How valid are the common concerns raised against water birth? A focused review of the literature.

BACKGROUND Women have birthed in water for many years, with researchers finding a number of benefits for mother and baby. Despite these benefits, many health institutions and clinicians are hesitant to support women's access to water immersion in birth for a number of reasons. As such, this paper aimed to (1) select five common concerns raised against water birth and (2) examine whether research supports these concerns as being evidence-based. METHOD A literature review was conducted to (1) select the concerns for review and to (2) review each selected concern as to whether they were supported by the current evidence. A recent review of women's access to, and uptake of, water immersion in Queensland, Australia, was also used to determine the concerns for review in order to better capture concerns relevant to Australian practice. FINDINGS Three clinical concerns were selected for review: water aspiration, neonatal and maternal infection, and neonatal and maternal thermo-regulation; and two concerns around the practice of water birth were selected: skills and education of workforce, and emergency procedures in case of maternal collapse. The three clinical concerns were not found to be supported by the available evidence and the two practice concerns can be addressed by appropriate policy, guidelines and practice. CONCLUSION The reviewed common concerns against water birth are not evidence-based nor are they sufficient to prevent women from accessing the use of water in labour and birth. Health institutions and clinicians should ensure they take adequate precautions to enable women access to this valued and effective method of birth.