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Background Water immersion during labour and birth offers birthing women a means of non-pharmacological pain relief and a reduction in unnecessary and often routine intrapartum interventions [1]. Women who labour and birth in water are more likely to birth spontaneously and physiologically and experience fewer intrapartum interventions [2–4]. For the neonates of women who use water immersion during labour and birth, there are no additional risks compared to neonates born to women who do not use water immersion during labour and birth [5, 6]. In New Zealand, the use of water immersion during labour and birth is predominantly at home or in primary maternity facilities (midwife-led birthing units) for lowrisk women. Some secondary maternity units (for both uncomplicated and complicated pregnancies and births supported by multidisciplinary teams and access to operating theatres), and tertiary maternity units (for women with high-risk, complicated pregnancies, specialist services and level 3 neonatal intensive care unit) provide access to birth pools or baths for ‘low risk’ women to utilise during labour and birth [4]. For women without access to a primary birthing facility, the secondary or tertiary maternity unit may be her only option to use water immersion for labour and birth. The New Zealand maternity system is an integrated system of primary, secondary and tertiary care that is free for most women. A Lead Maternity Carer (LMC) of the woman’s choice is responsible for care throughout pregnancy, labour and birth, and postnatally to 6 weeks. The LMC can be a midwife, a general practitioner (family physician) with a diploma in obstetrics or a private obstetrician (who can charge a fee for service). The majority (93.6%) of pregnant women in New Zealand choose a case-loading community-based LMC midwife who provides continuity-of-care in the woman’s home, a midwife-led unit, or a secondary or tertiary hospital [7]. If the maternity care becomes complicated, the caseloading community-based LMC midwife will refer the woman to the obstetric specialist team at a secondary or tertiary hospital. The obstetric specialist team will work with the hospital-employed midwives (also known as core midwives) (50.7% of the midwifery workforce) [8], either to support the case-loading community-based LMC midwife to continue to provide care or to provide the woman’s care following transfer of care. There is a dearth of data available from secondary and tertiary maternity units where water immersion for labour and birth are offered, particularly in New Zealand. The lack of data is likely to be due to a lack of capacity of the information technology (IT) systems to record water immersion and water births. No complete national data is reporting on water immersion and water births across all maternity settings [7]. The only formal reporting of the use of water immersion for labour and birth comes from the Midwifery and Maternity Provider Organisation Ltd. (MMPO) from their midwife members [8]. In 2016, the most recently available published data, the percentage of water births was 10.8%, although 26.8% of women in the report sample used water immersion during labour. Women who gave birth at a

Getting into the water: a prospective observational study of water immersion for labour and birth at a New Zealand District Health Board