Laboring in Water Eases Pain

Women who are progressing slowly in labor experience less pain and require fewer medical treatments when they immerse themselves in warm water, according to a study published in the British Medical Journal (2004;328:314).

The first stage of labor is marked by the progressive dilation of the uterine cervix opening. Difficulty during this stage is known as dystocia; dilation that stalls or progresses very slowly is a form of dystocia. Long labor can lead to maternal fatigue and possibly fetal distress, and the risk of infection is higher if labor is prolonged after rupture of the membranes. This type of dystocia is most common in women in their first pregnancy, occurring in approximately 20%. It can be caused by unusual fetal position, large fetal size, small maternal pelvis, and certain pain-relieving medications. Anxiety and pain can perpetuate dystocia by triggering a stress response that reduces uterine activity.

Laboring in warm water is believed to reduce stress and ease pain, but its effect on the outcome of labor and delivery has not been adequately evaluated. Medical interventions, typically recommended shortly after dystocia is diagnosed, might include breaking of the fetal membranes (amniotomy) if the membranes have not spontaneously ruptured, and administration of oxytocin (a medicine that acts similarly to the hormone that stimulates labor) if the membranes have already ruptured or if amniotomy does not stimulate normal progression of labor. If normal labor does not begin in some reasonable time, the use of instruments, such as forceps, or surgery (cesarian section) might become necessary. Due to the serious risks associated with all of these interventions, the best time for their use (to ensure the greatest degree of safety for both mother and baby) remains controversial.

The current study compared labor in water with more common treatments for dystocia management. The 99 participants were healthy women delivering for the first time and diagnosed with dystocia because of poor progression of cervical dilation (less than one centimeter per hour). These women were randomly assigned to one of two groups: one group was moved to a warm pool to continue labor and received medical interventions if necessary, and the other group received only medical treatment (amniotomy and/or oxytocin) as needed. The pool temperature for water labor was maintained at 36 to 37°C (97 to 99°F) and the women were immersed to just above the breasts when sitting.

Women who labored in water experienced significantly less pain during labor than did women who received other treatment, and fewer women in the water labor group needed pain-relieving medication, although this difference was not statistically significant. The number of women treated with amniotomy or oxytocin was 25% lower in the water labor group. The duration of the first stage of labor and the number of women requiring instrument-aided or surgical delivery were similar and the health and well-being of the babies and mothers following delivery were not different between groups.

The results of this study suggest that laboring in water significantly reduces pain and the need for medical interventions without increasing the need for instrument or surgical delivery and without increasing the risk to infant or maternal health and safety. Larger studies are needed to confirm these findings.

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, VT, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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