Immersion in water in labour and birth

Abstract

BACKGROUND: Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Critics cite the risk of neonatal water inhalation and maternal/neonatal infection. OBJECTIVES: To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. METHODS: COMMENTSIt is already known by obstetricians and midwives that warm bath immersion is an effective method of non-pharmacological analgesia during labor. This action makes the mother relax and reduces the time taken for the first stage of labor. The meta-analysis in question took into account 12 randomized trials that demonstrated an average reduction of 32.4 minutes for the first stage and less need for epidural anesthesia (10%), but no change regarding infection rate, cesarean section rate, use of vacuum or forceps, or admission to the neonatal intensive care unit. One criticism that can be made of this meta-analysis is the heterogeneity of the studies surveyed and the different protocols. However, reduction of the times taken for dilation and descent and less use of anesthesia are constant factors in all the studies. Therefore, use of bath tubs for warm bath immersion in maternity hospitals that are willing to offer non-pharmacological methods of labor analgesia for their patients should be a level A recommendation.

Care in a birth center according to the recommendations of the World Health Organization

“…A systematic review of 3,243 women suggested that the use of this practice during the first stage of labor reduced the use of epidural anesthesia, with no adverse effects to either the mother or baby. The immersion bath was also associated with greater satisfaction with the childbirth experience (20) .…”

The effects of immersion in water on labor, birth and newborn and comparison with epidural analgesia and conventional vaginal delivery

“…There are also studies that have reported the disadvantages associated with water birth which include maternal and neonatal infections, as well as the possibility of respiratory problems for the newborn (7,8). Cluett and Burns in a review of 11 trials concluded that water immersion during the first stage of labour reduced the use of epidural/spinal analgesia, but there was limited data for other outcomes related to water use during the first and second stages of labour (9). They also stated that there was no evidence of increased adverse effects on the fetus/neonate or woman from labouring in water (9).…”

Hidroterapia e bola suíça no trabalho de parto: ensaio clínico randomizado

“…The early use of the warm bath (when dilatation is less than five cm) is related to increased use of analgesia when compared to women who use the intervention when dilatation greater than five cm. (7) The warm bath provides relief from pain and anxiety, increases the comfort, and provides positive feelings during the labor, (5,6) especially when combined with perineal exercise with the Swiss ball. (2) Its use facilitates a professional approach when patient-centered care is provided, which results in benefits for labor progress.…”

“…(2) Its use facilitates a professional approach when patient-centered care is provided, which results in benefits for labor progress. (7) The use of the Swiss ball to perform perineal exercises during labor is an auxiliary therapy in the obstetrical practice that promotes comfort and pain relief, labor progression, and favors the vertical position. (15) This intervention provides less need for medication and cesarean section.…”

“…(2)(3)(4) The warm bath, or hydrotherapy, is a non-pharmacological method that uses water heated to 37 o C as a therapeutic object, offering different benefits during labor, such as greater pain tolerance, stress reduction, regulation of uterine contraction pattern, and satisfaction with the labor process, by offering greater autonomy to the woman with regard to her choices, and the possibility for active participation by her companion. (2,(5)(6)(7) The effect of local heat during the bath stimulates redistribution of muscular blood flow, increasing relaxation and comfort. (2,5,8) The cost-effectiveness is good, since it is an easy to access, low cost technique.…”