Controversial issue in water birth to reduce perineal trauma

Introduction: Perineal trauma becomes a concern during childbirth. One method to reduce perineal trauma is through water birth; however, there is still a lack of publication about water birth. This study aims to appraise the benefit of water birth to reduce the perineal trauma. Materials and methods: Searching was conducted on Pubmed®, Cochrane Library®, and Medline® using keywords or MeSH. There were 4 eligible articles consisting of 1 case-control, 1 clinical trial, and 2 systematic reviews. Appraisal determining the validity, importance, and applicability (VIA) was conducted by two independent authors guided by British Medical Journal (BMJ) Evidence-based Medicine Toolkit. Results: There were no difference percentage of intact perineum (RR 1.16; 95% CI 0.99-1.35), episiotomy (RR 0.93; 95% CI 0.80-1.08), second degree tear (RR 0.94; 95% CI 0.74-1.20), and third/fourth degree tear (RR 1.37; 95% CI 0.86-2.17) between water birth and conventional birth in a systematic review. Another review showed that water birth decreased the use of episiotomy and the severity of perineal laceration. A prospective trial study concluded that water birth caused less requirement for obstetric intervention; however, it impacted to more perineal laceration. Another study showed lower episiotomy and higher intact perineum rates in water birth group. Conclusion: There is still inconsistency of water birth in reducing perineal trauma.