Intended for healthcare professionals

Clinical Review Lesson of the week

Underwater birth and neonatal respiratory distress

BMJ 2005; 330 doi: (Published 05 May 2005) Cite this as: BMJ 2005;330:1071
  1. Zainab Kassim, clinical research fellow in neonatology1,
  2. Maria Sellars, consultant in radiology2,
  3. Anne Greenough, professor of neonatology and clinical respiratory physiology (
  1. 1 Department of Child Health, Guy's, King's and St Thomas' School of Medicine, King's College Hospital, London SE5 9RS,
  2. 2 Department of Radiology, King's College Hospital, London
  1. Correspondence to: A Greenough
  • Accepted 16 March 2005


In 1992 the House of Commons Select Health Committee's report on maternity services recommended that all hospitals should provide women with the “option of a birthing pool where this is practicable.”1 A subsequent surveillance study of all NHS maternity units between 1994 and 1996 found that 0.6% of all deliveries in England and Wales occurred in water.2 Rawal and colleagues have suggested that water births have become popular among mothers and midwives because the buoyancy and warmth of the water promotes natural labour while providing a non-invasive safe and effective form of pain management.3 Practitioners and parents should remember, however, that birthing pools pose potential risks for the baby. We report on a newborn baby who developed respiratory distress due to aspiration after an underwater birth.

Case report

A full term male infant weighing 3150 g was born in the birthing pool of the labour ward of our hospital. His mother was a 34 year old, healthy primigravida who had …

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