July 2026
Midwife Expert News
ICM Portugal • New studies and data • Guideline Updates
Summer has arrived with a vengeance here in the UK but we’re keeping a cool head to share some key updates in the midwifery world. It was fantastic to meet so many passionate colleagues at ICM in Portugal and it’s encouraging that we have plenty of new studies to review.
Thank you for being part of the MidwifeExpert community
Dianne and the Midwife Expert Team
ICM Lisbon, Portugal
Midwifery leaders from more than 120 countries gathered in Lisbon for the 2026 ICM Congress, delivering a clear message: the world urgently needs one million more midwives.
Across five days, the conference highlighted the global shortage, celebrated midwife‑led innovation, and launched a landmark Joint Declaration committing midwives, nurses, obstetricians, paediatricians, and neonatal specialists to work together to improve maternal and newborn outcomes.
Delegates shared evidence showing that investing in midwives could prevent millions of deaths, strengthen health systems and reduce unnecessary intervention in childbirth. Education quality, leadership development and political commitment were recurring themes, with countries announcing new workforce plans and renewed focus on regulation and training standards.
The Congress closed with a call for unified global action, positioning midwives not only as essential clinicians, but as leaders shaping the future of maternity care worldwide.
Reflections from Lisbon — Strengthening Global Midwifery Together
Attending the 2026 ICM Congress in Lisbon was a genuinely energising experience. The opportunity to meet with midwives from across the world, many of whom I’ve collaborated with for years, was a particular highlight. These gatherings remind us how powerful it is when midwives share practice, challenge assumptions and exchange ideas that strengthen care for women and families everywhere.
The discussions this year were particularly rich: workforce development, leadership, education standards, and the ongoing need to protect physiological birth were all front and centre. What stood out most was the collective determination to push midwifery forward, not just clinically but politically and professionally.
Lisbon provided an excellent setting for this work: well organised, accessible, and conducive to meaningful conversation. I left feeling encouraged, connected and proud of the global midwifery community’s commitment to improving outcomes and advancing our profession.
Latest Studies…
Retrospective Study of Birth Outcomes at a Maine Birth Center Comparing Neonates Born Into Water to Those Born on Land
Abstract
Water birth is a method of delivering a baby from the maternal environment into a warm tub and placed into the mother's arms. While increasing numbers of nationally accredited birth centers and hospitals are standardizing protocols for best practices, concerns of neonatal safety raised by pediatricians and obstetric providers remain.
Objective:
This study aims to compare outcomes of water born neonates to those born via standard land birth to self –selected cohorts designated as low risk for obstetric complications in a freestanding birth center in New England.
Study Design/setting:
A retrospective chart audit of women giving birth in water with a matched cohort who birthed on land and their neonatal outcomes. Population studied: Women of child bearing age between 18 and 45 meeting low-risk pregnancy criteria as designated by the standards set by A.A.B.C (American Association of Birth Centers.) All deliveries were completed at a freestanding birth center in Portland, Maine between 1999 and 2008.
Outcome measures/Results:
475 charts were reviewed by two separate reviewers. Of the 320 women included in the study, 170 delivered in water and 150 delivered on land. Primigravids represented 49.7% (n = 159) of the sample. There were significant differences in the mean durations of both first and second stages of labor between women who delivered on land and women who delivered underwater (95% CI, P < .0001) with shorter mean first and second labor stages for women who delivered underwater. Of neonates born underwater, (n = 56) 32.9% had 1-minute Apgar scores of 7 or less and 2.9% (n = 5) had 5-minute Apgar scores of 7 or less while neonates delivered on land, (n = 55) 36.7% had 1-minute Apgar scores of 7 or less and 6.7% (n = 10) had 5-minute Apgar scores of 7 or less. Fewer abnormalities in initial vital signs were observed in neonates delivered in water than on land. No deaths occurred in either group.
Conclusion:
Neonates who were born into water did not experience higher levels of morbidity or mortality when compared to those born on land. In addition, women who delivered into water, on average, experienced shorter first and second stages of labor. Comment – stresses the points of knowledge base of physiology and fluid intake of isotonics not just water. Midwifeexpert is now encouraging 2 yearly updates for health practitioners who support waterbirth.
