Water birth: evidence analysis, clinical recommendations and view of the problem

Water birth has become increasingly widespread in many countries around the world. However, attitudes toward this practice remain mixed, largely due to the lack of large-scale studies that provide scientific evidence validating all of its benefits and risks. In our country, immersion in water during labor is available in many maternity hospitals. However, the main issue is the absence of national guidelines and standards for managing such births. The existing order of the Ministry of Health of Ukraine dated January 26, 2022, No. 170 “Physiological Labor” recommends the use of hydrotherapy for pain relief during labor but does not provide clear requirements regarding its implementation.In this article, we reviewed current perspectives on the management strategies and potential complications of water birth. Hospitals which offer water birth must have clearly defined protocols that include: candidate selection, maintenance and cleaning of baths and pools, infection control procedures, temperature regulation, monitoring of the woman during labor and fetus, management of each labor stage, and evacuation of patients from the water in emergency situations (complications).Since immersion in water during the I stage of labor and the actual delivery of the baby into water may have different outcomes, we presented data on the advantages and risks of each. Immersion in water during the I stage of labor has a positive analgesic effect, contributes to the shortening of labor duration, and is not associated with an increased rate of maternal or fetal complications. Delivery of the baby directly into the water may be associated with possible neonatal risks such as infection, respiratory distress, water aspiration, umbilical cord avulsion, and others. We also present literature data on the management of labor in the presence of certain complications and conditions: group B streptococcus colonization, premature rupture of membranes, shoulder dystocia, elevated body mass index, and more.