College of Nursing
105 Making Water Immersion During Labor and Delivery a Pain Management Option For All Birthing Patients
Morgan McMartin and Jessica Ellis
Background
One method of nonpharmacologic pain management during the labor process is water immersion. Water immersion is when laboring patients are immersed in warm water during labor, usually in a large tub or birthing pool. Water immersion has been shown to reduce maternal pain during labor and delivery, increase maternal satisfaction, shorten the duration of labor, and provide comfort and relaxation to birthing mothers. Current evidence does not suggest that there is an increased risk of adverse neonatal outcomes with water immersion during the first stage of labor, but water immersion during the second stage of labor is not currently recommended due to a need for increased research into neonatal safety when delivering while immersed in water.
Purpose
The purpose of this thesis is to describe sample characteristics from the dataset. The primary outcome is to identify the barriers or reasons why participants in the study did not give birth in water. A secondary outcome is comparing newborn outcomes between land births and water births by analyzing Apgar scores recorded in the study at 1 minute and 5 minutes after delivery.
Methods
This study is a secondary analysis of data gathered using the Utah Water Birth Study, which was an exploratory prospective cohort study from 2012 to 2020. The study enrolled a total of 1471 participants. Participants were enrolled from 36 weeks gestation to active labor (6 centimeters of cervical dilation) for participation in the study. Participants were evaluated for participation using strict inclusion and exclusion criteria. This single group enrolled patients at two birthing sites, with no comparison group.
Results
Of the 1471 participants enrolled in the study, only 382 participants had a water birth, which was around 26% of all enrolled participants. The main reasons why participants in the study did not have a water birth were recorded. These included epidural request (304 participants), medical indication to exit (302 participants), patient preference (264 participants), rapid labor progression (56 participants), arriving in advanced labor (52 participants), no availability of a birthing tub room (37 participants), nitrous oxide request (13 participants), no water birth provider available (5 participants), and other or not answerable (434 participants). The Apgar scores between land births and water births at 1 minute and 5 minutes after delivery were compared: analysis showed that the average Apgar scores for infants born via land birth without any water immersion were 7.45 at 1 minute and 8.80 at 5 minutes. The average Apgar scores for infants born via water birth were 7.33 at 1-minute and 8.53 at 5-minutes.
Discussion
A majority of the participants in the study did not have a water birth as they originally desired. It is important to analyze barriers in order to make water birth a more viable option for patients. The analysis of Apgar scores within this study demonstrates that water birth did not result in clinically important differences in Apgar scores for newborns, both at the one-minute Apgar and the five-minute Apgar. More research is needed in regard to the safety and effects of water immersion, specifically regarding the second and third stages of labor. This study has demonstrated that the nursing field will likely see an increase in patients desiring water births in hospital settings, as the safety of water immersion continues to be studied. Nurses working in maternity will likely need increased training and education in caring for patients requesting water births.
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