Pain, suffering, and trauma in labor and prevention of subsequent posttraumatic stress disorder

Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study

OBJECTIVES

The primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction.

METHODS

A prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth.

RESULTS

In the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores.

CONCLUSION

coping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.

Risk for trauma-related distress following difficult childbirth: Trajectories of traumatic intrusions across 2 years postpartum

There is heightened risk for maternal posttraumatic stress disorder (PTSD) during the perinatal period. However, it is unclear whether pregnancy and childbirth uniquely contribute to PTSD symptoms above and beyond elevations in negative affectivity that commonly occur among postpartum women (e.g., irritability, fatigue, depressed mood) and past trauma exposure. The present study explored the associations between childbirth stressors and trauma-related distress (TRD; intrusion and avoidance symptoms) across the 2 years following childbirth in a community sample of women (n = 159). Maternal TRD was assessed at pregnancy and four additional timepoints across 2 years postpartum. At pregnancy, mothers completed surveys measuring exposure to trauma and pregnancy-related anxiety. They also reported on pregnancy and childbirth complications across the first 6 months postpartum. Consistent with predictions, labor/delivery complications uniquely predicted increased maternal intrusions during the first 6 months postpartum above and beyond past trauma exposure. Furthermore, growth mixture models identified a subset of women with intrusion symptoms that persisted up to 2 years postpartum and, on average, exceeded the screening threshold for PTSD. Women who experienced greater labor complications were more likely to exhibit this clinical profile relative to low, stable symptoms. Findings highlight the importance of ongoing screening for TRD across the first 2 years postpartum, particularly among women who experience greater labor/delivery complications.

Childbirth-Related Psychological Trauma

Traumatic childbirth is an international public health problem because it is supposed that currently up to 45% of new mothers have reported such an experience. International rates of PTSD due to birth trauma range between 1.5 and 9 percent of all births. Birth trauma is defined as an event occurring during the labour and delivery process that involves actual or threatened serious injury or death of the mother or her infant. A traumatic event or situation creates psychological trauma when it overwhelms the individual's ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The aim of this article is to present a review of published data for childbirth trauma over various periods of time, as well as in different regions of the world. Studies were identified through a comprehensive search of PubMed, PsycInfo, ProQuest and PILOTS (Published International Literature of Traumatic Stress) over the last 20 years. More than 8000 articles were found. In this article we present and discuss some important findings.

Mental fitness during transition to fatherhood

Transition into fatherhood is often marked by a period of adjustment, uncertainty and psychological distress and challenges for many men, along with social isolation and relationship problems. Risk factors for paternal mental health issues are maternal depression, marital distress, parenting stress, gender role stress, mismatched expectations for pregnancy and after childbirth, poor physical health, inadequate self-care behaviours, avoiding seeking help for mental health issues, and having a child with sleeping, feeding and temperament problems. Paternal depression, anxiety and post-traumatic stress disorder can have negative impacts on the social and emotional wellbeing of fathers, their partners and their children. Nevertheless, these issues are not widely acknowledged, recognised or treated. Men’s mental health illness is a silent crisis. They often fail to seek help due to their feeling of shame, stigma for a lack of emotional control, distress or anxiety related to utilising mental health support services, and underrating the severity of their symptoms. These necessitate the need for timely attention, psychological support and proper education to minimise their risk of mental health issues. Although research has indicated fathers’ inclination toward being included in practices such as the mental health assessment, perinatal education and postnatal educational approaches need to be inclusive of fathers and encourage them to seek support for their paternal mental health issues and parenting difficulties.

A randomized controlled clinical trial of the effect of supportive counseling on mental health in Iranian mothers of premature infants

Background

Premature birth can affect maternal mental health. Considering that the mental health disorder in mothers may play a vital role in the growth and development of their children, therefore, this study was conducted to determine the effect of supportive counseling on mental health (primary outcome), mother-child bonding and infant anthropometric indices (secondary outcomes) in mothers of premature infants.

Methods

This randomized controlled clinical trial was carried out on 66 mothers with hospitalized neonates in the NICU of Alzahra hospital in Tabriz- Iran. Participants were randomly allocated into two groups of intervention (n = 34) and control (n = 32) through a block randomization method. The intervention group received 6 sessions of supportive counseling (45–60 minutes each session) by the researcher, and the control group received routine care. Questionnaires of Goldberg General Health and the postpartum bonding were completed before the intervention (first 72 hours postpartum) and 8 weeks postpartum. Also, the anthropometric index of newborns were measured at the same time.

