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Effects of Hydrotherapy During Labor

Hannah Breedlove, Jordan Dickey, Allison Giambattista

Department of Nursing, Youngstown State University

NURS 3749: Nursing Research

Dr. Valerie O’Dell

April 7th, 2021

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Abstract

The purpose of this research was to look at the relationship between hydrotherapy and its effects

on the mother and neonate during labor. The association between the difficulty of labor, duration

of labor, and pain experienced during labor were explored. This research was compiled from

nine sources. It was found that hydrotherapy resulted in positive outcomes on the duration of

labor, the pain experienced during labor, and the difficulty of labor. This research focused on the

three specific variables; however, there are other factors that hydrotherapy affects. For example,

hydrotherapy decreases the occurrence of severe lacerations of the perineum. Overall, the

research illustrates that the use of hydrotherapy during labor is beneficial to the mother and

decreases the difficulty, duration, and pain experienced.

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Effects of Hydrotherapy During Labor

Giving birth is a major life event and many women will remember each second of their

birth experience. During this time, specific nursing interventions are needed such as keeping the

mother comfortable and keeping the baby healthy during the delivery. One of these interventions

can be the use of hydrotherapy. Hydrotherapy is the immersion in water of a laboring women

during delivery. This is a non pharmaceutical measure that helps provide relaxation, usually

started in the active labor stage. Labor can be long and painful, and can cause many problems for

the mother in the psychological recovery. Many hospitals offer hydrotherapy to mothers who are

considered to have a low risk pregnancy and for women who have not received any anesthesia.

Without hydrotherapy, women may need forceps or vacuum assist if labor becomes too difficult,

pitocin to help induce contractions, and spinal anesthesia or pain medications to help decrease

the pain. These options could make the woman feel as if she is no longer in control of her body

during labor or that she may lose the immediate post-birth bonding opportunity with her newborn

baby. Many women are able to educate themselves about hydrotherapy and can ask their

obstetrician questions. Hydrotherapy is believed to help some aspects of labor. Therefore, the

following research question was addressed: In laboring women, how does hydrotherapy

compared to a supine position influence the difficulty, duration, and the pain during labor and

birth?

Literature Review

In order to research this topic in the nursing profession, this information was obtained

from OhioLINK databases. Articles used in this paper came from the databases of MEDLINE

and CINAHL plus. Nine sources were examined regarding the effects of hydrotherapy on

laboring women compared to lying supine, which means lying on their back during delivery.
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This research paper will discuss the effects of hydrotherapy on the difficulty, duration, and pain

on the laboring women during delivery.

Difficulty

In laboring women, hydrotherapy has been effective in reducing the overall difficulty of

labor. There are two types of hydrotherapy used during labor, immersion and shower

hydrotherapy. Warm water immersion is defined as “Immersion in a tub with depth that allows

for complete submersion of the abdomen to the breast level” (“A Model Practice Template,”

2017). While a woman is submerged in water, it gives her the ability to move and change

positions comfortably, decreasing the amount of stress hormones produced, therefore improving

uterine contractility.

Hydrotherapy may be effective in giving relief from pain while promoting labor progress

by allowing the laboring woman freedom to move and change positions. When immersed

in water, the laboring woman may experience decreased environmental resistance,

allowing her to move and change positions easily (Stark, M.A. et al., 2008).

While in labor, positioning and movement are key in promoting the progress of labor and

reducing the need for labor augmentation. Labor augmentation can increase the difficulty and

length of labor. By avoiding augmentation with the use of hydrotherapy, a shorter and less

stressful labor and birth can be achieved. In the sitting position, the dimensions of the pelvis are

increased and can allow for easier descent of the fetus. When comparing sitting/squatting in an

upright position in a bathtub to lying in a supine position in bed, the sitting/squatting

arrangement has advantages. This positioning in water allows women to move more freely and

they are more likely to sway the pelvis in order to cope with contractions. An upright position

can also produce more effective contractions. “Hydrotherapy allows freedom of movement and
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freedom to be an active participant in her labor and birth, supporting the normal labor process”

(Stark, M.A. et al., 2008). The ability to move around easier in a tub of warm water may help

women feel more comfortable changing positions and performing movements such as rocking

and swaying in rhythmic patterns to encourage fetal descent.

The second type of hydrotherapy is the use of warm showers during labor. While

immersion therapy may not be for some women, showering is an effective use of water to aid the

birth process. Showering can provide comfort and relaxation with an overall positive labor

experience. The use of hydrotherapy can decrease difficulty of labor by reducing pain, giving the

mother a sense of control, and overall relaxation of the mind and body. “It offers care-givers

(midwives, nurses, and/or partner) an opportunity to develop the skills required to provide

woman-centered care, form therapeutic rapport with women, empower their decision making and

participation, and control over their bodies” (Lee, S-L. et al., 2013). By decreasing mental stress

the mother is more likely to have a positive labor experience and decreased difficulty of labor.

In an uncomplicated labor, hydrotherapy should be encouraged for all mothers.

Immersion or the use of warm showers is cost effective and can provide relief for mothers

avoiding the use of pharmaceutical therapies during their labor experience. With the data

collected over many years, hydrotherapy is seen as a safe, convenient, and effective way for

laboring mothers to reduce pain, anxiety, and decrease difficulty and duration in the early stages

of labor. Positioning and movement are two crucial elements in the progression of labor.

Hydrotherapy allows for both of these elements to be conducted freely. Due to the use of these

techniques, the mother can also experience positive physical hygiene effects that can help them

feel more comfortable and relaxed, reducing her stress. “Numerous clinical studies have since

shown that immersion baths induce relaxation, relieve pain, and lower blood pressure” (Lee, S-L.
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et al., 2013). In mothers looking to avoid the use of pharmaceutical drugs to help relieve pain and

augment labor, hydrotherapy is a great option and is becoming more popular as time goes on.

