WATER BIRTH SAFETY Part 7 Why Do the UK and US Give Different Advice About Water Birth?

Why Do the UK and US Give Different Advice About Water Birth?

Here's an interesting one.

If you research water birth safety in the UK and then do exactly the same thing using American guidance, you may wonder whether everyone has been reading the same research.

The UK and US currently take somewhat different positions.

What does the UK say?

NICE's current UK guidance says women should be offered the option to consider giving birth in water. Its recommendation followed a review of newer large cohort studies involving low-risk, term, singleton pregnancies.

NICE concluded that the evidence consistently suggested water birth was not associated with increased severe adverse outcomes for mothers or babies, although the certainty of much of the evidence was low and some uncertainties remain.

What does the US say?

The American College of Obstetricians and Gynecologists (ACOG) takes a more cautious position.

ACOG supports water immersion during the first stage of labour for healthy women with uncomplicated term pregnancies, but its published Committee Opinion recommends that birth itself take place on land because it considers the evidence around underwater delivery insufficient.

There's an important bit of context here: That ACOG opinion was published in 2016.

NICE's water-birth recommendation was updated in 2025 after considering substantial newer evidence.

That doesn't mean one organisation is “right” and the other is “wrong”.

It does mean that professional guidance can be produced at different times, using different bodies of available evidence and different thresholds for making recommendations.

So what should parents do?

Look at the evidence. Ask questions. Discuss your own circumstances with your maternity care provider.

And remember that guidelines are enormously useful — but the date on the guideline matters too.

Science, rather inconveniently, does keep happening.

Sources

NICE – Current Intrapartum Care and Water Birth Guidance

NICE – Water Birth Rationale and Impact

ACOG – Immersion in Water During Labor and Delivery

2024 Water Birth Systematic Review and Meta-analysis

This article provides general information and does not replace individual medical or midwifery advice.