{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T22:33:35Z","timestamp":1782945215735,"version":"3.54.5"},"reference-count":45,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Water birth has gained increasing attention as an alternative childbirth method intended to promote maternal comfort and physiological labor while potentially reducing obstetric interventions. However, evidence regarding its maternal and neonatal safety compared with conventional delivery approaches remains heterogeneous. This study aimed to evaluate maternal and neonatal outcomes associated with water birth compared with conventional spontaneous vaginal delivery in a secondary obstetric center. By focusing on vaginal births, the study evaluates the specific impact of water immersion on perineal integrity and neonatal transition. Methods: We conducted a retrospective cohort study including 3747 deliveries recorded at a tertiary maternity unit over a five-year period. Among these, 692 births occurred in water (water birth group) and 561 were conventional vaginal deliveries (land birth group), both managed under a standardized institutional protocol. Maternal characteristics, obstetric outcomes, and neonatal parameters were extracted from medical records and compared between the two cohorts. Primary outcomes included rates of episiotomy, perineal trauma and neonatal indicators such as Apgar score. Statistical analyses were performed to assess differences between groups using appropriate comparative tests. Results: Water birth was associated with a significantly lower rate of episiotomy compared with land birth (5.06% vs. 13.72%, OR 0.33, 95% CI 0.22\u20130.50, p &lt; 0.001). Neonatal outcomes, including Apgar scores and NICU admissions, did not differ significantly between the two cohorts. Conclusions: In this retrospective cohort, water birth among selected low-risk pregnancies was associated with reduced obstetric intervention, particularly episiotomy, without evidence of adverse neonatal outcomes. These findings suggest that water birth may represent a safe and feasible option in carefully selected low-risk pregnancies when strict clinical protocols are applied.<\/jats:p>","DOI":"10.3390\/life16040661","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T11:38:26Z","timestamp":1776080306000},"page":"661","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Maternal and Neonatal Outcomes of Water Birth Compared with Conventional Vaginal Delivery: A Five-Year Retrospective Cohort Study from Southeastern Europe"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7600-0571","authenticated-orcid":false,"given":"Dragos","family":"Brezeanu","sequence":"first","affiliation":[{"name":"6th Department, Faculty of Medicine, Ovidius University of Constanta, 900527 Constanta, Romania"},{"name":"Armonia Hospital, 900500 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5631-9509","authenticated-orcid":false,"given":"Ana-Maria","family":"Brezeanu","sequence":"additional","affiliation":[{"name":"6th Department, Faculty of Medicine, Ovidius University of Constanta, 900527 Constanta, Romania"},{"name":"Armonia Hospital, 900500 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Stase","sequence":"additional","affiliation":[{"name":"6th Department, Faculty of Medicine, Ovidius University of Constanta, 900527 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9000-4731","authenticated-orcid":false,"given":"Vlad","family":"Tica","sequence":"additional","affiliation":[{"name":"6th Department, Faculty of Medicine, Ovidius University of Constanta, 900527 Constanta, Romania"},{"name":"Armonia Hospital, 900500 Constanta, Romania"},{"name":"Romanian Academy of Scientists, 050444 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1136\/bmj.324.7342.892","article-title":"Has the medicalization of childbirth gone too far?","volume":"324","author":"Johanson","year":"2002","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kokkosi, E., Stavros, S., Moustakli, E., Vedam, S., Potiris, A., Mavrogianni, D., Antonakopoulos, N., Panagopoulos, P., Drakakis, P., and Gourounti, K. (2025). Informed consent in perinatal care: Challenges and best practices in obstetric and midwifery-led models. Nurs. Rep., 15.","DOI":"10.3390\/nursrep15080273"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Volkert, A., Bach, L., Hagenbeck, C., K\u00f6ssendrup, J., Oberr\u00f6hrmann, C., Okumu, M.R., and Scholten, N. (2024). Obstetric interventions\u2019 effects on the birthing experience. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06626-5"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hamdan, Z., Bou Deleh, R., Al Khoury, J., Soufan, S., Haddad, R., Dabaj, E., Azar, S., Ghadieh, H.E., and Zoghbi, M. (2025). Telemedicine in obstetrics: Building bridges in reproductive healthcare\u2014A literature review. Reprod. Med., 6.","DOI":"10.3390\/reprodmed6040030"},{"key":"ref_5","first-page":"CD000111","article-title":"Immersion in water during labour and birth","volume":"5","author":"Cluett","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"F357","DOI":"10.1136\/archdischild-2015-309600","article-title":"Neonatal outcomes of waterbirth: A systematic review and meta-analysis","volume":"101","author":"Taylor","year":"2016","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Reviriego-Rodrigo, E., Ibargoyen-Roteta, N., Carregu\u00ed-Vilar, S., Mediavilla-Serrano, L., Uceira-Rey, S., Iglesias-Cas\u00e1s, S., Mart\u00edn-Casado, A., Toledo-Ch\u00e1varri, A., Ares-Mateos, G., and Montero-Carcaboso, S. (2023). Experiences of water immersion during childbirth: A qualitative thematic synthesis. BMC Pregnancy Childbirth, 23.","DOI":"10.1186\/s12884-023-05690-7"},{"key":"ref_8","first-page":"45","article-title":"The effects of immersion in water on labor, birth and newborn and comparison with epidural analgesia and conventional vaginal delivery","volume":"13","author":"Ozyer","year":"2012","journal-title":"J. Turk. Ger. Gynecol. Assoc."