Lesson 2 focuses on the clinical decision-making process behind determining who is eligible for waterbirth and when it may not be appropriate. Barbara Harper presents a detailed overview of hospital inclusion criteria, drawing from both U.S. and U.K. guidelines, and emphasizes the importance of individualized risk assessment in every birth setting.

This lesson breaks down contraindications into two key categories: absolute (such as maternal fever, untreated infections, or abnormal fetal heart rate) and relative or controversial (such as VBAC, malposition, or induction of labor). Barbara encourages providers to distinguish between true pathology and variations of normal physiology, always prioritizing safety while honoring maternal autonomy.

Special attention is given to the importance of informed consent and patient-provider communication. Participants are guided through how to educate families on the benefits, risks, and realistic expectations of waterbirth—especially when factors like gestational diabetes, PROM, or breech presentation are present.

Lesson 2 also explores professional opinions and institutional policies, including contrasting statements from ACOG and ACNM, offering providers a broader context for navigating institutional hesitancy. Through real-world case considerations and a hospital video demonstration, Barbara illustrates how nuanced eligibility decisions can support both safety and access.

By the end of Lesson 2, participants will be equipped with clear criteria and clinical insight to determine when waterbirth is appropriate, how to assess risk dynamically, and how to engage in informed, respectful discussions with birthing families.