Today it is possible to deliver in water, even in a hospital, in many countries after a normal pregnancy. It is reported that water causes the perineum to become more elastic and relaxed, reducing the incidence and severity of tearing and decrease the need for episiotomy. The woman herself, the partner or the midwife can assist at the moment of the birth in the bathtub. 
According to scientific publications 80% of water births are hands off. This means that no perineal support is used when the baby’s head is crowning. Perineal support is documented in several publications to prevent OASIS. The midwife is not able to observe the perineum, the color, the elasticity or signs of perineal tears in water. Based on the scientific articles and published data, 3% of women giving birth in water will experience an OASIS. 
                      Switzerland 2000                2.7 %
                      Oslo, Norway 2005             3.2 %
                      Reykjavik, Iceland  2011     3.0 %
                      England  2019                     3.1 %
Women classified as low-risk patients should not have any severe perineal tears at all! The midwife has a responsibility to inform about the negative aspects as well. Every birthing woman has to have an opportunity to make an informed decision about water birthing. Every woman can, by herself, minimize the risk of a tear, by choosing a birthing position which allows control and optimal manual support technique at the end of delivery.