Comparison of Traditional Births to Water Births on Perineal Trauma: A Review of Literature

Ashlyn Beck, SN, Marissa Cribbs, SN, Katelyn Longston, SN, Alyssa Vincent, SN, Alexis Fischer, SN, Kaytie Griffiths, SN
Faculty Mentor: Professor Dean Brereton
Department of Nursing, College of Health Sciences

⮚In a study with 207 women participating in water birth 43 of

INTRODUCTION METHODOLOGY them had perineal lacerations (Mollamahmutoğlu et al, 2012)
⮚ Women laboring in water had less severe vaginal and perineal
⮚ Background ⮚Databases searched included EBSCOHost, CINAHL, PubMed, lacerations compared to those that were participating in
⮚Midwifery/water birth based on the fact that birth is a normal Google scholar, Sciencedirect , Wiley Online Library traditional birth (Yinglin Liu et al, 2014)
event and naturally should not have any complications (Lewis et ⮚Search terms: “water birth” and “perineal trauma ” and ⮚Obstetric Anal Spincter Injuries (OASI) has a risk factor of 3.3% in
al., 2018) “maternal outcome”, full-free text articles from 2011-2022 water birth and 1.6% in land birth (Preston et al., 2019)
⮚Benefits of waterbirth: mothers’ comfort, participation in
⮚Inclusion criteria included studies involving laboring women
using water birth or water immersion to have a better DISCUSSION
delivery, and reduction of pain, labor duration, need for
outcome compared to the traditional form of vaginal birth or
episiotomy, and cesarean sections (Kolivand et al., 2014) • Implications
cesarean birth, perineal trauma, perineal outcome
⮚“One woman just ‘really wanted to avoid ‘hardcore’ pain relief, ⮚Exclusion criteria included studies involving cesarean
- Research data supports perineal trauma would be more likely to
occur during water birth, but not as severe as traditional land births
I thought [waterbirth] might be a form of relaxation” (Lewis et method of delivery only, on land vaginal delivery as the main • Strengths
al., 2018) method, and studies with lack of sufficient evidence - Multiple articles that were reviewed were specific to perineal
⮚Patient’s words describing unsuccessful waterbirth include: outcomes in those that labored in water compared to those that
affirming, distressing, enduring, quick, natural, empowering, labored on land
and long (Lewis et al., 2018) RESULTS - Multiple articles that were reviewed were specific to improved pain
⮚Patient’s words describing successful waterbirth include: relief during labor in water compared to pain relief during labor on
amazing, magical, easy, perfect, fantastic, great, awesome, ⮚ Nineteen articles reviewed with eight included in final sample land
surreal, wonderful, and beautiful (Lewis et al., 2018) ⮚ There is a chance for increased perineal trauma when having a • Limitations
waterbirth compared to a normal birth(Cortes et al., 2011) - There are few studies on perineal trauma and water birth
⮚Stage 1 perineal tear involves limited skin and connective tissue
⮚“Nearly 43% of women had an intact perineum following birth - Many midwives misdiagnosed the degree of tear, which can make
involvement with limited bleeding (Araújo et al., 2019) gathering data about the severity of tears difficult
with first- and second-degree perineal tears being most
⮚Stage 2 perineal tear reaches perineal muscles (Araújo et al., - Studies only had access to hospital records
common” (Maude et al., 2016)
2019) • Future Recommendations
⮚Stages 3 and 4 perineal tears reach anal sphincter complex - Larger sample size
(Araújo et al., 2019) - Consistency with diagnosis of tears

REFERENCES
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https://doi.org/10.1590/1806-93042019000400003
Cortes, E., Basra, R., & Kelleher, C. J. (2011). Waterbirth and pelvic floor injury: A retrospective study and postal survey using ICIQ
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https://doi.org/10.1016/j.ejogrb.2010.11.012
Dr. Tracy Fawns
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of Midwifery & Reproductive Health, 2(4), 220–226.
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Bovbjerg, M. L., Cheyney , M., & Everson, C. (2016, January 20). Maternal and newborn outcomes ... - wiley online library. Wiley Online Library.
women who achieved and did not achieve a waterbirth. BMC Pregnancy & Childbirth, 18, 1–N.PAG.
⮚Third degree tears doubled with women that had a waterbirth
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https://doi.org/10.1186/s12884-017-1637-5
Menakaya, U., Albayati, S., Vella, E., Fenwick, J., & Angstetra, D. (2012, October 31). A retrospective comparison of water birth and conventional vaginal Maude, R. M., & Kim, M. (2020). Getting into the water: a prospective observational study of water immersion for labour and birth at a
birth among women deemed to be low risk in a secondary level hospital in Australia. Women and Birth. Retrieved March 29, 2022, from (Cortes et al., 2011) New Zealand District Health Board. BMC Pregnancy & Childbirth, 20(1), 1–12. https://doi.org/10.1186/s12884-020-03007-6
⮚ Rate of episiotomy was higher (32.3%) in women having a
https://www.sciencedirect.com/science/article/pii/S1871519212000728
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https://doi.org/10.1007/s00192-019-03879-z

water birth on perineal trauma compared to other forms was associated with fewer perineal lacerations and lower rates Yinglin Liu, Yukun Liu, Xiuzhi Huang, Chuying Du, Jing Peng, Peixian Huang, & Jianping Zhang. (2014). A comparison of maternal and
neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy & Childbirth, 14(1),

of episiotomies (Araújo et al., 2019) 1–7. https://doi.org/10.1186/1471-2393-14-160

of birth?