Maternal and Neonatal Outcomes of Water Birth Compared with Conventional Vaginal Delivery: A Five-Year Retrospective Cohort Study from Southeastern Europe
Dragos Brezeanu, Ana-Maria Brezeanu, Simona Stase, Vlad Tica
PMID: 42073470 PMCID: PMC13117489 DOI: 10.3390/life16040661
Abstract
Background: Water birth has gained increasing attention as an alternative childbirth method intended to promote maternal comfort and physiological labor while potentially reducing obstetric interventions. However, evidence regarding its maternal and neonatal safety compared with conventional delivery approaches remains heterogeneous. This study aimed to evaluate maternal and neonatal outcomes associated with water birth compared with conventional spontaneous vaginal delivery in a secondary obstetric center. By focusing on vaginal births, the study evaluates the specific impact of water immersion on perineal integrity and neonatal transition.
Methods: We conducted a retrospective cohort study including 3747 deliveries recorded at a tertiary maternity unit over a five-year period. Among these, 692 births occurred in water (water birth group) and 561 were conventional vaginal deliveries (land birth group), both managed under a standardized institutional protocol. Maternal characteristics, obstetric outcomes, and neonatal parameters were extracted from medical records and compared between the two cohorts. Primary outcomes included rates of episiotomy, perineal trauma and neonatal indicators such as Apgar score. Statistical analyses were performed to assess differences between groups using appropriate comparative tests.
Results: Water birth was associated with a significantly lower rate of episiotomy compared with land birth (5.06% vs. 13.72%, OR 0.33, 95% CI 0.22-0.50, p < 0.001). Neonatal outcomes, including Apgar scores and NICU admissions, did not differ significantly between the two cohorts.
Conclusions: In this retrospective cohort, water birth among selected low-risk pregnancies was associated with reduced obstetric intervention, particularly episiotomy, without evidence of adverse neonatal outcomes. These findings suggest that water birth may represent a safe and feasible option in carefully selected low-risk pregnancies when strict clinical protocols are applied.
Cost-effectiveness analysis of water immersion vs. epidural analgesia during labour. A ten-year study in the Balearic Islands, (Spain)
Carmen Herrero-Orenga 1, Laura Galiana 2, Juan Carlos Fernández-Domínguez 3, Noemí Sansó 4, Xavier Espada Trespalacios 5, Ramón Escuriet 6
PMID: 42085800 DOI: 10.1016/j.midw.2026.104840
Abstract
Problem and background: Value-based healthcare calls for selecting interventions that achieve optimal outcomes at the lowest cost. Although water immersion and epidural analgesia are effective for childbirth pain relief, few studies have compared their cost-effectiveness in real-world clinical settings.
Aim: This study aimed to evaluate the cost-effectiveness of water immersion compared to epidural analgesia during birth in a hospital setting.
Methods: A cost-analysis was undertaken. Data were drawn from a ten-year observational cohort study including 1,134 low-risk women. Healthcare costs were estimated according to the analgesic option chosen during labour, incorporating baseline costs, mode of birth, and any unexpected clinical events. For the water-immersion group, additional costs related to infrastructure adaptation and professional training were included to assess the return on investment. All costs were calculated using the public tariffs in force in the Balearic Islands.
Findings: Economically, the average cost per woman was €2,134 for water immersion versus €3,010 for epidural analgesia, with annual savings of €47,992. The initial investment in water immersion facilities was recovered within the first year.
Discussion: These findings suggest that water immersion is a safe, effective, and cost-saving alternative to epidural analgesia. It aligns with value-based healthcare by improving outcomes, reducing interventions, and respecting women's preferences.
Conclusions: Policymakers and health managers should consider integrating water immersion as a standard pain management option in maternity services. Its implementation can enhance quality of care and optimise healthcare resource use, particularly in public systems aiming for sustainable, woman-centred models of intrapartum care.
