Water Immersion and Pain Control in Labor
by Kimberly A. Boehmler, MSN, CNM
The healing and pain-relieving properties of water have been hailed over the centuries, and the use of water immersion during labor is becoming a popular pain control option for women who are looking for ways to avoid the use of painkillers and anesthetic drugs. Hospitals across the country are now including whirlpool baths as part of their maternity ward facilities and birthing suite renovations, and women are becoming increasingly aware of the benefits of hydrotherapy in labor.
Hydrotherapy, defined as the therapeutic use of warm water, is a proven, natural remedy. Who hasn’t felt the physical and mental relaxation that comes with soaking in a hot tub? When a woman enters a warm bath while in hard labor, the first obvious effect is of immediate pain relief ("Aaah!…"). There are three factors at work in a whirlpool tub that contribute to this benefit: heat, buoyancy, and massage.
Immersion in warm water raises the body temperature and causes the blood vessels to dilate, resulting in increased circulation. The blood vessel dilation can help to lower the blood pressure of a laboring woman and decrease any fluid retention or swelling. Warm water also eases tension in the mother’s shoulders and back, an important consideration for women experiencing back pain in labor. The buoyancy of the water reduces body weight by approximately 90%, relieving pressure on joints and muscles and creating the relaxing sensation of weightlessness. The massaging action from the force of the jets helps to relax tight muscles and stimulates the release of endorphins, the body’s natural pain killers. The tension and muscle tightness that many laboring women feel, especially first-time moms, greatly contributes to the amount of pain they experience.
Unlike epidural medications, which can sometimes slow labor and lead to Cesarean sections, it has been shown that women placed in whirlpool tubs during active labor not only experienced relaxation and decreased pain, but also progressed rapidly with cervical dilation, resulting in a shorter labor. This is thought to be caused by the release of oxytocin, a hormone that can produce more effective and synchronized uterine contractions, thereby facilitating cervical dilation and progression in labor. In fact, the time when the laboring woman is anticipating the bath often is associated with a fast progression in cervical dilation, an effect that cannot easily be explained by physiologists. It seems to be in relation to the symbolism of water (i.e. listening to the noise of the water filling the tub).
Women should be aware that hydrotherapy is even more effective when used in conjunction with various other labor support measures such as touch, visualization and patterned breathing. It is also important that water temperature be maintained at approximately 37°C and that women drink plenty of fluids to prevent dehydration.
With these points in mind, water immersion can be used as a simple, safe and effective option in relieving childbirth-associated pain, especially for those interested in an alternative to medications.
Editorial provided by Kimberly A. Boehmler, MSN, CNM of Franklin Midwifery Associates at Riddle Memorial Hospital in Media, Pennsylvania.