Retrospective Cohort Study of Hydrotherapy in Labor

The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials

BACKGROUND

Currently, there is poor evidence of the effect of hydrotherapy on patients with knee osteoarthritis (OA). The authors performed a meta-analysis from randomized controlled trials to determine the efficacy and safety of a hydrotherapy program on measures of pain and knee function in individuals living with knee OA.

METHODS

A literature review included PubMed, EMBASE, Cochrane Library, Science Citation Index, ScienceDirect, and Ovid. Studies evaluating the efficacy of hydrotherapy for knee OA up to August 2023 were included. The research was reported based on the preferred reporting items for systematic reviews and meta-analysis guidelines to ensure the reliability and verity of results. Statistical analysis was performed using Stata/SE version 15.0.

RESULTS

A total of six randomized controlled trials were included for data extraction and meta-analysis. The present study revealed that there were significant differences between the two groups regarding the pain intensity at 1 week (WMD=-0.429; 95% CI: -0.679 to -0.179; P =0.001), 4 week (WMD=-0.308; 95% CI: -0.587 to -0.030; P =0.030) and 8 week (WMD=-0.724; 95% CI: -1.099 to -0.348, P <0.001). Furthermore, hydrotherapy was associated with improved outcome of the Western Ontario and McMaster Universities Arthritis index at 1 week (WMD=-3.314; 95% CI: -6.484 to -0.145, P =0.040), 4 week (WMD= -3.630; 95% CI: -6.893 to -0.366, P =0.029) and 8 week (WMD=-3.775; 95% CI: -7.315 to -0.235; P =0.037). No serious adverse events were observed in all patients who received hydrotherapy.

CONCLUSION

Hydrotherapy is efficacious and safe for reducing pain and improving functional status in individuals with knee OA, without increasing the risk of adverse effects.

Neonatal outcomes after water birth: A retrospective cohort study

OBJECTIVE

To compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used.

METHODS

A retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software.

RESULTS

A total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4).

CONCLUSIONS

The results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.

Content Analysis of Water Birth Policies With Implications for Practice and Research

OBJECTIVE

To identify areas of agreement and variation in clinical guidance documents (protocols, policies, or guidelines) that direct water birth care.

DESIGN

Qualitative descriptive.

SETTING

The clinical guidance documents studied covered water birth in home and hospital settings.

SAMPLE

The sample included 22 water birth guidance documents in English from six countries. The documents were obtained by request and resulting snowball sampling.

MEASUREMENTS

The framework method was adapted as an analytic tool, and a structured matrix output was used to organize and support the method of qualitative content analysis using a general inductive approach. Areas of general agreement and variations in practice guidelines for water birth were identified.

RESULTS

Criteria for a term, singleton, and cephalic presentation with reassuring maternal and fetal status were the most consistent for inclusion. The reliance on "low-risk" status was strongly present but without a uniform definition. A history of previous cesarean birth, body mass index, use of opioid pain medication, adequate labor progress, and vaginal bleeding were found to vary in directed care, and scarce supporting evidence was offered. Meconium-stained fluid variably excluded water birth in most documents, but this was not supported by evidence. The inconsistent findings from this study are cohesive in the evidence they provide for needed research in areas that affect access to water birth. The findings also provide nurses and birth providers with evidence-based guidelines for water birth care.

CONCLUSION

There was variation across guidance documents, demonstrating that water immersion is a flexible intervention that can be implemented in different settings and locations while following individual facility protocols for processes for care. An identified area of concern comes from examples of overly restrictive policies for water birth based on opinion or perceived risk rather than evidence from research.

Effects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort

BACKGROUND AND PURPOSE

Labour pain is a constantly increasing pain. This study thus aims to determine the effects of acupressure and shower on labour pain and postpartum comfort.

METHODS

In this randomized controlled trial (RCT), the control group consisted of 40 pregnant women, while the experimental groups consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4-5, 6-7 and 8-10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale (VAS) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data.

RESULTS

Pain was significantly reduced in both of the experimental groups, in contrast to the control group, in all periods of the study (p < 0.001). Postpartum comfort also significantly increased in the experimental groups compared to the control group (p < 0.05).

CONCLUSION

Acupressure and showering are effective in reducing labour pain and increasing postpartum comfort. Midwives and nurses can therefore apply them as inexpensive and easy to administer methods for labour pain relief.