YouTube as a Source of Water Birth Information: An Analysis of Gaps, Misalignments, and Adherence With American College of Obstetricians and Gynecologists (ACOG) Guidelines
Antonia Oladipo , Natasha Malonza , Erika Fleming , Jamie Chen , Katherine M Collamore , Michel'le Bryant
PMID: 42255792 PMCID: PMC13238166 DOI: 10.7759/cureus.108351
Abstract
Background Water birth is increasingly popular, yet debates persist regarding its safety and efficacy. There is a need to assess the accuracy and sentiment of publicly available water birth content, and it is essential that water birth content be accurate to support informed decision-making. Objective To identify whether certain YouTube video characteristics play a role in determining whether the contents of the video are aligned with the published recommendations set forth by the American College of Obstetricians and Gynecologists. Materials and methods An analysis of the top 100 English-language YouTube videos on "water birth" sorted by "most viewed" was conducted on March 9, 2023. After applying inclusion and exclusion criteria, a final set of videos met the inclusion criteria and were included in the analysis. Video characteristics were recorded. Video accuracy was assessed against 16 ACOG water birth guidelines. Scores: 1 (accurate), 0 (not mentioned), or -1 (inaccurate). Transcripts were analyzed using MonkeyLearn Sentiment Analyzer to determine sentiment. Results Of the videos analyzed, the majority were neutral in their accuracy, while a smaller proportion were deemed accurate or contained inaccuracies. Critical safety topics, such as umbilical cord avulsion or neonatal infection risks, were almost universally omitted. Videos created by healthcare professionals demonstrated greater accuracy, while personal vlogs were predominantly neutral. Sentiment analysis revealed that most videos conveyed a negative sentiment, followed by positive and then neutral sentiment. Notable geographic disparities were observed, with North American content exhibiting greater emotional polarization compared to international content. Conclusion Most widely viewed YouTube content on water birth lacks alignment with ACOG guidelines, particularly regarding risk communication, posing misinformation risks.
Effects of Water Immersion Versus Epidural as Analgesic Methods during Labor among Low-Risk Women: A 10-Year Retrospective Cohort Study
Carmen Herrero-Orenga 1 2 3, Laura Galiana 4, Noemí Sansó 2 3, Myriam Molas Martín 1, Araceli Castro Romero 1, Juan Carlos Fernández-Domínguez 2 3
PMID: 39408098 PMCID: PMC11476211 DOI: 10.3390/healthcare12191919
Abstract
Background: Adequate pain relief during childbirth is a very important issue for women and healthcare providers. This study investigates the effects on maternal and neonatal outcomes of two analgesic methods during labor: water immersion and epidural analgesia.
Methods: In this retrospective observational cohort study at a first-level hospital, in Spain, from 2009 to 2019, 1134 women, low-risk singleton and at term pregnancy, were selected. Among them, 567 women used water immersion; 567 women used epidural analgesia for pain control. Maternal outcomes included mode of birth and perineum condition. Neonatal outcomes included 5 min Apgar score, umbilical cord arterial pH, and Neonatal Intensive Care Unit admissions. Chi-square tests and Mann-Whitney U tests, together with their effect sizes (Cramer's V, odds ratio, and Cohen's d) were used to test the main hypotheses.
Results: Spontaneous vaginal birth was almost 17 times more likely in the water immersion group (OR = 16.866 [6.540, 43.480], p < 0.001), whereas the odds of having a cesarean birth were almost 40 times higher in the epidural group (OR = 39.346 [3.610, 429.120], p < 0.001). The odds of having an intact perineum were more than two times higher for the water immersion group (OR = 2.606 [1.290, 5.250], p = 0.007), whereas having an episiotomy was more than eight times more likely for the epidural group (OR = 8.307 [2.800, 24.610], p < 0.001). Newborns in the water immersion group showed a better 5 min Apgar score and umbilical cord arterial pH and lower rates in admissions at the Neonatal Intensive Care Unit.
Conclusions: Women choosing water immersion as an analgesic method were no more likely to experience adverse outcomes and presented better results than women choosing epidural analgesia.
Rest And Restore Postnatal Pain Management
Framework “Midwifery Led Care”
Pooja Singh, Suman Lata, Tanima Verma, Lokesh Kumar Sharma
M.Sc. Nursing, King George’s Medical University, India1
Assistant Professor, King George’s Medical University, India2
Assistant Professor, King George’s Medical University, India3
M.Sc. Nursing, King George’s Medical University, India4
Abstract:
Background: The postnatal period is marked by significant physiological and psychological adjustments for women, often accompanied by pain that can impede recovery and well-being. Traditional pain management relying on pharmacological interventions has limitations, prompting the exploration of non-pharmacological
alternatives. Midwifery care, with its woman-centered and holistic philosophy, is uniquely positioned to implement such approaches.
