Novel insights on the possible effects of water exposure on the structural integrity of the perineum during a waterbirth

Abstract

Dear Editor, The effects of water immersion on the skin and anatomical structures of the perineum have been reported to be conflicting with reports of increased, unchanged or reduced rates of obstetric perineal trauma. A second-degree perineal trauma refers to the disruption of the perineal muscles and the rectovaginal fascia, and could result in pelvic organ prolapse and may have a negative effect on the individual’s sexual function1,2. For those studies reporting that a waterbirth may be protective of a second-degree tear, it has been proposed that the underlying mechanisms involve the buoyancy effect of water that reduces the weight of the infant upon delivery3, the positive effect of warmth resulting in vasodilation and increased perineal blood supply4, and a more conservative management of birth with more spontaneous pushing and a slower delivery5