(Reuters Health) - Giving birth in water, also known as immersion labor and delivery or waterbirth, appears safe for mother and baby, at least when it takes place in a hospital.

Increasing numbers of women choose to labor and give birth in water, particularly in midwifery-led settings, so it is important to understand the benefits and possible risks for women and their newborns.

Dr. Elizabeth R. Cluett from University of Southampton in the UK and colleagues evaluated the effects of water immersion during labor and/or birth using information from 15 studies involving a total of 3,663 women.

Immersion had no meaningful effect on rates of spontaneous vaginal delivery, vaginal delivery with the help of forceps or other devices, or cesarean section, the authors reported in the Cochrane Database of Systematic Reviews.

Women who went through the first stage of labor with immersion were slightly less likely than women without immersion to need an epidural.

There was not enough information to determine whether waterbirth affected the rates of moderate to severe tears in the perineum, the area between the vagina and the anus, or the amount of blood loss during labor and delivery.

There was no evidence that immersion increased unwanted effects to the baby or woman, regardless of the stage of labor when immersion took place.

There are several caveats to these findings. All the studies took place in hospital labor and delivery units, and none of the studies took place in midwifery-led care settings. Most studies did not indicate whether it was the first time a woman had given birth or it was a later pregnancy. And there was a lack of information about how selective the studies were on which women they included.

For all these reasons, the researchers suggest that “further research is needed particularly for waterbirth and its use in birth settings outside hospital labor wards before we can be more certain of these effects. Research is also needed about women’s and caregivers’ experiences of labor and birth in water.”

Dr. Thomas G. Poder from CIUSSS de l’Estrie-CHUS, Sherbrooke, Quebec, Canada, who has also reviewed the advantages and disadvantages of waterbirth, told Reuters Health by email, “(The current study) missed some important points, that is, maternal relaxation and satisfaction (and) promotion of a model of obstetric care more focused on the needs of mothers, particularly the empowerment of women to realize their full potential.”

“Waterbirth is safe if properly managed,” he said. “So, this should be a choice offered to mothers.”

Dr. Megan Cooper, researcher and lecturer in midwifery and nursing at University of South Australia in Adelaide recently surveyed midwives regarding their waterbirth experiences and last year analyzed Australian policies and guidelines for water immersion during labor and birth. She told Reuters Health by email, “Water immersion for labor and birth is a safe option for women who are at low risk of complications. As both a method of pain relief and an alternate mode of birth, water immersion is associated with positive outcomes that extend beyond the physical. Not only does water immersion support women to achieve a physiological and non-medicalized labor and birth, but women commonly have a more positive birth experience.”

“There is increasing demand for options of care that can offer women alternatives to pharmacological analgesia and improved chances of having a normal physiological birth,” she said. “We have an ever increasing evidence base that demonstrates that water immersion provides such an alternative without any increased risk to the woman or baby. Despite this, there remains a lack of support for this option in some settings, possibly due to the fear of adverse events, that for the most part, are documented as possible or theoretical.”

“The research is continually demonstrating that there is no additional risk to the woman or baby, so we should seek to offer this option to women who request it,” Dr. Cooper said.

Dr. Cluett did not respond to a request for comments.

SOURCE: bit.ly/2lHYdAY Cochrane Database of Systematic Reviews, online May 16, 2018/