Materials and Methods: The framework categorizes relaxation techniques into physical modalities (massage, TENS, hydrotherapy, positioning, thermal therapies, breathing), psychological techniques (relaxation techniques, VR, music, distraction), and complementary/alternative approaches (hypnosis, religion/health integration,support therapy, aromatherapy). The physiological underpinnings of relaxation and support are explored, highlighting the autonomic nervous system, hormonal mechanisms (oxytocin, endorphins, cortisol reduction), and musculoskeletal benefits. The role of family support and Kangaroo Mother Care in enhancing relaxation and well-being is also discussed.
Results: Integrating the "Rest and Restore" framework into midwifery practice offers multifaceted benefits. For postnatal mothers, this includes reduced pain perception, decreased reliance on medication, lowered stress and anxiety, improved physical recovery, hormonal balance, enhanced mood, increased self-efficacy, and strengthened mother-infant bonding. For newborns, benefits encompass improved thermoregulation, cardiorespiratory and blood glucose stability, enhanced sleep, improved brain development, and secure attachment. Families experience stronger partner involvement and overall improved well-being.
Conclusion: The "Rest and Restore" framework, incorporating diverse relaxation and supportive techniques within midwifery-led care, presents a holistic and effective approach to postnatal pain management. This framework empowers women, promotes physiological and psychological restoration, and enhances the postnatal
experience for mothers, newborns, and families, aligning with the core values of midwifery practice.
Portraying Birth in the Digital Age: How YouTube Shapes Perceptions of Waterbirth
Carlee Denholtz, Apeksha Mewani, Corey H. Basch ,Adi Gutiqi & Grace C. Hillyer
Waterbirth, the practice of laboring and/or delivering in warm water, has gained popularity for its reported benefits, including reduced pain, lower intervention rates, and higher maternal satisfaction, although concerns about safety remain. This study analyzed 90 YouTube videos (2009–2025) to examine the portrayal of waterbirth online. Most videos were personal, emotional, and anecdotal, often highlighting positive experiences while downplaying risks. Over time, content evolved from longer, experience-based videos to shorter, story-focused formats that featured more explicit depictions. Misleading claims appeared in some videos, and a few contained scientific references. Findings suggest YouTube significantly shapes public perceptions of waterbirth, emphasizing emotion over evidence.
Redefining Waterbirth Spaces: The Rationale Behind MidwifeExpert’s New Design and Refresh Service
At MidwifeExpert, we believe that the environment in which birth takes place is more than just a backdrop—it’s a vital part of the experience for families and a daily reality for staff. That’s why we’re proud to officially launch our new Waterbirth Pool Room Design and Refresh Service, created to help maternity units around the world elevate their birthing spaces with confidence, clarity and care.
This service is the result of decades of hands-on experience and global insight. As Dianne Garland, founder of MidwifeExpert, explains:
“During my travels around the world, I’ve seen the very best and unfortunately, the worstof pool room design. It’s clear to me that both mothers and staff deserve the best environments possible: spaces that are safe, efficient and emotionally supportive.”
Drawing on this international perspective, our consultancy offers tailored design solutions and recommendations that blend clinical excellence with calming aesthetics. From optimised equipment selection and placement to lighting and layout, every detail is considered to support physiological labour and enhance staff workflow.
We also understand the financial pressures many units face. That’s why our service is designed to maximise the efficiency of available budgets, ensuring that even modest investments can lead to meaningful improvements in safety, satisfaction, and reputation.
Whether you’re refreshing an existing room or starting from scratch, MidwifeExpert is here to help you create a space that reflects your commitment to excellence in maternity care.
Women's Knowledge, Perception and Acceptability of Waterbirth: A Cross-Sectional Survey of Tertiary Hospitals in Abuja, North-Central Nigeria
MC Eze, HM Abdul, BO Altraide, VN Nwude, C Onyema - IPS Journal of Public Health, 2025
Women had good knowledge and perception of waterbirths high level of interest and willingness if service is offered.