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nori, W., Kassim, M.A.K., Helmi, Z.R., Pantazi, A.C., Brezeanu, D., Brezeanu, A.M., Penciu, R.C., and Serbanescu, L. (2023). Non-pharmacological pain management in labor: A systematic review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237203"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Herrero-Orenga, C., Galiana, L., Sans\u00f3, N., Mart\u00edn, M.M., Romero, A.C., and Fern\u00e1ndez-Dom\u00ednguez, J.C. (2024). Effects of water immersion versus epidural as analgesic methods during labor among low-risk women: A 10-year retrospective cohort study. Healthcare, 12.","DOI":"10.3390\/healthcare12191919"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/jmwh.12194","article-title":"Waterbirth: An integrative analysis of peer-reviewed literature","volume":"59","author":"Nutter","year":"2014","journal-title":"J. Midwifery Womens Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S961","DOI":"10.1016\/j.ajog.2023.08.034","article-title":"Water birth: A systematic review and meta-analysis of maternal and neonatal outcomes","volume":"230","author":"McKinney","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.1542\/peds.110.2.411","article-title":"Water birth\u2014A near-drowning experience","volume":"110","author":"Nguyen","year":"2002","journal-title":"Pediatrics"},{"key":"ref_14","first-page":"1031","article-title":"Legionella pneumophila pneumonia in a newborn after water birth: A new mode of transmission","volume":"7","author":"Franzin","year":"2001","journal-title":"Emerg. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists, and American Academy of Pediatrics (2016). Immersion in water during labor and delivery. ACOG Committee Opinion No. 679. Obstet. Gynecol., 128, e231\u2013e236.","DOI":"10.1097\/AOG.0000000000001771"},{"key":"ref_16","unstructured":"Royal College of Obstetricians and Gynaecologists, and Royal College of Midwives (2006). Immersion in Water During Labour and Birth, RCOG Press. Joint Statement No. 1."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/jmwh.12394","article-title":"Maternal and newborn outcomes following waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 cohort","volume":"61","author":"Bovbjerg","year":"2016","journal-title":"J. Midwifery Womens Health"},{"key":"ref_18","first-page":"740","article-title":"Comparison of maternal and newborn outcomes between waterbirth and land birth in a single health system","volume":"65","author":"Sidebottom","year":"2020","journal-title":"J. Midwifery Womens Health"},{"key":"ref_19","first-page":"311","article-title":"Evidence-based care of women promoting safe and satisfying waterbirth","volume":"31","year":"2017","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_20","first-page":"377","article-title":"Comparison of maternal and fetal outcomes between water birth and land birth: An observational study","volume":"31","author":"Cortes","year":"2011","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_21","first-page":"255","article-title":"The influence of water immersion on labor and birth outcomes","volume":"50","author":"Edmonds","year":"2021","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/aogs.13286","article-title":"Waterbirth in Sweden: A comparative study","volume":"97","author":"Ulfsdottir","year":"2018","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_23","unstructured":"World Health Organization (2018). WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience, World Health Organization."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: Global and regional estimates","volume":"6","author":"Betran","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alipour, A., Hantoushzadeh, S., Hessami, K., Shobeiri, F., Moosavi, S., Bahrami, N., Amini, E., Shamshirian, A., Heydari, S.T., and Ashrafi-Rizi, H. (2022). A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-05133-9"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Brezeanu, D., Brezeanu, A.M., Stase, S., and Tica, V.I. (2025). Adolescent pregnancy in Southeastern Romania: A ten-year retrospective cohort from a regional referral center. Medicina, 61.","DOI":"10.3390\/medicina61122162"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/S0140-6736(18)31930-5","article-title":"Short-term and long-term effects of caesarean section on the health of women and children","volume":"392","author":"Sandall","year":"2018","journal-title":"Lancet"},{"key":"ref_28","unstructured":"Euro-Peristat Project (2018). European Perinatal Health Report: Core Indicators of the Health and Care of Pregnant Women and Babies in Europe in 2015, Euro-Peristat Project. Available online: https:\/\/www.europeristat.com."