Who Gives Birth in the Water? A Retrospective Cohort Study of Intended versus Completed Waterbirths

INTRODUCTION

Most waterbirth studies have been conducted outside the United States with a primary focus on birth outcomes. Studies to date provide limited information about how often women choosing waterbirth end water immersion before the birth and about the reasons for tub exit. This study examines a cohort of women intending a hospital-based waterbirth and documents the timing and reasons for tub exit. Demographic, clinical, and intrapartum care provider characteristics among women completing waterbirth were compared with those who exited the water prior to birth.

METHODS

This is a collaborative, multisite study from 2 health systems (8 hospitals) using retrospective electronic health records from August 2014 through December 2017.

RESULTS

Of 576 women who entered the waterbirth tub, 48% exited prior to the birth. The primary reasons for exit were maternal choice (50%), medical indication (32%), and provider decision (13%). Women exiting in the first stage did so primarily by choice (57%), whereas medical indication (42%) was the most common reason among women exiting in the second stage. Women who completed waterbirth did not differ from those who exited prior to birth with regard to age, race, ethnicity, country of origin, language, marital status, or intrapartum care provider specialty. Women completing waterbirth were more likely to have previously given birth (72% vs 47%) and to have a provider with more water immersion births during the study period (65% vs 55%).

DISCUSSION

Giving birth in the tub was associated with parity and intrapartum care provider experience. Half of the women intending waterbirth in this study exited the tub, with variation in exit reason by stage and provider type. It is important for women to understand that they or their provider may change the birth plan based on labor progress and maternal experience.

Culture, bathing and hydrotherapy in labor: An exploratory descriptive pilot study

OBJECTIVE

Though bathing (hydrotherapy) is widely used during labor to decrease anxiety and pain and to promote relaxation, the influence of cultural beliefs about bathing by parturients is virtually unknown. This pilot study explored pregnant women's experiences of bathing, bathing in labor, and cultural beliefs about bathing.

DESIGN

An exploratory, descriptive design.

SETTING

Low risk obstetrical clinics.

PARTICIPANTS

Healthy Hispanic, Black, White, American-Indian and Asian women (N = 41) at >37 weeks gestation.

METHODS

During a routine prenatal visit women responded to a brief openended questionnaire on the use of bathing. Data was captured using a modified ethnographic method involving observation and note taking with thematic analysis and quantification of percent response rates.

FINDINGS

Forty-six percent (N = 41) of women used bathing for purposes other than hygiene but only 4.9% (N = 41) of these women bathed during a previous labor. The women described bathing as relaxing, easing, calming, and efficacious for relief of menstrual cramps and labor contractions. Ten percent of women reported cultural beliefs about bathing.

CONCLUSIONS

Women who bathe, report relief of anxiety, menstrual and labor pain and promotion of mental and physical relaxation. The findings do not support the view that bathing is associated with identifiable cultural beliefs; rather, they suggest that bathing is a self-care measure used by women. This practice is likely transmitted from generation to generation by female elders through the oral tradition. Assumptions that race or ethnicity precludes the use of bathing may be faulty. Cautionary instructions should be given to pregnant women who are <37 completed weeks of gestation, to avoid bathing for relief of cramping or contractions and to seek immediate health care evaluation. Study of culturally intact groups may uncover additional themes related to bathing in labor and as a self-care measure for dysmenorrhea.

An Assessment of the Effects of Hydrotherapy During the Active Phase of Labor on the Labor Process and Parenting Behavior

This study was conducted to assess the effect on labor process and parenting behavior of hydrotherapy applied during the active phase of labor. This quasi-experimental study was conducted by using an equivalent comparison group ( n = 40). The participants in the experimental group whose cervical dilation was 5 cm were taken to the hydrotherapy tub. This application continued until cervical dilation reached 10 cm. The Participants Questionnaire, The Birth Follow-up Questionnaire, The Postpartum ]collection tools. The duration of the active phase and second stage of labor was extremely short in the experimental group in comparison with the equivalent comparison group ( p = .001). The Visual Analogue Scale (VAS) scores of the experimental group were lower than those of the equivalent comparison group when cervical dilation was 6 cm and 10 cm ( p = .001). The experimental group also displayed more positive parenting behavior and positive labor feeling ( p = .001).