Routine intrapartum care practices in the United States frequently obstruct physiologic childbirth, even among healthy women who desire to birth naturally. Most women who give birth in the United States receive numerous obstetrical interventions, including some form of pharmacological pain relief like epidural analgesia and anesthesia despite potential negative impacts on maternal and fetal circulation, labor progress, and normal birth rate. Research demonstrates that intrapartum hydrotherapy may facilitate physiologic birth and decrease routine obstetric interventions that characterized maternity care in the United States. Clinical practices are often influenced by factors unrelated to research and optimal practices and outcomes. Cultural factors and the practice styles of individual health care providers all impact women’s choices for pain-relief methods, including labor and birth in water. The midwife is in a key position to act as a catalyst for institutional change in promoting a safe alternative or adjunct to analgesia and anesthesia in childbirth.