'To bathe or not to bathe' during the first stage of labor

Abstract

Objective: Does a warm tub bath relieve labor pain? How is it experienced by the parturient?

Design: prospective randomised trial.

Setting: labor ward of a teaching hospital with a uniform active labor management.

Participants: one hundred and ten nulliparous low risk women, at term, in true spontaneous labor. Fifty-four women had a bath, 56 women served as controls.

Mean outcome measures: labor pain (assessed by means of a visual analogue scale) and post partum patients' bathing experience (by means of a self-made questionnaire).

Results: The study group and the control group were comparable with respect to maternal age, weight, length, duration of gestation, cervical status and labor pain sensation before randomisation. Absolute values of labor pain were not statistically different between the two groups, yet this latter progressed differently: in the bathing group the initial pain sensation (V.A.S.) was 6.8, and this remained stable during the first 25 minutes (V.A.S. = 6.7) and then rose to 8.2 after a mean of 53 minutes. In the control group, labor pain rose progressively from 6.3 to 7.3 after 25 min and to 8.7 after a mean of 52 min (p < 0.01, Student t-test). There was no difference in the use of epidural analgesia. There were no differences in labor duration nor in the frequencies of either operative deliveries or neonatal complications. Eighty percent of the bathers experienced soothing of the pain and all but one reported body relaxation. Ninety percent wanted to bathe again during a next labor.

Conclusion: Bathing provided no objective pain relief. It had, however, a temporal pain stabilizing effect possibly mediated through the improved ability to relax in between contractions. No side effects were found. It gives great satisfaction to users. Bathing, in conjunction with other forms of analgesia, is recommended.