthing person will decrease the black infant and maternal mortality rate significantly by 2030.” Says Bancoff. Aliza is known for her compassionate and empowering approach to doula work, and she has been featured in numerous media outlets, including United Nations Maternal Health Report, Parent Magazine, CafeMom, theBump and many more. Aliza's journey into doula work began when she gave birth to her first child and felt a strong calling...