- maternal and neonatal infections, particularly with ruptured membranes;
- umbilical cord avulsion or rupture, leading to serious hemorrhage and shock;
- neonatal respiratory distress, near-drowning, or drowning that results from tub-water aspiration; and
- seizures and perinatal asphyxia.
Although it had been claimed that neonates delivered into water do not breathe-in or swallow water because of a protective "diving reflex"; the report found cases showing that in compromised neonates, the diving reflex is overridden, which may lead to gasping and aspiration of the surrounding water. Although rare, the report found a case of aspiration of contaminated water that led to a pseudomonas aeruginosa, a serious bacterial infection, and death.
The report noted the absence of peer-reviewed studies with rigorous protocols, making it difficult to know exactly what all the benefits and complications are, and encouraged more studies on the efficacy and safety of water deliveries.
 "Immersion in Water During Labor and Delivery," Pediatrics, published online March 20, 2014; DOI: 10.1542/peds.2013-3794.