You can still tear during a water birth if you don't have good perenium management - just like you wont necessarily tear during a 'land' birth. There are still no gurantees about it no matter what you do, but you can certainly give yourself the best chance of not tearing by using perenial massage, warm compresses during the birth, slow birth of the baby's head etc, upright birthing positions.
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The results are in - Scar tissue and Endo removed!
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