birth in a kneeling positionWhere do you plan to give birth? Many women who plan to give birth at home, also plan on using a birth pool. If you plan to give birth in a hospital setting, maybe your hospital has a birth pool. So you may be wondering about the pros and cons of birth in water versus birth ‘on land’.

I recently saw a question online from a mum who was planning a home birth in a birth pool. Her care provider had told  her that birthing in water is leads to more perineal trauma.

So is there any truth to this particular statement? Let’s look at the research.

As one study points out, quite a lot of the research on birth in water isn’t of great quality. However, most researchers are in agreement that birth in water is associated with benefits like shorter labours, less use of synthetic oxytocin and less pain medication required by mothers. But what about the pelvic floor?

The Pelvic Floor and Birth in Water

Giving birth in water has many benefits that directly and indirectly affect your chances of having a significant perineal tear. Here are some of them:

  • Lower episiotomy rates – episiotomy is a risk factor for 3rd and 4th degree tears, so avoiding one decreases your risk.

  • Decreased need for synthetic oxytocin

  • Mothers are more likely to adopt upright positions

  • Decreased need for epidural

When we look at pelvic floor outcomes, the research is mixed when it comes to water birth. Several studies (Oligbah 2000, Mollamahmutoghn 2012, Cortes 2011 and McPherson 2014) found increased rates of severe perineal trauma during water births. However, these studies, apart from the McPherson study had very small numbers of women and although large (16,000 women) the McPherson study focused on just one institution for it’s research, which isn’t ideal.

A very large literature review (including the best quality research on water birth) was published in 2014. This piece of research points out that overall, giving birth in water is associated with decreased risk of severe perineal trauma. It also found that the was a lower risk of post partum haemorrhage for women who birthed in water.

Yes or No to Water Birth?

So is birthing in water a good idea for the pelvic floor? It probably is. The benefits of water birth – upright positions, decreased episiotomy rates, less oxytocin and avoiding an epidural all help to protect the pelvic floor. One study shows at a year post partum, birth in water didn’t affect pelvic floor function for better or worse. But it’s certainly worth considering for these benefits alone.

Most studies on water birth have found that mums report less pain and a more enjoyable experience of birth if they laboured and or gave birth in water. So if you feel like slipping into a lovely warm birthing pool during labour, go for it – it certainly won’t do your pelvic floor any harm!