Water births have been much talked about, but how safe are they? The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recently issued a joint committee opinion paper on the topic. 

They reviewed the limited research available on the potential benefits and risks of water births, and broke their statement down into water immersion during labor and water immersion during delivery, which is an important distinction.

The pros are that it "may be associated with decreased pain or use of anesthesia and decreased duration of labor," wrote the joint committee, adding, "However, there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes."

Even it may make labor more pleasant, there are no differences in perineal trauma or tears, or in the need for assisted vaginal deliveries or Cesarean sections. An important note, says Jeffrey L. Ecker, M.D., a high-risk obstetrician at Massachusetts General Hospital in Boston and chair of ACOG's Committee on Obstetric Practice, is that if a mom-to-be does choose to spend some time in water during the first stage of labor, she and her baby are still being monitored at the normal intervals.

But the second stage—delivery—is an entirely different story: "The advice of the group is that it should not be done," says Ecker. "There are potential risks and the benefits have not been demonstrated."

The joint committee wasn't able to find any benefits to delivering underwater. They did, however, list potential rare but serious risks based on the case studies and series they examined: higher risk of infections for both mom and baby, difficulty in regulating the baby's body temperature, an increased chance of umbilical cord damage, respiratory issues from the baby inhaling water, and even the possibility that the baby could have seizures or asphyxiate after birth.

Of course, the committees noted that the research available on the topic was limited. But they concluded: "The practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent."

More in detail here.