},{"key":"ref_29","unstructured":"Eurostat (2023). Surgical Operations and Procedures Statistics\u2014Caesarean Sections, European Commission. Available online: https:\/\/ec.europa.eu\/eurostat."},{"key":"ref_30","first-page":"805","article-title":"The Romanian experience in modern obstetrics: Between tradition and evidence-based medicine","volume":"47","author":"Rotar","year":"2019","journal-title":"J. Perinat. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Sanders, J., Barlow, C., Brocklehurst, P., Cannings-John, R., Channon, S., Gale, C., Cutter, J., Hughes, J., Hunter, B., and Lugg-Widger, F. (2026). Establishing the Safety of Waterbirth for Mothers and Their Babies: The POOL Cohort Study with Nested Qualitative Component, National Institute for Health and Care Research. Health Technology Assessment, No. 30.15.","DOI":"10.3310\/GGHD6684"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/s12978-023-01690-0","article-title":"Understanding the barriers and facilitators related to birthing pool use from organisational and multi-professional perspectives: A mixed-methods systematic review","volume":"20","author":"Cooper","year":"2023","journal-title":"Reprod. Health"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Thomaidi, S., Sarantaki, A., Tzitiridou Chatzopoulou, M., Orovou, E., Jotautis, V., and Papoutsis, D. (2025). The Rising Global Cesarean Section Rates and Their Impact on Maternal and Child Health: A Scoping Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14228102"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Aughey, H., Jardine, J., Moitt, N., Fearon, K., Hawdon, J., Pasupathy, D., Urganci, I., and Harris, T. (2021). Waterbirth: A national retrospective cohort study of factors associated with its use among women in England. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03724-6"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18332\/ejm\/188193","article-title":"Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives\u2019 experiences","volume":"8","author":"Larsson","year":"2024","journal-title":"Eur. J. Midwifery"},{"key":"ref_36","first-page":"e2208","article-title":"Neonatal outcomes following delivery in water: Evaluation of safety in a district general hospital","volume":"10","author":"Peacock","year":"2018","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.wombi.2012.10.006","article-title":"How valid are the common concerns raised against water birth? A focused review of the literature","volume":"26","author":"Young","year":"2013","journal-title":"Women Birth"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.3390\/applmicrobiol3040089","article-title":"The Vaginal Microbiome during Pregnancy in Health and Disease","volume":"3","author":"Mendz","year":"2023","journal-title":"Appl. Microbiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1097\/AOG.0000000000005590","article-title":"Regenerative medicine in gynecology","volume":"143","author":"Balough","year":"2024","journal-title":"Obstet. Gynecol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Brezeanu, A.M., Brezeanu, D., Stase, S., Chirila, S., and Tica, V.I. (2025). Intraoperative Platelet-Rich Plasma Application Improves Scar Healing After Cesarean Section: A Prospective Observational Pilot Study. Healthcare, 13.","DOI":"10.3390\/healthcare13222905"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Brezeanu, A.M., Brezeanu, D., and Tica, V.I. (2025). Intraoperative Platelet-Rich Plasma (PRP) for Post-Cesarean Scar Healing: A Single-Center Randomized Controlled Pilot Study. Healthcare, 13.","DOI":"10.3390\/healthcare13222928"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Brezeanu, D., Brezeanu, A.M., Chirila, S.I., and Tica, V. (2025). A Preliminary Study of Intravaginal Lactic Acid Gel (Canesbalance\u00ae) for Post-Episiotomy Healing: A Randomized Clinical Trial. Healthcare, 13.","DOI":"10.20944\/preprints202506.1508.v1"},{"key":"ref_43","first-page":"e84517","article-title":"The Effectiveness of Topical Lactic Acid Gel in Episiotomy Wound Healing and Its Impact on Sexual Quality of Life After Childbirth: A Prospective Study","volume":"17","author":"Brezeanu","year":"2025","journal-title":"Cureus"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3889\/oamjms.2023.11073","article-title":"A literature review on postpartum perineal wound care: Epidemiology, impact, and future interventions","volume":"11","author":"Girsang","year":"2023","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1891\/1058-1243.23.3.124","article-title":"Birth, bath, and beyond: The science and safety of water immersion during labor and birth","volume":"23","author":"Harper","year":"2014","journal-title":"J. Perinat. Educ."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/4\/661\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T12:02:04Z","timestamp":1776081724000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/4\/661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":45,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["life16040661"],"URL":"https:\/\/doi.org\/10.3390\/life16040661","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}