Results

There was no statistically significant difference between the two groups in terms of socio-demographic characteristics. After the intervention, based on ANCOVA with adjusting the baseline score, mean score of mental health (AMD: -9.8; 95% Confident Interval (95% CI): -12.5 to -7.1; P < 0.001) and postpartum bonding (AMD: -10.0; 95% CI: -0.6 to 13.9; P < 0.001) in the counseling group was significantly lower than those of the control group; however, in terms of weight (P = 0.536), height (P = 0.429) and head circumference (P = 0.129), there was no significant difference between the two groups.

Conclusions

Supportive counseling may improve mental health and postpartum bonding in mothers of premature infants. Thus, it may be recommendable for health care providers to offer it to mothers.

Trial registration

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N45. Date of registration: October 29, 2018.

Enhanced Doula Support to Improve Pregnancy Outcomes Among African American Women With Disabilities

Aim

This article is a meta-analysis of studies examining the influence of doula support on birth outcomes among African American women with disabilities. While an estimated 11% of women in their childbearing years are impacted by some type of disability, mothers with disabilities are faced with risks during pregnancy. When risks in addition to maternal disability are present, mothers may encounter extra barriers that impede receipt of effective care.

Method

A meta-analysis of studies revealed women with disabilities are at risk for poor birth outcomes. Specifically, women of color living in poverty-stricken areas are at a greater risk for adverse birth outcomes.

Results

As a result of adverse experiences related to birth, mothers may experience levels of traumatic stress. To advocate for better pregnancy and birth outcomes, the intervention of doula support is emphasized.

Conclusion

There is a widely recognized need to promote better pregnancy outcomes among African American women to address disproportionate birth outcomes. Strategies to enhance doula support among African American women with disabilities are offered. Implications include future research surrounding the development of a training program for doulas specific to disability, trauma-informed care, and maternal mental health.

Health-care practitioners' assessment and observations of birth trauma in mothers and partners

BACKGROUND

Evidence shows that traumatic childbirth can cause ongoing distress, often referred to as birth trauma. This can have an impact on parents and the couple relationship, and consequently identifying and supporting parents with birth trauma is important to practice.

AIM

To investigate the experiences of health-care practitioners from the United Kingdom (UK) in assessment for birth trauma, perceived occurrence of birth trauma and observed impact on parents and the couple relationship.

METHODS

An online survey of UK health-care practitioners working with parents in the first postnatal year.

RESULTS

A sample of 202 practitioners reported identifying birth trauma in 34.4% of mothers and 25.0% of partners. Assessment for birth trauma was only conducted for 50.3% of mothers and 25.9% of partners. The most observed symptoms were re-experiencing among mothers (87.1%) and avoidance among partners (50.9%). Birth trauma was perceived as impacting on the couple relationship for 29.8% of mothers and 26.9% of partners. Written responses provided more detailed observations of the impact of birth trauma.

CONCLUSION

Understanding how birth trauma may present differently in mothers and partners could support effective assessment. Once birth trauma is identified, parents require personalised support to help them cope with the impact.

Effect of the Sacred Hour on Postnatal Depression in Traumatic Childbirth: a Randomized Controlled Trial

Introduction: the implementation of the baby’s nine instinctive stages as a sacred hour after birth is very effective in starting breastfeeding. About half of newly delivered mothers have reported a traumatic childbirth experience often associated with mental health problems. The present study aimed to examine the effect of the sacred hour on the depression in traumatic childbirths.

Methods: In this clinical trial, 84 mothers who had experienced a traumatic childbirth were randomly allocated into the intervention (n = 42) and control (n = 42) groups. The intervention group received sacred hour (baby’s nine instinctive responses), but the control group received only the routine care. Postnatal depression was evaluated as primary outcome at 2 week, 4-6 week and 3 month intervals after the delivery. The data were analyzed using t test, chi-square test and the repeated measures analysis of variance.

Results: The results showed that the marginal total mean (SD: standard deviation) scores of depression in the intervention and control groups were 7.5 (2.6) and 9.6 (2.6); therefore, the mean difference (95% CI) between the groups (-2.1, (-3.2,-0.95)) was significant.

Conclusion: The implementation of the sacred hour is recommended as a preventive approach to reduce the postnatal depression in women with a traumatic childbirth experience.

