TitleOpposition to Waterbirth Is Not Evidence Based.
Publication TypeJournal Article
Year of Publication2020
AuthorsBovbjerg, ML
JournalJ Womens Health (Larchmt)
Date Published10/2020

This issue of Journal of Women's Health includes an article by Papoutsis et al., who reported that waterbirth is associated with a slight increase in the risk of any birth-related perineal trauma, but no increased risk of obstetric anal sphincter injuries (OASIS).1 Prior study on waterbirth is inconclusive in terms of both any genital tract trauma and more severe genital tract trauma. Regarding any perineal trauma (the flip side of intact perineum), numerous authors have reported that waterbirth is either not associated with trauma or is associated with lower rates of any birth-related genital tract trauma,2–6 whereas two others,7,8 including the largest study to date (n = 6534 waterbirths),8 both reported an increase in trauma associated with waterbirth. For more severe trauma, both Cortes et al.7 and Otigbah et al.2 reported double the number of third-degree tears in the waterbirth group; similarly, Preston et al.9 reported a doubling of OASIS specifically. In contrast, Dahlen et al.10 reported that waterbirth was protective against second-, third-, and fourth-degree tears, and a recent article by Burns et al.11 reported no association between waterbirth and OASIS. Henderson et al.12 reported an increase in second-degree, but not higher order, tears among nulliparas only. The new Papoutsis article,1 which included data from n = 1007 women who had waterbirths and a large number of controls who did not, is certainly an interesting contribution to the literature; however, potentially because of methodological issues with this literature as a whole, it is still unclear whether waterbirth is associated with maternal genital tract trauma in any meaningful way.

Alternate JournalJ Womens Health (Larchmt)
PubMed ID33006506