title: Waterbirth and pelvic floor injury: a retrospective study and postal survey using ICIQ modular long form questionnaires.
abstract: OBJECTIVE
  Benefits attributed to waterbirth (WB) include a shorter second stage of labour and reduction of perineal trauma. The aim of this study is to assess the incidence of perineal trauma and pelvic floor function following WB compared to land birth (LB).
  
  
  METHODS
  We conducted a retrospective analysis on the incidence of perineal trauma following a spontaneous WB (n=160) or a LB (n=623). Data were collected using the hospital's healthcare database, which codes information on pregnancy outcomes and related variables. ICIQ-VS for vaginal symptoms, and the ICIQ-KH Long Form (KHQ) were used to assess pelvic floor function a year after delivery.
  
  
  RESULTS
  Length of 2nd stage was significantly shorter in the WB group. Although this did not translate into less perineal trauma, the incidence of 3rd degree tears appeared to be doubled in the WB group. 77 (38.5%) women from the WB group and 54 (22%) from the LB group answered the postal questionnaires. A significant number of women reported vaginal and urinary symptoms, however the difference between both groups was not statistically significant.
  
  
  CONCLUSIONS
  Waterbirth results in a shorter 2nd stage of labour. This does not lead to less overall perineal trauma or better pelvic floor performance postpartum. Physical limitations in protecting the perineum during the expulsion phase may be associated with an increase in the incidence of 3rd degree tears in the WB population.
authors.affiliation: Guy's & St Thomas' Hospital NHS Foundation Trust, Women's Health Department, Obstetrics & Gynaecology, London, United Kingdom. eduard@doctors.org.uk
authors.forename: Eduardo
authors.initials: E
authors.lastname: Cortes
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Basra
authors.forename: Con J
authors.initials: CJ
authors.lastname: Kelleher
mesh_terms: D001494:Baths / Q000523:psychology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007748:Labor Stage, Second; D008499:Medical Records; D009321:Natural Childbirth / Q000009:adverse effects / Q000379:methods / Q000523:psychology; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000293:injuries*; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology; D014623:Vaginal Diseases / Q000453:epidemiology