Background: Waterbirth is practised, accepted and acknowledged in many countries worldwide as one of the natural options for labour and childbirth due to its evidence-based benefits. Despite its increasing popularity in many regions of the world, waterbirth is not yet widely practiced in Abuja, Nigeria. Understanding women’s perceptions, knowledge and acceptability regarding the practice is essential to inform evidence-based integration into maternity services.
Objectives: The objectives of the study were to assess the knowledge, perceptions and acceptability regarding waterbirth among antenatal women in public tertiary hospitals in Abuja, north-central Nigeria.
Methods: The study adopted a quantitative descriptive cross-sectional design. The setting was the three government-owned tertiary hospitals in Abuja. 331 women were randomly sampled from those who met inclusion criteria, and data were collected through semi-structured questionnaires. Data were analysed using SPSS version 27 and involved the use of descriptive and inferential statistics; the data were presented in frequency tables, percentages, grand means, standard deviations, and bar charts.
Results: The questionnaire return rate was 90%, with a total of 331 responses. More than half, 190 (57.4%), of the women had a high level of knowledge; 131 (39.6%) had moderate knowledge; and very few, 10 (3.0%), had a low level of knowledge about waterbirth. Perception about waterbirth was positive for the majority, 278 (83.9%); the grand mean of 2.95±0.92 was greater than the criterion mean of 2.50. More than three quarters more – 255 (77.0%) of the women indicated a high extent of acceptability for waterbirth; the grand mean of 2.79±0.89 was greater than the criterion mean of 2.50. There was a statistically significant relationship between perception and extent of acceptability of waterbirth as p<0.05 (n = 408, r = 0.58, p = 0.00).
Conclusion: Women in Abuja have good knowledge of waterbirth, positive perceptions, and a high level of acceptability, suggesting an interest and willingness to embrace services if offered. There may be need further studies to validate these findings.
Exploring Barriers and Facilitators to Waterbirth Implementation: A Qualitative Study of Maternity Care Providers in Tertiary Hospitals in Abuja, Nigeria
MC Eze, HM Abdul, BO Altraide, VN Nwude, C Onyema - IPS Journal of Public Health, 2025
Highlights potential barriers, personal factors, lack of (local) evidence, non existent waterbirth services, finances, cultural beliefs and lack of awareness.
Potential facilitators-training of personnel, guidelines and management support.
Background: Globally, waterbirth is recognized as a birthing option that offers women benefits such as pain relief, relaxation and comfort during labour and a positive childbirth experience, while reducing the need for medical interventions. Despite evidence-based benefits, its implementation remains limited in African settings, including Abuja, Nigeria, where waterbirth is yet to be introduced.
Objective: The objectives of the study were to explore the perspectives of maternity care providers regarding potential barriers and facilitators to the implementation and use of waterbirth in public tertiary hospital settings in Abuja, North-Central Nigeria.
Methods: The study adopted a descriptive qualitative approach. Purposive sampling technique was used to select the three public tertiary hospitals within Abuja. Participants consisted of 13 midwives and 10 obstetricians with varying years of experience in maternity care, purposively sampled until data saturation. A semi-structured interview guide was used for the data collection and data were manually analysed using the Braun and Clarke six steps thematic analysis.
Results: Findings were grouped into two themes: the potential barriers and potential facilitators to waterbirth implementation and use. Potential barriers were various personal factors, lack of local evidence, non-existence of services, institutional constraints, among others. Potential facilitators were availability of services, training or education of maternity care providers, adequate funding, stakeholder sensitisation, provision of waterbirth resources, including protocols/guidelines and institutional support.
Conclusion: Integrating waterbirth practices into Nigeria’ maternal healthcare is feasible and this study provides baseline understanding of maternity care provider’s views regarding potential facilitators and barriers. Adequate institutional support, sufficient funding, provision of infrastructure, including protocols/guidelines and appropriate training of providers are critical. Equally, important are inclusion of waterbirth into the national maternal health policy document, as well as public sensitisation to increase awareness and demystify implementation and use of waterbirth.
Bridging Cultures Through Waterbirth: A Conversation with the Doula Collective India
This week in London, I had the pleasure of reconnecting with Divya Deswal from the Doula Collective India; a valued colleague I first met in Delhi and again in Cochin back in 2012. Our conversation centred around the ongoing development of waterbirth worldwide and the barriers that still exist in many countries. Cultural and medical dynamics often limit women’s access to water even for labour, let alone birth, so it’s invaluable to discuss perspectives and gain insight from professionals around the world.
