The purpose of this research study was to identify and describe US midwives' knowledge and use of sterile water injections to relieve pain during labor. Research studies have shown that injections of sterile water to relieve low back pain during labor are effective with good maternal satisfaction. However, no knowledge is available about their use by midwives in the United States. Questionnaires were mailed to a random sample (N = 450) of midwives who were members of the American College of Nurse-Midwives (ACNM). One hundred thirty-two respondents (29%) returned the questionnaire. One-fourth (26%) of the midwives use sterile water injections, although infrequently. More than half of the midwives use the intracutaneous injection technique, and most use a total of four injections. Most midwives give the injections between contractions, with the assistance of another person, and report very good pain relief. Of those not using sterile water injections, most had no experience or training in use of the method and were interested in learning more about their use. While sterile water injections are a good treatment for back pain during labor, there is a lack of knowledge among midwives about this method of pain relief during labor and an interest in knowing more.