Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE: The objective of this review is to determine whether or not “Does water immersion in the course of labor decrease the risk of perineal injury during vaginal delivery?”

STUDY DESIGN: Review of three English Language primary studies published in 1996, 2001 and 2002.

DATA SOURCES: Two Randomized, Double-Blind, Controlled trials as well as One Case Control Study which evaluated Maternal and Neonatal Outcomes during labor and delivery were found using PubMed and Cochrane Databases.

OUTCOME MEASURED: Each study looked at women who used water immersion during labor and those that did not. The outcomes measured were those regarding maternal and neonatal outcomes, including Perineal Trauma of varying degrees. Visual Inspection was the method employed by experienced clinicians evaluating the women after giving birth to determine the extent, if any, of damage to the perineum. Women were given a rating of Intact, Episiotomy,
First, Second, Third, and in one study, Fourth degree tear. P-values were employed to assess clinical significance of outcomes measured.

RESULTS: All of the studies showed that immersion in water during labor does not significantly reduce the likelihood of perineal tearing.

CONCLUSION: Results of the studies measuring perineal tears in women using water immersion during labor demonstrate that water immersion during labor has no effect on the likelihood of perineal injury. The only study in which women were allowed to give birth into the water itself showed a significant decrease in the risk of vaginal trauma in women who give birth in water. Further research is warranted to determine whether actual delivery into water vs. land has a beneficial outcome for women with regard to perineal trauma and long-term sequelae.