Does a Baby Take a Breath Underwater During a Waterbirth?

It's probably the first question people ask when they see a waterbirth:

“Wait… how does the baby not breathe underwater?”

It seems completely logical. A baby is born, their face enters the water, and eventually every newborn needs to take that first breath.

So why doesn't a baby normally inhale a big gulp of pool water?

The answer has everything to do with the incredible transition a baby's body makes from life inside the womb to life outside of it.

Babies Aren't Breathing Air Before Birth

Before birth, a baby's lungs aren't doing the job they'll do after birth.

Inside the uterus, baby is surrounded by amniotic fluid. Oxygen reaches the baby through the placenta and umbilical cord, not by breathing air through the nose and mouth.

Oxygenated blood travels from the placenta through the umbilical cord to baby while carbon dioxide travels back toward the placenta.

In other words, throughout pregnancy, the placenta is doing the gas-exchange work that baby's lungs will take over after birth.

And that doesn't instantly change simply because baby's head has emerged.

So What Happens During a Waterbirth?

During a planned waterbirth, baby is born completely beneath the surface of warm water and is then gently brought to the surface.

Until the newborn transitions to breathing air, placental circulation may continue through the umbilical cord.

The transition from fetal circulation to newborn breathing involves a complex combination of physiological changes.

Temperature, sensory stimulation, changing pressures and rising carbon dioxide levels all play roles in initiating newborn respiration.

When baby reaches the surface and is exposed to air, the transition toward breathing with the lungs begins.

That first breath helps expand the lungs and triggers major changes in the baby's circulation.

It's one of the most dramatic physiological transitions the human body will ever make.

But Does Being Underwater Stop a Baby From Breathing?

It's more accurate to say that a healthy newborn born underwater is not expected to initiate normal breathing while still submerged during an appropriately managed waterbirth.

There are physiological mechanisms involved in the transition that generally delay the initiation of breathing until the baby reaches the air.

However, this is also why waterbirth needs to be managed appropriately.

It would be misleading to say that a baby simply cannot inhale underwater under any circumstances.

Certain complications—particularly if a baby is compromised—can potentially interfere with the normal transition and create a risk of gasping or aspiration.

That's one reason careful candidate selection, monitoring and trained birth attendants are important parts of waterbirth safety.

Why Is the Baby Brought Up Gently?

You've probably noticed that in waterbirth videos, babies aren't typically rushed or yanked out of the pool.

They're usually brought gently and smoothly to the surface.

Once baby's face reaches the air, it should remain above the water.

A newborn who has been exposed to air should not be intentionally submerged again.

Your birth provider will guide this process and assess baby as the transition occurs.

What About the Umbilical Cord?

During those first moments, baby is generally still connected to the placenta by the umbilical cord.

If circumstances allow, many families and providers practice delayed cord clamping.

The cord may continue pulsating for a period after birth while baby transitions from placental oxygenation to breathing with the lungs.

This is another reason the transition isn't as simple as:

Underwater = not breathing.
Air = breathing.

The newborn circulatory transition happens over time.

What Is the First Breath Actually Doing?

That first breath is pretty extraordinary.

Before birth, baby's lungs contain fluid and receive only a small portion of the blood flow they'll receive after birth.

When breathing begins, the lungs expand with air.

Pressure within the lungs changes.

Blood flow through the lungs increases dramatically.

And fetal circulatory pathways begin changing as baby's body transitions away from relying on the placenta.

Within moments, the cardiovascular system starts reorganizing itself for life outside the womb.

All while you're staring at a brand-new human wondering how they possibly just fit inside you.

Is Waterbirth Safe for Every Baby?

No birth option is appropriate for every pregnancy.

Waterbirth eligibility can depend on factors such as gestational age, maternal and fetal health, baby's position, pregnancy complications and the policies of your birth setting and provider.

Sometimes a person who planned a waterbirth will need to leave the pool because circumstances have changed.

That's not a failed waterbirth.

That's a birth plan adapting to what parent and baby need.

The Womb-to-Water Transition Isn't the Big Change—Water-to-Air Is

One of the most fascinating things about waterbirth is realizing that baby has already spent months developing in a fluid-filled environment.

Birth into warm water doesn't immediately mean baby suddenly needs to breathe that water.

The enormous physiological transition occurs as baby leaves placental life behind and begins life as an air-breathing newborn.

So when you watch a waterbirth and see a baby emerge beneath the surface before being gently lifted into their parent's arms, you're witnessing something pretty remarkable:

the final moments of fetal life followed by the beginning of newborn life.

And it can happen within seconds.

This article is for educational purposes only and is not a substitute for individualized medical advice. Waterbirth carries benefits and risks and is not appropriate for every pregnancy. Discuss waterbirth eligibility, safety protocols and your individual circumstances with a qualified maternity care provider experienced in waterbirth.