Lived Traumatic Childbirth Experiences of Newly Delivered Mothers Admitted to the Postpartum Ward: a Phenomenological Study

Introduction: Childbirth is a stressful event in every woman's life, leading to traumatic deliveries in half of the cases. This study aimed at describing mothers’ lived experiences which make them perceive their childbirth as traumatic.

Methods: In this descriptive phenomenological study, based on the DSM-V-A criteria, 32 mothers who had perceptions of a traumatic event during their labor and delivery were explored through semi-structured interviews, and the collected data were analyzed using the Colaizzi’s method.

Results: Four main themes could be extracted from the experiences of the mothers. The first theme was sensational and emotional experiences followed by clinical experiences, legal experiences and human dignity, and environmental experiences. The sensational and emotional experiences included four main categories (anxiety, fear, sorrow, anger). The theme of clinical experiences included two main categories (avoidable and unavoidable childbirth complications). The theme of legal experiences and human dignity included two main categories (non-observance of the charter of patient rights, and non-observance of human rights). The theme of environmental experiences also included two main categories (lack of proper supervision and management).

Conclusion: To prevent traumatic childbirth and its negative effects, different psychological aspects of childbirth need to be identified.

The effects of Psychoeducation on the Traumatic Perception of the Birth Phenomenon in women with Substance-use Disorders

Objective: The present study evaluates the traumatic perception of the birth phenomenon in women with substance-use disorders (SUD) and to investigate the effects of psychoeducation on this perception. Material and Methods: The study was conducted between January and July 2017, and involved 60 women with SUD who were divided into two groups: intervention (n = 30) and control (n = 30). The study was carried out using the semi-experimental "pre-post test matched group model," and the Traumatic Perception of Birth Psychoeducation Program (TPBPP) was applied. Results: Traumatic birth perception was found to be decreased after TPBPP was applied in four modules to women with SUD. Conclusion: TPBPP is an effective psychoeducation model in the reduction of the traumatic perception of birth in women with SUD.

PTSD post-childbirth: a systematic review of women's and midwives' subjective experiences of care provider interaction

OBJECTIVE

Review primary research regarding PTSD Post-Childbirth (PTSD-PC) that focussed on Quality of Provider Interaction (QPI) from the perspective of women who developed PTSD-PC, or midwives.

BACKGROUND

Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). Women's subjective experiences of childbirth are the most important risk factor in the development of PTSD-PC, with perceived QPI being key.

METHODS

A systematic search was performed for PTSD-PC literature. Reviewed papers focussed on either women's subjective childbirth experiences, particularly QPI, or midwives' perspectives on QPI. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced.

RESULTS

Fourteen studies were included. Three features of QPI contribute towards developing PTSD-PC: interpersonal factors; midwifery care factors; and lack of support.

CONCLUSION

QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives should be grounded on evidence highlighted in this review, along with further high-quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives' knowledge and needs regarding their role within QPI.

The trauma of birth

The trauma of birth is an international concern for all childbearing women globally. Since changes in 1994 to the Diagnostic Statistical Manual that included childbirth as a potentially traumatic event, several clusters of researchers, particularly representing the Scandinavian countries, the United Kingdom, and Australia, have emerged. Their research findings appear in numerous publications; yet, what is known from these studies is based on a variety of methodological designs and differing measurement tools making it difficult to draw many firm conclusions (Ayers, 2004 ; Ayers, Joseph, Mc-Kenzie-McHarg, Slade, & Wijma, 2008 ). This review offers information obtained from frequently cited, current and seminal research studies describing the trauma of birth among women of the world.

Perceptions of quality across the maternal care continuum in the context of a health financing intervention: Evidence from a mixed methods study in rural Malawi

BACKGROUND

In 2013, Malawi with its development partners introduced a Results-Based Financing for Maternal and Newborn Health (RBF4MNH) intervention to improve the quality of maternal and newborn health-care services. Financial incentives are awarded to health facilities conditional on their performance and to women for delivering in the health facility. We assessed the effect of the RBF4MNH on quality of care from women's perspectives.

METHODS

We used a mixed-method prospective sequential controlled pre- and post-test design. We conducted 3060 structured client exit interviews, 36 in-depth interviews and 29 focus group discussions (FGDs) with women and 24 in-depth interviews with health service providers between 2013 and 2015. We used difference-in-differences regression models to measure the effect of the RBF4MNH on experiences and perceived quality of care. We used qualitative data to explore the matter more in depth.

