Underwater birth and neonatal respiratory distress

Editor—We were concerned and dismayed to see the case report by Kassim et al of respiratory distress for a baby born in water being cited as evidence of the risk of underwater birth.¹,² Respiratory conditions can occur after any birth, and in the absence of discernible antenatal fetal compromise they are not particular to water birth. This account by two neonatologists and a radiologist from a prominent London centre is likely to provoke fear among practitioners and parents.

Having recently reviewed the evidence about immersion in water during labour and birth we concluded that a clear need existed for further evidence about the safety and effectiveness of water birth.³ This systematic review provided no basis to deny this care option for women with uncomplicated pregnancy.

Unfortunately this case report contributes to unreliable evidence and information women are offered when making decisions and choices for labour and birth. Safety and effectiveness of immersion in water for birth should be evaluated in a well designed randomised controlled trial. Neither opponents nor proponents serve women and babies well by continuing to accumulate anecdotal reports to support their own biases.