A randomised controlled trial evaluating the effect of immersion bath on labour pain
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)
- et al.
Labour pain assessment: validity of a behavioral index
Pain
(1985) - et al.
The value of a pilot study in breast feeding research
Midwifery
(2004) - et al.
A prospective randomized trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia
Midwifery
(2004) - et al.
Early or late bath during the first stage of labour: a randomized study of 200 women
Midwifery
(1997) - et al.
Water immersion and the effect on labour
Journal of Nurse Midwifery
(1993) - et al.
Hydrotherapy in labour
Research in Nursing & Health
(2001) - et al.
To bathe or not to bathe during the first stage of labour
Acta Obstetricia et Gynecologica Scandinavica
(1994) - Cluett, E.R., Nikodem, V.C., McCandlish, R.E., Burns, E.E., 2007. Immersion in water in pregnancy, labour and birth...
- et al.
Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour
British Medical Journal
(2004)
Cited by (50)
Content Analysis of Water Birth Policies With Implications for Practice and Research
2023, Nursing for Women's HealthEffects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :In another study also by Benfield et al. that investigated the effects of hydrotherapy on anxiety, pain, neuroendocrine responses and contraction dynamics during delivery, showers reduced labour pain intensity as well [17]. According to the results of da Silva et al.’s randomized controlled study conducted with 108 primipara participants, labour pain was significantly lower in women who took a shower for 60 min when their cervical dilation was 6–7 cm than in women in the control group, who did not receive this intervention [19]. In another study conducted with 92 women, the women in the experimental group with cervical dilations of 4 and 7 cm who took a standing shower for 5 min felt less pain than the participants in the control group [13].
Factors influencing the use of birth pools in the United Kingdom: Perspectives of women, midwives and medical staff
2019, MidwiferyCitation Excerpt :As the proportion of birth rooms with pools is lower in obstetric than in midwifery units (Which? Birth Choice, 2019), this is likely to affect women's access to intrapartum water immersion. Immersion in water for labour provides a number of benefits, including analgesia (Eberhard et al., 2005; da Silva et al., 2009), relaxation (Benfield et al., 2010; Ulfsdottir et al., 2018), reduced likelihood of intervention (Burns et al., 2012; Henderson et al., 2014), increased breastfeeding initiation and higher maternal satisfaction (Lathrop et al., 2018). Limited research on the safety of waterbirth indicates no evidence of increased risk of an adverse outcome for women or neonates from immersion in water for labour or birth (Taylor et al., 2016; Shaw-Battista, 2017; Cluett et al., 2018; Vanderlaan et al., 2018).
No. 355-Physiologic Basis of Pain in Labour and Delivery: An Evidence-Based Approach to its Management
2018, Journal of Obstetrics and Gynaecology CanadaN° 355-Fondements physiologiques de la douleur pendant le travail et l'accouchement: approche de soulagement basée sur les données probantes
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Selon une revue systématique Cochrane, lorsque la femme est dans un bain d'eau, le risque d'infection serait le même que les membranes soient rompues ou non93. La température de l'eau ne devrait toutefois pas dépasser 38 °C pour la sécurité du bébé94, 95. Quelques études ont montré que l'accouchement dans l'eau ne comportait pas plus de risque que les autres types d'accouchement, mais les données à ce sujet sont encore insuffisantes pour permettre la formulation de recommandations.