RESULTS

We did not observe a statistically significant effect of the intervention on women's perceptions of technical care, quality of amenities and interpersonal relations. However, in the qualitative interviews, most women reported improved health service provision as a result of the intervention. RBF4MNH increased the proportion of women reporting to have received medications/treatment during childbirth. Participants in interviews expressed that drugs, equipment and supplies were readily available due to the RBF4MNH. However, women also reported instances of neglect, disrespect and verbal abuse during the process of care. Providers attributed these negative instances to an increased workload resulting from an increased number of women seeking services at RBF4MNH facilities.

CONCLUSION

Our qualitative findings suggest improvements in the availability of drugs and supplies due to RBF4MNH. Despite the intervention, challenges in the provision of quality care persisted, especially with regard to interpersonal relations. RBF interventions may need to consider including indicators that specifically target the provision of respectful maternity care as a means to foster providers' positive attitudes towards women in labour. In parallel, governments should consider enhancing staff and infrastructural capacity before implementing RBF.

Grand Multiparous Mothers' Embodied Experiences of Natural and Technological Altered Births

In-depth interviews of a purposive sample (n = 14) of grand multipara mothers (five or more births) was conducted to investigate the mothers' embodied experiences of natural, technologically altered births and oxytocin inductions in U.S. hospitals from 1973 to 2007. A comprehensive secondary analysis of the lived experiences of natural birth and the high use of technology and oxytocin during birth, which was found in an original theme of a previous study, was explored. An overarching theme emerged of Embodiment of Birthing in U.S. Hospitals. Two patterns: Embodied Technological Altered Natural Births and Embodied Technologically Altered Induced Births were uncovered. Childbirth educators, doulas, and nurses are an integral part of creating changes in hospital settings, which discourage nonmedically indicated inductions and encourages changes in hospitals.

An Evidence Review and Model for Prevention and Treatment of Postpartum Posttraumatic Stress Disorder

Postpartum posttraumatic stress disorder (P-PTSD) is a variant of posttraumatic stress disorder (PTSD) that, although relatively prevalent, is under-researched. Up to one-third of women in the United States describe childbirth as traumatic, with 9 percent of women meeting the criteria for PTSD outlined by the American Psychiatric Association. These statistics are sobering in light of common use of analgesia during birth as well as hospital birth environments promoting family-centered maternity care. How can a seemingly natural event, such as childbirth, be associated with PTSD? This review includes a description of key variables associated with P-PTSD. Socioeconomic, environmental and genetic determinants are discussed, as are evidence-based prevention and treatment approaches.

Attitudes and behaviours of maternal health care providers in interactions with clients: a systematic review

Background

High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care.

Methods

Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded.

Findings

Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients’ attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being.

Conclusions

The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12992-015-0117-9) contains supplementary material, which is available to authorized users.

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.

Humanized Childbirth and Cultural Humility: Designing an Online Course for Maternal Health Providers in Limited-Resource Settings

This article reviews the implications of disrespect and abuse in maternal health services, the growing movement to humanize childbirth and promote cultural humility, and one strategy to build an online course to address this issue among maternal health workers in Mexico. Reports of disrespect and abuse have been widely reported by women seeking health services, including maternity care, across the globe. Evidence indicates offenders are often health care professionals who do not consider their behavior inappropriate and believe they are acting in the interests of both mother and baby. These same providers are often overworked, underpaid, and have few role models who humanize childbirth and demonstrate cultural humility. Strategies which aim to foster competencies in humanized childbirth and cultural humility among health providers are lacking in current health professional training programs. Using the case of Mexico, the authors describe the template and justification for an online course for novice to expert health professionals to build competencies in humanized childbirth and cultural humility. Recommendations for future work are discussed.

Improving vaginal examinations performed by midwives

A vaginal examination (VE) is an essential part of midwifery care, and is routinely performed when assessing the progress of labour. As evidence shows that during labour women may find VEs unpleasant, embarrassing and sometimes painful, the aim of this article is to review literature on the use of VEs during labour and to synthesise information from the available literature on how to provide an effective VE. The studies considered were retrieved from three databases (the Cumulative Index to Nursing and Allied Health Literature [CINAHL], SCOPUS and MEDLINE) using the following search terms: "VEs in labour", "midwives and use of VEs" and "women experiences of VEs in labour". The literature reviewed suggests that midwives are not careful about VEs. Therefore, a concerted effort is needed to pay attention to the frequency of VEs, the management of pain and distress, information-giving and the preferences of the patient, so that the patient can feel in control during a VE.

