Warm tub bathing during labor: maternal and neonatal effects

Abstract

Aim. To study possible detrimental maternal and neonatal effects of immersion in warm water during labor. Design. Prospective randomized controlled bathing during first stage of labor vs no bathing. Setting. Obstetrical departments at a university hospital and two central hospitals. Primary end-point. Referral of newborns to NICU. Material and methods. Randomization took place by means of sealed opaque envelopes at each delivery unit. Preconditions for participation in the study were: singleton parturient wishing to bathe, a gestational duration of at least 35 weeksπ0 days, a planned vaginal delivery, normal admission test, regular contractions and cervix dilated to at least 3-4 cm. Parturients randomized to the 'no bath' control group were allowed to use a shower. Rupture of the membranes was not a contra-indication to participation. Those excluded from randomization were women with intra-uterine growth retardation, meconium-stained amniotic fluid, or in the event that the tub was occupied by another randomized parturient. Main results. On average, parturients stayed in the tub for 50-60 min. No significant difference was seen regarding the referral rate to NICU among 612 cases vs 625 controls, OR 0.8; 95% CL 0.2, 3.1. The OR for epidural analgesia was 1.0; 95% CL 0.8, 1.3. Nor was any significant difference seen in the rate of perineal tear grade III-IV (OR 1.3), instrumental delivery (OR 1.1), cesarean section (OR 1.8), or maternal post partum stay on the ward. During the neonatal period, no significant difference was seen in the number of newborns with Apgar Ͻ7 at 5 min (4 vs 5), neonatal distress (OR 2.2) or tachypnéa (OR 1.0). Conclusion. In the present study no negative effects of bathing during labor could be discerned. The results indicate that expectant mothers wishing to bathe during labor may do so without jeopardizing their own, or their newborns' wellbeing after birth.

Application of Nonpharmacologic Methods to Relieve Pain during Labor: The Point of View of Primiparous Women

“…After the 1990s, when the WHO included the immersion bath as an NPM to be used during labor, there was increased interest in generating sufficient evidence to support this practice. During the last two decades, most of randomized clinical trials have evaluated immersion baths (Cluett, Pickering, Getliffe, & James, 2004;Ohlsson et al, 2001;Rush et al, 1996; Silva, Oliveira, & Nobre, 2009) and some controlled clinical trial of therapeutic intervention type rated aspersion showers (Davim et al, 2008;Santana et al, 2013), pointing to several benefits, among which are higher levels of satisfaction with the labor experience and pain relief, as long as certain conditions, such as a minimum dilation of 3 centimeters, are met before initiating its application. Although warm showers followed by breathing techniques and changes in position were the most commonly used NPMs (Table 1), having generated high levels of satisfaction, the method that actually produced the highest degree of satisfaction was focused attention, followed by the birth ball (Table 3).…”

Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour

“…Indeed, three of the admissions to the neonatal unit were between nine and 48 hours after delivery, while the three admissions immediately after birth were associated with temperature regulation. Comparative studies of labour in water found no increase in admissions to neonatal units or other markers of neonatal distress 23 – 25. It is clearly important to ensure ongoing audit of neonatal outcomes for women who labour in water.…”

Labouring women who used a birthing pool in obsteric units in Italy: prospective observational study

“…Benefits to women of labouring in water include buoyancy and ease of movement facilitating women to maximise pelvic diameters which may lead to improved fetal flexion and easier delivery [8]. The warm water increases maternal relaxation reducing pain perception [9], and may lead to improved uterine perfusion and reduced blood pressure [10].…”