Water Birth as Neuroendocrine Medicine: A Critical and Integrative Review of Hormonal and Psychophysiological Impacts on Maternal and Neonatal Outcomes

Background Water birth, involving labor or delivery in warm water, has gained attention as a physiologically respectful, patient-centered practice. Beyond its analgesic effects, emerging evidence suggests that water immersion during labor modulates neuroendocrine responses, enhances maternal psychological outcomes, and supports neonatal adaptation. However, the hormonal and psychophysiological dimensions of this practice remain under-investigated in mainstream perinatal discourse. Content This review synthesizes the most current literature (2000–2025) through an integrative framework, critically analyzing the impact of warm water immersion on maternal neurohormonal regulation—particularly oxytocin, endorphins, cortisol, and prolactin—and its effects on labor progression, breastfeeding success, and postpartum mood. It explores how immersion influences parasympathetic activation, stress attenuation, perineal integrity, and neonatal physiological transition. A PRISMA-guided literature screening process filtered over 3,000 studies to identify high-quality clinical trials, cohort studies, and systematic reviews. Although not registered with PROSPERO, the methodology followed structured and transparent screening principles to ensure rigor. Emphasis is placed on candidate selection, safety protocols, contraindications, and the implications of water birth as a non-pharmacologic, systems-level intervention in maternity care. Summary Findings suggest that water birth promotes an optimal hormonal milieu, contributing to shorter labors, increased maternal satisfaction, early initiation of breastfeeding, and reduced incidence of postpartum blues and depression. When implemented under evidence-based guidelines, it demonstrates a favorable risk-benefit profile for low-risk pregnancies. The review underscores the neuroendocrine underpinnings of humanized birth and positions water birth as a potential enhancer of maternal-infant physiological synchrony. Nonetheless, variability in biomarker sampling methods, rare but serious complications, and limited long-term outcome data should temper interpretation and guide cautious integration. Outlook This article calls for the integration of water birth into national perinatal policy frameworks as a strategic, cost-effective, and empowering birth option. Future research should expand hormonal biomarker analysis, address safety outcomes in diverse populations, and investigate long-term developmental effects on neonates born via water immersion. Greater attention to infrastructural readiness, medico-legal environments, and global scalability will also be essential for equitable adoption. Water birth stands not as an alternative, but as a frontier in evidence-based, hormonally intelligent perinatal care.