Giving birth with epidural analgesia: the experience of first-time mothers

The purpose of our qualitative descriptive study was to describe the birth experiences of women using epidural analgesia for pain management. We interviewed nine primiparas who experienced vaginal births. Five themes emerged: (a) coping with pain, (b) finding epidural administration uneventful, (c) feeling relief having an epidural, (d) experiencing joy, and (e) having unsettled feelings of ambivalence. Although epidural analgesia was found to be effective for pain relief and may contribute to some women's satisfaction with the birth experience, it does not guarantee a quality birth experience. In order to support and promote childbearing women's decision making, we recommend improved education on the variety of available pain management options, including their risks and benefits. Fostering a sense of caring, connection, and control in women is a key factor to ensure positive birth experiences, regardless of pain management method.

Moving beyond the debate: a holistic approach to understanding and treating effects of neuraxial analgesia

Neuraxial analgesia is here to stay, yet, spirited debate continues over potential harms and the quality of research that fails to identify them. This paper proposes moving beyond the debate and examining holistically the impact of neuraxial analgesia on the psychophysiology of mother and baby. A review of alterations in functioning of many systems is followed by a suggested four-part protocol to partially restore normal physiology and emotional well-being, and improve outcomes of neuraxial analgesia.

Labor pain management other than neuraxial: what do we know and where do we go next?

Analgesia and coping with labor pain can prevent suffering during childbirth. Nonpharmacologic methods help women manage labor pain. Strong evidence is available for the efficacy of continuous one-to-one support from a woman trained to provide nonmedical care during labor, immersion in warm water during first-stage labor, and sterile water injected intracutaneously or subcutaneously at locations near a woman's lumbosacral spine to reduce back-labor pain. Sterile water injections also reduce the incidence of cesarean deliveries. Nitrous oxide labor analgesia is not potent, but helps women relax, gives them a sense of control, and reduces and distracts their perception of pain. It is inexpensive; can be administered and discontinued safely, simply, and quickly; has no adverse effects on the normal physiology and progress of labor; and does not require intensive monitoring or co-interventions. Parenteral opioids provide mild-to-moderate labor pain relief, but cause side effects. Although observational studies have found associations between maternal use of opioids and neonatal complications, little higher level evidence is available except that meperidine is associated with low Apgar scores. Patient-controlled intravenous administration of remifentanil provides better analgesia and satisfaction than other opioids, but can cause severe side effects; continuous monitoring of arterial oxygen saturation, anesthesia supervision, one-to-one nursing, and availability of oxygen are recommended. The demand for inexpensive, simple, safe but effective labor pain management for women will undoubtedly increase in places that lack wide access to it now.

Efficacy of warm showers on labor pain and birth experiences during the first labor stage

OBJECTIVE

To determine the efficacy of warm showers on parturition pain and the birth experiences of women during the first stage of labor.

DESIGN

Randomized controlled trial (RCT).

SETTING/PARTICIPANTS

The study was conducted from July 10, 2010 to January 12, 2011 in the maternity ward of a Taipei City regional teaching hospital, site of approximately 220 to 250 births per month. Ninety-two expectant mothers were recruited (recruitment rate: 70.8%) and allocated by block randomization into the two arms of the study. In total, 80 women completed the trial: 41 in the control group and 39 in the experimental group.

METHODS

Participants in the experimental group received warm shower bath interventions. Each shower lasted 20 minutes. After a 5-minute full body or lower back shower, participants could spend 15 minutes directing shower water toward any body region that felt most comfortable. Facilities allowed participants to stand and sit as desired. Water was constantly monitored and maintained at a temperature of 37°C. Participants in the control group received standard childbirth care.

RESULTS

Labor pain and the birth experience were assessed using the Visual Analogue Scale for Pain (VASP) and the Labour Agentry Scale, respectively. After adjusting for demographic and obstetric data, experimental-group women who participated in warm showers reported significantly lower VASP scores at 4-cm and 7-cm cervical dilations, and higher birth experiences than the control group.

CONCLUSION

Apart from the positive physical hygiene effects, warm showers are a cost-effective, convenient, easy-to-deploy, nonpharmacological approach to pain reduction. This intervention helps women in labor to participate fully in the birthing process, earn continuous caregiver support, feel cared for and comforted, and have a more positive overall experience.