The case of a newborn who developed a life-threatening infection has led to calls for women to be cautious when considering a water birth.
The report, published in the current edition of Canadian Medical Association Journal, detailed the case of a baby born healthy and weighing 3.49 kilograms at birth.
However, at just eight days old she was admitted to hospital with a fever, poor feeding and fussiness. That same day, she was moved to the intensive care unit with multiple organ failure due to sepsis (overwhelming infection).
After multiple tests, the baby was found to be infected with Legionella. She was started on antibiotics and spent five weeks on a ventilator.
"Our case serves to highlight a severe and potentially fatal adverse neonatal outcome of underwater birth, especially when pre-filled heated pools are used," the doctors wrote in the case study.
However, experts say there are benefits to water births and steps can be taken to minimise any risk involved.
Midwife Amanda Bude, from Groovy Babies, says a number of factors in the Canadian case increased the risks to this baby.
Firstly, the mother gave birth in water that was pre-filled three days before she delivered. Ms Bude said it's absolutely vital to use clean, fresh water to prevent infections like Legionalla. In Australia, she says birth pools are only filled once the woman goes into labour.
Obstetrician and Gynaecologist Dr Joseph Sgroi agrees it's important to use clean water before a labouring woman hops into a tub.
However, he said, "Even if you fill a tub with sterile water, it becomes contaminated with flora (bugs) the minute the woman sits in the tub.
"Therefore, there is no way to ensure the water will be contaminant-free."
The mother in this case also delivered her baby in a hot tub. Hot tubs (or spas) are not recommended during labour or delivery.
In fact, the recommended temperature for water in a water birth in is between 35 and 37 degrees Celsius. During labour, a midwife should regularly monitor that temperature.
If the water is too hot, the baby can overheat. Conversely, if the water is too cold, Dr Sgroi explained the baby can lose body heat trying to keep warm.
While Ms Bude advocates for water births, she says there are certain situations when women are advised against delivering in water.
For instance, if the pregnancy is pre-term, or there is bleeding or an infection during labour, or if there is a medical condition such as epilepsy.
Both Ms Bude and Dr Sgori agree if proper precautions are taken regarding the cleanliness and temperature of the water, labouring in water can provide many stress-reducing and pain-relieving benefits for women with uncomplicated pregnancies.
But their opinions differ on whether such women should give birth in water.
Dr Sgroi says there's a lack of evidence-based research on the topic. While he says many women have uncomplicated water births, he notes that complications have been reported.
He also points out that emergencies can happen during delivery, and that these can be difficult to manage if you're giving birth in water.
For these reasons, Dr Sgroi advises women who are using water immersion while they are in labour, to give birth to their baby outside of the water.
However Ms Bude says water births can "empower" mums-to-be, as long as they take proper precautions, including having a care provider who is confident in water births assisting them.
If you follow these precautions, she says, water birth can be "a gentle and calmer way to birth a baby".