Following our conversation, we’re hoping to organise a series of online teaching sessions in the coming months for doulas, midwives, and medical teams in India. These sessions will focus upon the safety and benefits of waterbirth, supported by robust evidence and numerous published studies, many of which can be found in our MidwifeExpert Newsletters.
I also shared details about my new consultancy service designed to support the creation or redesign of waterbirth pool rooms; a growing global need as maternity spaces evolve.
Lastly, we touched on my forthcoming book and the welcome potential for Indian contributions, including personal stories from families as well as insights from professionals. (If you’re interested in contributing please complete the contact form at the bottom of this newsletter or email info@midwifeexpert.com.)
It was wonderful to catch up with Divya and I hope that the mutual sharing of our expertise leads to productive and positive outcomes.
Crowning Moment: When Our Patron Dropped By
Delegates at this year’s Royal College of Midwives Annual Conference in Birmingham were treated to a truly memorable moment when Her Royal Highness The Princess Royal made a surprise appearance. As Patron of the RCM, her presence was both an honour and an inspiration to all in attendance.
In her address, The Princess Royal expressed heartfelt thanks to midwives and maternity support workers for their unwavering dedication and the life-changing impact they have on women and families across the UK. Her words resonated deeply, reminding us all of the value and visibility of our profession.
We are immensely grateful that Her Royal Highness took the time to join us. Her visit brought a sense of pride and encouragement that will stay with us long after the conference ended. It was a powerful reminder of the importance of our work and the strength of our midwifery community.
Maternal and neonatal outcomes of in-water and out-of-water births in low-obstetric-risk labour: a retrospective observational study at Piacenza hospital. Journal of Biomedical Practitioners Vol.9 No.1 2025
Elisa Piccolo et al
Department of Women's Health, Childhood and Adolescence, UOC Obstetrics and Gynaecology, Piacenza Local Health Unit - Italy
Abstract
INTRODUCTION: The utilisation of birth pool immersion during labour and delivery constitutes one of the primary non-pharmacological methods for alleviating pain. Consequently, an increasing number of women are opting to employ aquatic environments as a means of managing the childbirth experience. However, the literature reports conflicting data and poor-quality evidence on maternal and neonatal outcomes. It becomes important to understand whether water birth is safe for both woman and baby. The objective of this research is to evaluate and compare neonatal outcomes, including infections, admission to the neonatal intensive care unit, and Apgar scores at one and five minutes, alongside maternal outcomes such as vagino-perineal lacerations, postpartum haemorrhage, the duration of labour and the expulsive phase, as well as infections, between water birth and non-water birth scenarios.
METHODS: A retrospective observational cohort study employing a parallel design was undertaken. A total of 698 women with low-risk obstetric pregnancies were included and stratified into two groups based on the type of delivery. Data analysis was performed using STATA 16.0 software, applying both descriptive and inferential statistical methods to assess the study variables. A logistic model was created for the study population to identify which variables may contribute to an increased likelihood of injury to the perineum.
RESULTS: The research sample comprised 698 deliveries, which were evenly distributed between the two cohorts. The groups exhibited homogeneity concerning maternal age, parity, administration of antibiotic treatment during labour, and positivity rates of vaginal-rectal swabs. A further notable discrepancy (p<0.05) was observed in the volume of postpartum blood loss; however, the difference was minimal in both cohorts. Logistic regression analysis revealed that for each 1 cm increase in infant head circumference, the risk of perineal injury increased by 1.3 times (OR = 1.27; p = 0.002).
CONCLUSIONS: The study identified no significant differences in maternal and neonatal outcomes between water and non-water births. Consequently, it appears both suitable and prudent to permit women experiencing low-risk obstetric labour the autonomy to decide whether to deliver in a water-based setting or not. However, further studies are needed. Despite the findings presented, it is crucial to emphasise that further investigation and analysis are absolutely necessary.
Reference Including
[1] Garland D, Jones K. Waterbirths: supporting practice with clinical audit. MIDIRS Midwifery Digest 2000;10(3):333-6.
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