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October 26, 2016

American College of Nurse-Midwives’ Statement Regarding the new ACOG/AAP Committee Opinion, “Immersion in Water During Labor and Delivery

ACOG’s new committee opinion released this month reflects a significant change from its past opinion which called for women having a water birth only as part of a clinical trial. While this new opinion is a positive step, ACOG continues to recommend against water birth in second stage labor.

ACNM believes this new opinion still does not accurately recognize women’s desire for access to this option, nor does it reflect the large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor and birth. The new bulletin continues to reinforce that immersion in water during the first stage of labor may be associated with numerous benefits to women, which ACNM and American Academy of Pediatrics (AAP) also agree.

ACNM has been in communication with ACOG to express our concerns and our disagreement with the conclusions of this committee opinion, and has sent additional, up-to-date information on water birth outcomes to ACOG and AAP for the committee’s consideration.ACNM, in collaboration with AABC, MANA and NACPM, has completed the development of a Model Practice Template for Hydrotherapy During Labor and Birth. This template, which will be released by the Journal of Midwifery and Women’s Health in the next month, will provide guidance for protocol development in order to offer water birth as an option to families who desire it in the home, hospital and birth center settings.

As this ACOG committee opinion is disseminated and media stories emerge, it is critical that ACNM members are equipped with accurate information to have informed discussions with women and families, as well as with professional colleagues. The nation’s top experts in water birth have been working closely with our national office staff team and ACNM leadership to encourage the dissemination of accurate information about water birth.

Please refer to ACNM’s position statement on Hydrotherapy During Labor and Birth.

Summary of ACNM position regarding water birth and the ACOG committee opinions:

  • Women need accurate, reliable information when making decisions about the birth of their child, including how to manage their pain so they can be as comfortable as possible. Consulting with a qualified healthcare provider will ensure that the risks, benefits, alternatives and research are discussed so women can make informed choices. After consulting with her health care provider, if a woman chooses to labor and give birth in water, she should receive all the support she needs to make it a safe and pleasant experience.

  • Midwives are experts at working with women during pregnancy to ensure that their concerns are heard and their questions are answered. They help women understand the evidence and choose what is works best for their pregnancy, labor and birth and they listen to the personal preferences of the women they serve.

  • Most water births occur under the care of a midwife and it has been a safe option for decades that provides comfort with good outcomes for the mom and her baby. ACNM members serve women who are having water births in hospitals, birth centers and the home. ACNM supports ongoing access to water birth and we encourage more maternity care providers to become educated about its safe use in order to ensure that women are fully informed.

  • ACNM concurs with results of randomized clinical trials – a reliable form of research – that demonstrate that “immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor.” With healthcare organizations (like ACNM, ACOG and AAP) in agreement on this, more healthy women are likely to have access to this information and practice—which is great news for women.

  • However, this new ACOG/AAP opinion statement cautions about immersion in water during the second stage of labor. These cautions are similar to those in their prior publications, including warnings about a lack of data on the safety and benefits of water birth. The organizations refer to case studies of adverse outcomes, but case studies are not a reliable form of research, and should not be the foundation for their conclusion that women should get out of the tub when they enter second stage labor.

  • ACNM believes that this committee opinion does not accurately reflect the large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor and birth. Despite limitations, the best available research indicates that water birth is associated with perinatal outcomes similar to those expected in a low-risk population. In other words, healthy women and their babies generally stay healthy during and after normal labor and water birth. One of the largest studies of outcomes for women and newborns experiencing a water birth confirms this finding. See JMWH article. Therefore, water birth is a reasonable choice for healthy women to make in collaboration with their care provider, given the state of the science.

  • We agree that more quality research about water birth is needed, particularly in the US, but international studies already support water immersion as an option that women should consider for their labor and birth, and the additional studies since the last publication of the ACOG water immersion clinical bulletin continue to reinforce this conclusion.

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American College of Nurse-Midwives.
8403 Colesville Rd, Suite 1550 | Silver Spring MD 20910
Phone: 240-485-1800 | Fax: 240-485-1818
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