Togs on or Togs off? Perineal outcomes for women who birth in water compared to women who do not

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      Women with low-risk pregnancies who birthed at a Birth Centre co-located at a northern Queensland tertiary hospital have the option to birth in water. Controversy exists over the perineal outcomes for waterbirths. To provide women with advice regarding birth options, more evidence is required. This study aimed to assess whether there was any difference in the rates and severity of perineal trauma for women with low-risk pregnancies who birthed in water compared to those who did not birth in water.


      Perinatal data pertaining to all women who gave birth at a Birth Centre, co-located within the grounds of a tertiary referral hospital, during the period 1 October 2010 – 31 December 2021 were reviewed retrospectively.


      Of the 1,748 women who birthed in the Centre during the study period.
      702 (40.2%) birthed in water. Women who birthed in water were statistically more likely to have an intact perineum (that is not have any genital trauma) compared to women who did not birth in water (ꭓ2 = 6.643, df=1, p=0,10). Similarly, women who birthed in water were statistically less likely to have severe perineal trauma (defined as a third- or fourth-degree tear), compared to those who did not birth in water (ꭓ2= 7.448, df = 1, p=0.006). Secondary outcomes were also statistically significant. Women who birthed in water required less narcotic analgesia compared to those who did not birth in water (ꭓ2= 41.538, df = 1, p=0.000), and were less likely to have a postpartum haemorrhage (ꭓ2= 7.565, df = 1, p=0.006).


      In this low-risk population, waterbirth is associated with an increase in intact perineums and a decrease in severe perineal trauma. Women who are choosing to avoid narcotic analgesia would benefit from waterbirth. Midwives counselling women on the benefits of waterbirth can present these findings to assist women in making decisions regarding their birth options and use of water in labour and birth. Given these positive outcomes of data pertaining to over a decade of practice, we feel confident in providing this information to women who plan to birth in the Birth Centre.
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