Maternal and Neonatal Outcomes of Water Birth Compared with Conventional Vaginal Delivery: A Five-Year Retrospective Cohort Study from Southeastern Europe

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 0.22–0.50, p < 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.