title: The risks of underwater birth.
abstract: OBJECTIVE
  We performed a retrospective review of the literature on the complications that could be associated potentially with water birth.
  
  
  METHODS
  We performed an extensive review of the medical literature using the Pub Med search engine, which is available through the National Library of Medicine. We also examined the Cochrane review on immersion in pregnancy, labor and birth.
  
  
  RESULTS
  Our review revealed 74 articles regarding water births. We found 16 citations that described complications that were associated with underwater birth. Possible complications that were associated with water birth included fresh water drowning, neonatal hyponatremia, neonatal waterborne infectious disease, cord rupture with neonatal hemorrhage, hypoxic ischemic encephalopathy, and death. Our systematic review did not identify an adequately controlled trial of delivery underwater (second stage of labor underwater) compared with delivery in air.
  
  
  CONCLUSIONS
  Water birth may be associated with potential complications that are not seen with land-based birth. The rates of these complications are likely to be low but are not well defined.
authors.affiliation: Department of Obstetrics and Gynecology, Maine Medical Center, Portland, ME 04102, USA. cartia@mmc.org
authors.forename: Michael G
authors.initials: MG
authors.lastname: Pinette
authors.forename: Joseph
authors.initials: J
authors.lastname: Wax
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001720:Birth Injuries / Q000453:epidemiology / Q000209:etiology; D000529:Complementary Therapies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007101:Immersion; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends; D009321:Natural Childbirth / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D014867:Water
chemical_list: D014867:Water