INTRODUCTION: The accessibility of YouTube videos has made it a popular platform for seeking and sharing pregnancy advice, especially experiences related to “natural” delivery methods like water births. Therefore, it is important to understand which video characteristics amassed more views as well as explore the relationship between characteristics and accuracy of information. We aim to assess what components of water birth YouTube videos are predictive of more accurate content with evidence based on American College of Obstetricians and Gynecologists (ACOG) guidelines. METHODS: A YouTube search on “water birth” was conducted using the filter “most viewed.” The first 100 videos were selected using a strict inclusion criteria, and video characteristics were recorded. Video views ranged from 457,296 to 78,035,874. Reviewers scored videos in accordance with published guidelines using the “ACOG Water Birth Rubric.” Chi-squared goodness-of-fit and independence tests were performed to assess significance of differences between groups. RESULTS: Out of 96 videos, 13.1% from North America were scored as accurate, versus 15% from other continents (P=.5754). Only 14.4% of videos from personal channels were accurate, despite comprising 71.8% of all videos in the top 100. All videos from doulas and midwives scored neutral, and there were no videos from health care professionals with advanced degrees. Commercial videos had the highest amount of accurate videos at 16.6%. Videos with a supportive figure in the thumbnail had significantly less videos graded as inaccurate (3.5%) compared to those without (18%; P=.0003). CONCLUSION: Patients use YouTube videos as a resource for pregnancy information, particularly for alternative birthing practices. North America has some of the most popular videos and personal channels that often deviate from ACOG guidelines. Our findings highlight an urgent need for health care professionals to guide patients towards evidence-based resources, especially for alternative birth practices, and contribute accurate and informative content on such platforms.