ACOG Green Journal: Neonatal Outcomes After Delivery in Water



To assess neonatal intensive care unit (NICU) admissions and neonatal outcomes after water birth or land birth in an alternative birthing center.


We conducted a prospective observational study of preselected low-risk parturients separated into three groups depending on their location for labor and delivery: land–land, water–land, and water–water. Delivery outcomes, labor length, maternal pain assessment, need for newborn resuscitation, and NICU admission and diagnoses were collected. The primary outcome was admission to the NICU.


There were 2,077 total deliveries from April 2015 to December 2019, consisting of 458 land–land deliveries, 730 water–land deliveries, and 889 water–water deliveries. The rate of NICU admission was 2.8% (95% CI 1.5–4.8%) for land–land deliveries, 4.1% (2.8–5.8%) for water–land deliveries, and 2.0% (1.2–3.2%) for water–water deliveries. A post hoc power analysis revealed a 70% power to detect a 2.1% difference in NICU admissions between the water–land and water–water groups.


In this cohort of low-risk pregnant women, births in water and on land were associated with similar rates of admission to the NICU.

doi: 10.1097/AOG.0000000000004545

ACOG Green Journal: Neonatal Outcomes After Delivery in Water