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Ryan Saktika Mulyana
Departemen Obstetri Dan Ginekologi, Fakultas Kedokteran, Universitas Udayana, RSUP Sanglah, Bali, Indonesia
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Environmental Science Health Professions Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Public Health Social Sciences Veterinary

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Water Birth as Neuroendocrine Medicine: A Critical and Integrative Review of Hormonal and Psychophysiological Impacts on Maternal and Neonatal Outcomes Sanjaya, I Nyoman Hariyasa; Andonotopo, Wiku; Dewantiningrum, Julian; Pramono, Mochammad Besari Adi; Mulyana, Ryan Saktika; Pangkahila, Evert Solomon; Akbar, Muhammad Ilham Aldika; Yeni, Cut Meurah; Aldiansyah, Dudy; Bernolian, Nuswil; Wiradnyana, Anak Agung Gede Putra; Darmawan, Ernawati; Stanojevic, Milan; Kurjak, Asim
Indonesian Journal of Perinatology Vol. 6 No. 2 (2025): Available online : 1 December 2025
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v6i2.79

Abstract

Background: Water birth, defined as labor and/or delivery conducted in warm water, has gained increasing recognition as a patient-centered and physiologically supportive birth practice. Beyond analgesia, growing evidence indicates that water immersion during labor modulates maternal neuroendocrine regulation, psychological well-being, and neonatal physiological adaptation. Nevertheless, these hormonal and psychophysiological mechanisms remain insufficiently integrated into conventional perinatal research and clinical frameworks. This review aims to synthesize current evidence on the neuroendocrine, psychophysiological, obstetric, and neonatal effects of water birth and to evaluate its clinical effectiveness and safety in low-risk pregnancies. Methods: An integrative review was conducted using a PRISMA-guided approach to identify peer-reviewed studies published between 2000 and 2025. Literature searches retrieved 3,287 records from major biomedical databases, of which 44 studies (12 randomized controlled trials, 19 cohort studies, 6 case–control studies, and 7 systematic reviews) met inclusion criteria. Data were synthesized thematically, focusing on maternal hormonal responses (oxytocin, β-endorphins, cortisol, prolactin), labor outcomes, breastfeeding, postpartum mood, neonatal adaptation, and safety considerations. Results: Across study designs, water immersion during labor was associated with increased endogenous oxytocin and β-endorphin activity and reduced stress-related hormonal responses. Clinically, first-stage labor was shortened by approximately 42–78 minutes, and epidural analgesia use was reduced by 30–50% compared with conventional land birth. Episiotomy rates were generally below 5%, and maternal satisfaction scores were consistently higher. Early breastfeeding initiation occurred in 86–92% of water birth cases, with exclusive breastfeeding rates at six weeks ranging from 66–77%. Neonatal outcomes, including 5-minute Apgar scores and NICU admission rates, were comparable to or slightly better than conventional birth in low-risk populations, with no consistent increase in infection or respiratory complications when standardized protocols were applied. Conclusion: Water birth supports a hormonally optimized and psychologically protective labor environment, with measurable benefits for labor efficiency, maternal experience, breastfeeding success, and neonatal physiological transition. When implemented under evidence-based guidelines, it represents a credible non-pharmacological option within contemporary, physiology-informed maternity care.
Co-Authors A. A. Ngurah Laksamana Yudha A.A. Ngurah Laksamana Yudha Adhi Pribadi Agustinus Darmawan Hariyanto Aldiansyah, Dudy Aldika Akbar, Muhammad Ilham Alfonso Anggriawan Aloysius Suryawan Anak Agung Gede Putra Wiradnyana Anak Agung Ngurah Anantasika Andonotopo, Wiku Anom Suardika Bachnas, Muhammad Adrianes Bambang Rahardjo Cut Meurah Yeni Daniel H. Susanto Darmawan, Ernawati de Liyis, Bryan Gervais Deantri, Fanny Denni Prasetyo Endang Sri Widiyanti Endang Sri Widiyanti Evert Solomon Pangkahila Hartanto Hartanto I Gde Sastra Winata I Made Darmayasa I Nyoman Gede Budiana I Nyoman Hariyasa Sanjaya I Wayan Artana Putra I Wayan Megadhana I Wayan Megadhana Ida Bagus Gde Fajar Manuaba Ida Bagus Putra Adnyana Jagannatha, Gusti Ngurah Prana Jaya Kusuma Julian Dewantiningrum Kamajaya, I Gusti Ngurah Agung Trisnu Kevin Agastya Duarsa Kirana, Ni Wayan Kartika Candra Kurjak, Asim Made Suyasa Jaya Mahastya, I Wayan Cahya Manuaba, Ida Bagus Gede Fajar Ni Kadek Mulyantari Ni Wayan Ariati Trisna Dewi Nicholas Renata Lazarosony Nuswil Bernolian Nyoman Bayu Mahendra Pradnyaandara, I Gusti Bagus Mulia Agung Pradnyana, I Wayan Agus Surya Pramono, Mochammad Besari Adi Putu Doster Mahayasa Rey Jauwerissa Sri Sulistyowati Stanojevic, Milan Surya, I Gede Ngurah Harry Wijaya Sutedja, Jane Carissa Theresia Monica Rahardjo Tjokorda Gde Agung Suwardewa Wibawa, I Bagus Satriya Wijaya Surya, I Gede Ngurah Harry William Alexander Setiawan Wiradnyana, Anak Agung Gede Putra