“This piece of paper says no”: Larger-bodied women’s experiences trying to access water immersion for labour and birth

BACKGROUND: Water immersion for labour and birth supports physiological birth and positive birth experiences. Larger-bodied women experience more complications from obstetric interventions yet are often denied access to water immersion. AIM: To explore larger-bodied women's experiences of trying to access water immersion for labour and birth in Australia. METHODS: This qualitative sub-study draws on data from the RADIANT study, a consumer-led project exploring weight-inclusive maternity care. Using an online Photovoice method, 65 participants shared images and narratives in moderated discussion groups and virtual workshops. Data related to water immersion for labour and birth were analysed using reflexive thematic analysis. FINDINGS: Four themes were identified: 1) "Because your body mass index (BMI) is too high"; 2) "Rugs frequently pulled out"; 3) "No input or final say"; and 4) "Little energy left to fight". DISCUSSION: Findings reveal that BMI-based restrictions and inconsistent clinical practices undermine autonomy and equitable access to the effective pain relief offered through water immersion for labour and birth. Women reported emotional distress, reduced trust in care, and challenges self-advocating in a system that often pathologises their larger bodies. CONCLUSION: Larger-bodied women value access to water immersion for pain relief during labour and birth but face systemic barriers. A shift toward weight-inclusive individualised care is needed to support informed choice and respectful maternity care.