The Effects of Hydrotherapy on Anxiety, Pain, Neuroendocrine Responses, and Contraction Dynamics During Labor

Abstract

Background Hydrotherapy (immersion, or bathing) is used worldwide to promote relaxation and decrease parturient anxiety and pain in labor, but the psychophysiological effects of this intervention remain obscure. Design A pre-test post-test design with repeated measures was used to examine the effects of hydrotherapy on maternal anxiety and pain, neuroendocrine responses, plasma volume shift and uterine contractions during labor. Correlations among variables were examined at three time points (pre-immersion and twice during hydrotherapy). Methods Eleven term women (mean age 24.5 years) in spontaneous labor were immersed to the xiphoid in 37°C water for 1 hr. Blood samples and measures of anxiety and pain were obtained under dry baseline conditions and repeated at 15 and 45 min of hydrotherapy. Uterine contractions were monitored telemetrically. Results Hydrotherapy was associated with decreases in anxiety, vasopressin and oxytocin levels at 15 and 45 min (all p < .05). There were no significant differences between pre-immersion and immersion pain or cortisol levels. Pain decreased more for women with high baseline pain than for women with low baseline levels at 15 and 45 min. Cortisol levels decreased twice as much at 15 min of hydrotherapy for women with high baseline pain as for those with low baseline pain. Beta-endorphin levels increased at 15 min but did not differ between baseline and 45 min. During immersion, uterine-contraction frequency decreased. A positive plasma volume shift at 15 min was correlated with contraction duration. Conclusions Hydrotherapy during labor affects neuroendocrine responses that modify psychophysiological processes.

Hidroterapia e bola suíça no trabalho de parto: ensaio clínico randomizado

“…The early use of the warm bath (when dilatation is less than five cm) is related to increased use of analgesia when compared to women who use the intervention when dilatation greater than five cm. (7) The warm bath provides relief from pain and anxiety, increases the comfort, and provides positive feelings during the labor, (5,6) especially when combined with perineal exercise with the Swiss ball. (2) Its use facilitates a professional approach when patient-centered care is provided, which results in benefits for labor progress.…”

“…Most studies describe their use alone, and compare effectiveness with other interventions, mainly addressing pain management in labor. (2,5,6,9) They are part of the international policy strategies for caring the women during pregnancy, labor and childbirth. (10,12,13) Their use must be respected and encouraged by professionals who provide care for childbirth, if chosen by the parturient.…”

“…The parturients were instructed to adopt the standing or sitting position for the 30 minute duration of the bath. (2,5,6) The perineal exercise as a therapeutic intervention was performed using the Swiss ball. The parturients were instructed to sit on the ball with their legs flexed, at a 90º angle, knees apart, with the plantar region of the feet resting on the floor, performing movements of propulsion and pelvic rotation for 30 minutes.…”

“…(2)(3)(4) The warm bath, or hydrotherapy, is a non-pharmacological method that uses water heated to 37 o C as a therapeutic object, offering different benefits during labor, such as greater pain tolerance, stress reduction, regulation of uterine contraction pattern, and satisfaction with the labor process, by offering greater autonomy to the woman with regard to her choices, and the possibility for active participation by her companion. (2,(5)(6)(7) The effect of local heat during the bath stimulates redistribution of muscular blood flow, increasing relaxation and comfort. (2,5,8) The cost-effectiveness is good, since it is an easy to access, low cost technique.…”

“…(2,(5)(6)(7) The effect of local heat during the bath stimulates redistribution of muscular blood flow, increasing relaxation and comfort. (2,5,8) The cost-effectiveness is good, since it is an easy to access, low cost technique. (6) Perineal exercise with the Swiss ball facilitates the adoption of a vertical posture of the parturient in a comfortable sitting position, promoting well-being and pelvic mobility.…”