help_outline Skip to main content
Add Me To Your Mailing List

Promoting excellence in midwifery education!

News & Blog

New Waterbirth Research and Resources

Published on 2/8/2016

Educators – classroom faculty and clinical preceptors – need access to the latest information to make sure midwifery students are well prepared for clinical practice. Two new documents on waterbirth are now making their debut in the midwifery world, with a third due out this spring, which will inform midwives, educators, students and consumers.

The first, Maternal & Newborn Outcomes Following Immersion During Waterbirth: The MANA Statistics Project 2004-2009 by Marit L. Bovbjerg PhD, MS, Melissa Cheyney PhD, CPM, LDM and Courtney Everson MA, PhD, was published in the Journal of Midwifery and Women’s Health on January 20, 2016. This article examines data from the MANA Statistics Project 2.0 dataset which included over 18,000 women who gave birth at home and in birth centers with midwives, of which 35% were waterbirths. This is the largest cohort study to-date on waterbirth – examining more than 6,000 waterbirths – and the first large study from the United States. This study finds that being born underwater poses no increased risk of mortality or morbidity to newborns. Babies born in water were no more likely to experience low 5-minute Apgar, neonatal transfer to the hospital, hospitalization or NICU admission in the first six weeks, or neonatal death, when compared to non-waterbirth neonates. For women, waterbirth was not associated with hospitalization in the immediate postpartum period or within the first six weeks, or with maternal infection. However, this study shows that waterbirth did appear to slightly increase the risk of perineal tearing.

Results are congruent with findings from waterbirth studies in other settings, but are contrary to the ACOG/AAP clinical guidelines “Immersion in Water during Labor and Delivery” (ACOG Committee Opinion #594, April 2014), which acknowledges the safety and potential benefits (i.e., pain management) of laboring in water, but also states that the safety of birthing in water has not yet been established, and thus, these guidelines do not recommend waterbirth. Courtney Everson, AME Board member and co-author of the article, explains that the ACOG/AAP waterbirth guidelines were a primary impetus to this study.

For more information about this article, visit MANA’s blogpost at

Thanks to the Journal of Midwifery and Women’s Health, the article is now open source, so midwives, birth workers and clients can freely access it. You can find it here:

The second document, the MANA and CfM Position Statement on Water Immersion During Labor and Birth, is a joint position paper written for a broad audience including midwives and other health care professionals, consumers, and policy makers. It is co-authored by the Midwives Alliance of North America and Citizens for Midwifery. This paper provides an overview of available research and clinical wisdom on waterbirth. With over 80 citations, including Maternal & Newborn Outcomes Following Immersion During Waterbirth by Bovbjerg et al, and information from waterbirth activist Barbara Harper, the position paper

  • discusses the evidence for the safety of water immersion during labor and birth,
  • describes the benefits of water immersion for mother and baby,
  • suggests how these benefits may improve outcomes for families of color,
  • addresses consumer choice and shared decision making,
  • considers client values and individual needs,
  • lists factors that promote safety and success,
  • concludes with a recommendation that supports the use of water immersion during labor and birth, and
  • advises that water immersion for labor and birth should be made available to all birthing families across birth settings.

The MANA and CfM Position Statement on Water Immersion During Labor and Birth is available on the MANA website at

The authors of the article and the position paper were interviewed for the MANA blog, which you can find here:

The MANA position paper complements the existing ACNM position paper “Hydrotherapy During Labor and Birth” (

The third document is a clinical bulletin that is being drafted by a multi-stakeholder group with midwifery leadership and groundbreaking collaboration. This document will provide clinical guidelines for water immersion in labor and birth that can be used for both in-hospital and out-of-hospital birthing sites. Release is anticipated for this spring.