Course Content
Course Introduction: Start here!
We are pleased to welcome you to this comprehensive professional training program in waterbirth. Whether you are newly incorporating water immersion into your practice or seeking to advance your clinical expertise, this course provides the essential knowledge and certification required to safely and confidently support families choosing waterbirth. Grounded in current evidence and best practices, it is designed to strengthen your clinical decision-making and elevate your care as a birth professional. Developed and taught by Waterbirth International Director and renowned birth care educator Barbara Harper, this course reflects over four decades of clinical experience, research, and global teaching. In addition to training thousands of midwives, nurses, and physicians, Barbara has served as a consultant for hospitals and birth centers around the world—advising on clinical protocols and supporting the design and implementation of new waterbirth facilities. Her work continues to shape safe, respectful birth practices across diverse care settings. So let's get started!
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Part I: Foundations of Water Birth (Lessons 1-3)
Safety, Eligibility & Practical Considerations Part I lays the essential groundwork for understanding waterbirth as a safe, evidence-based option for low-risk pregnancies. Through three detailed lessons, you’ll explore the clinical rationale, research, and practical protocols necessary for safe implementation in any birth setting. Lesson 1: Labor and Birth in Water An in-depth look at the safety, history, and physiological benefits of waterbirth. This lesson covers maternal and neonatal outcomes, provider advantages, global C-section rates, and key research findings supporting the use of water immersion during labor and birth. Lesson 2: Inclusion Criteria and Contraindications This lesson defines eligibility and outlines both absolute and relative contraindications. It includes U.S. and U.K. hospital criteria, guidance on variations of normal physiology, VBAC considerations, informed consent protocols, and current positions from ACOG and ACNM. Lesson 3: Practical Matters Covers real-world applications and protocols such as fetal heart rate monitoring, water temperature, hydration, timing of immersion, and physiologic responses to water. You'll also examine hormonal effects, case studies like the Cluett trial, and best practices for recognizing and supporting normal physiological birth in water.
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Part II: The Physiology of Birth: Sensory, Neurological, and Neonatal Adaptation
Part II explores how the unique environment of water influences the sensory system, neurological function, and neonatal adaptation at birth. Through three thought-provoking lessons, you'll dive into the ways water immersion impacts the brain, body, and newborn transition—supporting safer, more instinctive, and more peaceful birthing experiences. Lesson 4: Sensory System Stimulation Discover how water immersion stimulates the parasympathetic nervous system, promoting comfort, peace, and relaxation during labor. This lesson explores the Blue Mind theory, sensory perception, the "Pyramid of Comfort Techniques," and how being surrounded by water changes the brain’s chemistry to support a smoother birth process. Lesson 5: How the Brain Works in Labor This lesson offers a deep understanding of the laboring brain, focusing on hormonal changes, pain perception, and neurological adaptations during waterbirth. You’ll learn how to support the natural instincts of labor through an environment that encourages oxytocin release, emotional safety, and optimal physiological function. Lesson 6: Keeping Baby Safe: Fetal Breathing Explore the mechanisms that protect the newborn during waterbirth, including fetal breathing suppression, the dive reflex, and how the baby transitions from fluid to air. This lesson provides clear explanations of neonatal safety, addressing common concerns and emphasizing the science behind waterbirth as a safe option for healthy newborns.
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Protected: Comprehensive Guide to Water Birth with Barbara Harper

Please use this video link:
https://www.youtube.com/watch?v=05nh5p5ULtg

This lesson explores the critical transition from fetus to newborn, with a focus on respiratory initiation, cardiovascular adaptation, and the importance of optimal cord clamping.

Key physiological processes include:

  • Trigeminal nerve activation: The 5th cranial nerve senses atmospheric pressure and chemical composition upon birth, signaling the start of neonatal transition.

  • Heart Shunt Closure: Spontaneous closure of the ductus arteriosus and foramen ovale initiates pulmonary circulation, shifting blood flow from fetal (8%) to neonatal (55%) lung perfusion.

  • Pulmonary Circulation Onset: Capillary erection in the lungs allows absorption of fetal lung fluid into vascular circulation, increasing blood volume and preparing for respiration.

  • Role of the Lymphatic System: Assists in fluid removal and is stimulated by skin-to-skin contact and breastfeeding, further promoting neonatal adaptation.

  • Placental Transfusion: Particularly critical for waterbirths and breech presentations; full-body emergence and exposure to air triggers the final transition.

  • Optimal Cord Clamping: Delaying clamping by at least 3–5 minutes allows for placental transfusion, improving lung compliance, increasing hemoglobin and ferritin levels, and enhancing long-term neurodevelopment.

  • Risk of Early Clamping: Can compromise perfusion, increase risk of anemia, and reduce brain myelination in critical regions.

The lesson also emphasizes the physiological basis for #WaitForWhite and includes two waterbirth videos that visually demonstrate these processes.

Exercise Files
WBI Provider Course 2025 Lesson 7 workbook.pdf
Size: 4.71 MB