Elsevier

Midwifery

Volume 25, Issue 3, June 2009, Pages 286-294
Midwifery

A randomised controlled trial evaluating the effect of immersion bath on labour pain

https://doi.org/10.1016/j.midw.2007.04.006Get rights and content

Abstract

Objective

to evaluate the effect of an immersion bath on pain magnitude during the first stage of labour.

Design

a randomised controlled trial comparing the pain scores of bathing and non-bathing nulliparous women during birth was employed.

Setting

the study was conducted at the Normal Birth Center of Amparo Maternal, São Paulo, Brazil.

Participants

108 birthing women, with 54 women randomly assigned to each group.

Interventions

when the birthing women presented at 6–7 cm of cervical dilation, they were placed in an immersion bath for 60 mins.

Outcome measures

pain scores, using a behavioural pain scale and a numeric scale, were recorded at two evaluation time points: at 6–7 cm of cervical dilation and 1 h after the first pain score evaluation.

Findings

at the first evaluation, on the behavioural scale, the means were 2.1 for both groups (p=0.914; 95% confidence intervals (CI) 1.9–2.3 for the control group and 2.0–2.2 for the experimental group). On the numeric scale, the means were 8.7 and 8.5 for the control and experimental groups, respectively (p=0.235; 95% CI 8.2–9.2 for the control group and 8.1–8.9 for the experimental group). At the second evaluation, the pain score means for both scales were statistically higher in the control group than in the experimental group. On the behavioural scale, the scores were 2.4 vs. 1.9, respectively, for the control and experimental groups (p<0.001; 95% CI 2.2–2.6 for the control group and 1.7–2.1 for the experimental group). On the numeric scale, the scores were 9.3 vs. 8.5, respectively, for the control and experimental groups (p<0.05; 95% CI 8.9–9.7 for the control group and 8.1–8.9 for the experimental group).

Conclusions

mean labour pain scores in the control group were significantly higher than those in the experimental group. The present findings suggest that use of an immersion bath is a suitable alternative form of pain relief for women during labour.

Introduction

The use of immersion baths during labour has become increasingly common among birth centres and hospitals worldwide. In Brazil, an approach which emphasises fewer interventions during labour and birth complements a trend in prenatal and labour care which began in the 1970s (Diniz, 2005). Newer birth centres have introduced bath tubs as an alternative form of pain relief for labouring women.

The relaxing effects of an immersion bath have been attributed to the physiological responses produced by hot water immersion. Water immersion during labour can reduce anxiety and catecholamine release, increase endorphin release, relax muscles, and promote buoyancy in the water which in turn decreases pressure on limbs and joints and allows freedom of movement (Cluett et al., 2007). Moreover, water immersion decreases blood pressure via vasodilatation and blood flow redistribution. This technique is considered safe; immersion bath has not been associated with longer labours, increases in surgical intervention, or poor neonatal outcomes. However, to the author's knowledge, no study to date has that systematically evaluated negative outcomes following water immersion during labour.

Several studies have attempted to establish the effects of immersion bath on the mother–baby bionomy (Schorn et al., 1993; Cammu et al., 1994; Eckert et al., 2001). However, it is difficult to compare findings across studies because most studies do not indicate the stage of labour in which the intervention was used. Moreover, in some cases, both nulliparous and multiparous women were included in the sample, and this distinction is an important factor in pain evaluation during labour. The use of oxytocin should be reported as well, because it influences pain sensation.

Previous studies have relied on various instruments to measure the effects of immersion bath on labour pain, including visual analogue scales (Cammu et al., 1994; Benfield et al., 2001) and the use of peridural analgesia (Schorn et al., 1993; Eriksson et al., 1997; Eckert et al., 2001; Ohlsson et al., 2001). However, the use of pharmacological analgesia is an indirect measure of pain sensation and does not reflect the woman's subjective evaluation of the pain magnitude. Labour and vaginal birth involves a great deal of pain, and relatively few studies have evaluated the effects of water immersion on labour pain. Therefore, the present study evaluated the effect of an immersion bath on pain magnitude during the first clinical stage of labour.

Section snippets

Participants

The study was carried out from October 2002 through June 2003 at the Normal Birth Centre of Amparo Maternal, a birth centre with an average of 1000 births each month, located in the city of São Paulo, Brazil, which uses active labour management. The inclusion criteria were: full-term nulliparous women with a live, cephalic presenting singleton fetus; absence of clinical or obstetrical complications; cervical dilation less than or equal to 6 cm at the time of admission; intact amniotic membranes

Pain scores

An initial evaluation of the pain scores was performed as soon as each woman arrived at the labour ward and after her randomisation and informed consent were conducted. In this first evaluation, the mean behavioural scale results were 1.6 for the control group and 1.7 for the experimental group (p=0.591), and the numeric scale scores were 7.1 and 6.7 (p=0.405) in the control and experimental groups, respectively. A trend towards higher pain levels is expected as labour progresses and the

Discussion

This study evaluated both observer-scored (behavioural scale) and self-reported (numeric scale) pain scores for women given a water immersion bath or no bath during active labour. Both pain scores differed (p<0.001 and p<0.05) at the second assessment (Table 3). These results are consistent with those obtained in a randomised clinical study, which evaluated the influence of immersion bath on nulliparous women with dystocia or cervical dilation of less than 1 cm/h. The experimental group

Conclusion

The present study explored the effects of water immersion bath on labour pain. The pain index scores among women who used the immersion bath were significantly lower than those of non-bathing women. The advantages of this non-pharmacological method may include a reduction and/or delay in the use of drugs for pain control, allowing the labouring women to play a more active role in the labour process (Fig. 1).

Acknowledgements

This work was supported by the Research Group “Nurse-Midwifery and Childbirth: care models, agents, and practices” of the School of Nursing at the University of São Paulo.

Special thanks to the birthing women who shared with us their labour experience and the Amparo Maternal nursing and midwifery staff.

References (19)

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