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. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (30 June 2011) and reference lists of retrieved studies. Selection criteria Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers. Data collection and analysis We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy. Main results This review includes 12 trials (3243 women): eight related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only. We identified no trials evaluating different baths/pools, or the management of third stage of labour. Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials). There was also a reduction in duration of the first stage of labour (mean difference −32.4 minutes; 95% CI −58.7 to −6.13). There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), caesarean sections (RR 1.21; 95% CI 0.87 to 1.68, eight trials), use of oxytocin infusion (RR 0.64; 95%CI 0.32 to 1.28,five trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (RR 1.58; 95% CI 0.63 to 3.93, five trials), neonatal unit admissions (RR 1.06; 95% CI 0.71 to 1.57, three trials), or neonatal infection rates (RR 2.00; 95% CI 0.50 to 7.94, five trials). Of the three trials that compared water immersion during the second stage with no immersion, one trial showed a significantly higher level of satisfaction with the birth experience (RR 0.24; 95% CI 0.07 to 0.80). A lack of data for some comparisons prevented robust conclusions. Further research is needed. Authors’ conclusions Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia and duration of the first stage of labour. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse ...

Waterbirth in Sweden – a comparative study

“…The birth experience was rated higher in the WBG. This is in line with previous studies, and the more positive experience is related to the water helping the woman to be relaxed, feel safe and in control .…”

Waterbirth in Sweden – a comparative study

“…The birth experience was rated higher in the WBG. This is in line with previous studies, and the more positive experience is related to the water helping the woman to be relaxed, feel safe and in control .…”

Therapeutic Showering in Labor

“…In contrast to hydrotherapy that has been shown to reduce pain and the use of epidural and spinal analgesia (Cluett & Burns, 2009), therapeutic showering in this sample did not significantly reduce perception of pain. This may be due to the design of the current study.…”

Labour Pain Management with Water Immersion

“…Epidural analgesia was applied in 26% of the present mothers, considerably lower than the frequencies of 82% (17), 78.1% (18), 67.8% (19) and 59% (20) reported in women not using water immersion during labour. In line with our findings, the Cochrane review by Cluett and Burns concluded that the use of water immersion favoured a reduced use of epidural analgesia (5).…”

Waterbirth in Sweden – a comparative study

“…The birth experience was rated higher in the WBG. This is in line with previous studies, and the more positive experience is related to the water helping the woman to be relaxed, feel safe and in control .…”

Therapeutic Showering in Labor

“…In contrast to hydrotherapy that has been shown to reduce pain and the use of epidural and spinal analgesia (Cluett & Burns, 2009), therapeutic showering in this sample did not significantly reduce perception of pain. This may be due to the design of the current study.…”

Labour Pain Management with Water Immersion

“…Epidural analgesia was applied in 26% of the present mothers, considerably lower than the frequencies of 82% (17), 78.1% (18), 67.8% (19) and 59% (20) reported in women not using water immersion during labour. In line with our findings, the Cochrane review by Cluett and Burns concluded that the use of water immersion favoured a reduced use of epidural analgesia (5).…”

Waterbirth in Sweden – a comparative study

“…The birth experience was rated higher in the WBG. This is in line with previous studies, and the more positive experience is related to the water helping the woman to be relaxed, feel safe and in control .…”

Therapeutic Showering in Labor

“…In contrast to hydrotherapy that has been shown to reduce pain and the use of epidural and spinal analgesia (Cluett & Burns, 2009), therapeutic showering in this sample did not significantly reduce perception of pain. This may be due to the design of the current study.…”

Labour Pain Management with Water Immersion

“…Epidural analgesia was applied in 26% of the present mothers, considerably lower than the frequencies of 82% (17), 78.1% (18), 67.8% (19) and 59% (20) reported in women not using water immersion during labour. In line with our findings, the Cochrane review by Cluett and Burns concluded that the use of water immersion favoured a reduced use of epidural analgesia (5).…”