Due to a new wave in young mothers avoiding pharmaceutical therapies, non-pharmacological

methods like hydrotherapy are more commonly being used.

Duration

The duration of labor varies from person to person. The early labor phase averages 8-20

hours for first time mothers and 5-14 hours for women who have been pregnant before. The

active stage of labor averages 2-4 hours, and the transition stage averages 1-3 hours. The second

stage, which is the birth of the baby, averages 0-3 hours. There are multiple factors that can

contribute to the duration of a woman’s labor, but this research paper examines hydrotherapy

specifically. In a review of 1600 water births, “the duration of the first stage of labor was

significantly shorter with a water birth than with a land delivery (Theoni A. et al., 2009). The

study compared 737 first time mother deliveries in water with 407 first time mother deliveries in

bed. The results showed a total of 380 minutes vs. 468 minutes for the duration of the first stage

of labor. In another study published in 2019, the effects of maternal birth positions on the

duration of the second stage of labor were reviewed. The second stage of labor begins when the

cervix is completely dilated, ten centimeters, and ends with the birth of the baby. The positions

being compared were flexible sacrum positions (standing, kneeling, sitting, squatting, birthing

ball, and lateral positions) and the supine position (lying face upward). According to the study,

“using a flexible sacrum position can reduce the duration of the second stage of labor by

21.12 minutes” (Berta et al., 2019). An upright position is beneficial for both the mother and the

infant. An upright position enables flexibility of the pelvis and helps the uterus to contract more
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efficiently. Although this study did not address hydrotherapy directly, it can be related. When a

woman uses hydrotherapy during labor, she is in an upright position. If the laboring woman is

not in the supine position, a conclusion can be drawn that the positions used during hydrotherapy

can decrease the duration of the second stage of labor. In another study from 2019, the effects of

hydrotherapy in the management of pain was reviewed. According to the study, “regarding

hydrotherapy in the form of the therapeutic shower, the results highlighted: quickness on pain

relief, short duration effect, easy to apply, no Although the study was mainly about the pain

aspect, it still showed that hydrotherapy had a positive effect on the duration of labor.

Pain

Hydrotherapy compared to lying supine leads to positive birthing experiences. This

happens by increasing vasodilation and buoyancy, thereby decreasing pain. Water immersion is a

non-pharmaceutical measure to help decrease the pain of childbirth. In the studies compared, the

participants had to be approximately five centimeters dilated and the hydrotherapy continued

until full cervical dilation. According to Tuncay (2019), “pregnant women preferred the

hydrotherapy methods more than the pharmacologic methods for pain management of the labor

process” (page 310). The studies show that when hydrotherapy is introduced while the patient is

at least five centimeters dilated, there is decreased pain and labor is more bearable. Tucany

(2019) also stated “immersion in water during the first stage of labor may be associated with a

decreased use of spinal and epidural analgesia…” (page 310). Hydrotherapy is known to

decrease pain by allowing laboring women to move more freely and allow the warm water to

reduce pressure from the contractions. Throughout these studies, evidence has shown that

decreased pain provided for a more positive labor process. This, in turn, allowed mothers to

conserve energy and strength to tend to their newborn faster. Decreasing pain during labor also
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helped the mother be less fatigued so the fourth stage of labor, or the golden hour, allowed for

more productive mother and baby bonding. Hydrotherapy allows the mother to continue

changing positions which is unable to happen if the mother receives any spinal or epidural

anesthesia. Changing positions will allow the mother to use gravity to encourage descent of the

baby and save energy. According to Carlsson, “The water was described as warm and soothing

for the vulva and perineum, which resulted in less pain in the second stage of labor.” (page

1225). Looking into the active stage of delivery, women had stated that pain was relieved by

being able to change the temperature of the water continuously. Hydrotherapy deemed to be

helpful when the women were in between contractions to promote rest and relaxation and to

control pain. Tuncay (2019) had found that “women who receive hydrotherapy cope with labor

pain better because pain relief reduces the release of catecholamines and increases endorphin

levels, which result in a decrease in anxiety.” (page 313). In another review, the authors

suggested that early intervention in labor complications that cause pain will ultimately decrease

labor pain all together. “The effects of hydrotherapy are rapid, occurring within 15 min of a

parturient entering the tub.” (Benfield, et. al., 2010) Hydrotherapy is an instant

non-pharmaceutical measure that helps make labor more comfortable and helps decrease pain

during the entire delivery. Overall, hydrotherapy in both studies seemed to be most helpful in the

active stage of delivery when the woman is about four to seven centimeters dilated. Laboring

women reported feeling more present in the delivery without the use of an epidural or pain

medications.
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Conclusion

In laboring women, hydrotherapy compared to lying supine influences the difficulty,

duration, and pain during labor and birth. In the multiple studies reviewed in this research paper,

there is profound evidence that the use of hydrotherapy can decrease labor difficulty, the amount

of pain, and shorten the duration of labor. Some of the positive effects of hydrotherapy include

allowing women the freedom to move and change positions frequently, prevention of tearing the

perineum during delivery, and reducing pain by relaxing tense muscles. Immersion hydrotherapy

and warm showers can also give the mother a sense of control over her labor and promote good

hygiene to help decrease stress and anxiety. With all of the physiological and psychological

benefits of hydrotherapy, a positive overall labor and birth experience can be had. Hydrotherapy

during labor is a safe, effective, non-pharmacological strategy in an uncomplicated pregnancy

that promotes a physiologic child birthing process and can help relieve the discomforts and stress

associated with labor and birth.

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