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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Course Breakdown & Materials
05:24
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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Lesson 1 : Introduction to Labor and Birth in Water
01:12:18
Lesson 1: Labor and Birth in Water
Lesson 2: Inclusion Criteria and Contraindications
01:12:43
Lesson 2: Inclusion Criteria and Contraindications
Lesson 3: Practical Matters in Waterbirth
01:04:26
Lesson 3: Practical Matters in Waterbirth
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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Lesson 4: Sensory System Stimulation
39:31
Lesson 4: Sensory System Stimulation
Lesson 5: How the Brain Works in Labor
44:56
Lesson 5: How the Brain Works in Labor
Lesson 6: Keeping Baby Safe – Fetal Breathing Inhibitors
50:46
Lesson 6: Keeping Baby Safe: Fetal Breathing Inhibitors
Part III: Neonatal Transition and Third Stage Physiology
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Lesson 7: Neonatal Transition Physiology I
50:02
Lesson 7: Neonatal Transition Physiology
Lesson 8: Neonatal Transition Physiology II
01:04:25
Lesson 8: Neonatal Transition Physiology II
Lesson 9: Neonatal Transition Physiology III
47:27
Lesson 9: Neonatal Transition Physiology III
Lesson 10: Physiologic Management of Third Stage
Lesson 10: PHYSIOLOGIC MANAGEMENT OF THIRD STAGE
Protected: Comprehensive Guide to Water Birth with Barbara Harper

This lesson explores the intricate process of neonatal transition—how a newborn physiologically adapts from life inside the womb to life in the outside world. Barbara Harper emphasizes that this is the most critical transformation in human life, requiring six key adaptations: breathing, temperature regulation, gut activation, microbial colonization, neuromuscular orientation to gravity, and the suck-swallow-breathe coordination for breastfeeding.

We examine how the quality of labor directly impacts this transition, priming the newborn with essential hormones and neurochemical signals that support respiration, circulation, and bonding. The lesson introduces the concept of “the pause”—a deliberate, respectful moment after birth where the baby remains in the water, undisturbed, allowing natural perfusion of the lungs before initiating breath. This pause supports neurosomatic integration and reduces unnecessary intervention.

A modified APGAR scoring system for waterbirths, drawn from Cornelia Enning’s research, is presented with expanded observation points including eye contact and the fetal fluid expulsion reflex. Providers are encouraged to rely on keen observation rather than immediate stimulation or assumptions based on outdated practices.

The physiology of the first breath is also discussed, including the role of carbon dioxide buildup, lymphatic clearance, and the shift in circulatory pathways. Visual timelines (e.g., 30 seconds, 90 seconds, 3 minutes, 10 minutes) guide providers in monitoring gradual signs of healthy adaptation. The importance of not rushing this process—especially for water babies or breech births—is emphasized.

The lesson introduces the concept of Newborn Assessment Priorities (NAP), which include heart rate, breath sounds, skin color, tone, and eye movement—shifting away from outdated reliance on crying or blanket-based stimulation. It also presents research on the role of catecholamines (stress hormones) released during labor, which protect vital organs, aid in glucose metabolism, and heighten alertness to support early bonding.

Ultimately, this lesson reinforces the provider’s role in practicing patience, presence, and informed observation—honoring the baby’s innate ability to transition gently and safely with uninterrupted support.

Exercise Files
WBI Provider Course 2025 Lesson 8 workbook.pdf
Size: 8.07 MB
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