The Effect of Hydrotherapy During Labor on Labor Pain, Duration of Labor, Birth Affectivity, and Breastfeeding
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Selcuk University
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Visual Analogue Scale (VAS)
Study Overview
Brief Summary
Warm showers are increasingly gaining attention for their positive impact on labor, yet studies on this topic in Turkey remain limited. No previous research has simultaneously evaluated the effects of warm showers on labor pain, duration, emotional state, and breastfeeding. As a simple, economical, accessible, and side-effect-free method, warm showers represent a practical and safe non-pharmacological option for pain relief and comfort during labor. This study aimed to evaluate the effects of hydrotherapy on labor pain, duration, breastfeeding, and emotional experience during childbirth.
Detailed Description
Childbirth is an unforgettable and unique experience for women. However, labor can sometimes be painful, challenging, and anxiety-inducing. Severe labor pain can negatively affect a woman's sense of control during labor, causing stress that may impact the health of the mother, fetus, and newborn. Traumatic birth experiences may hinder maternal-infant bonding and breastfeeding. Factors such as delivery method, medical interventions, pain, and fatigue can delay the initiation of breastfeeding and complicate the mother's adjustment to her new role. In supportive, intervention-free birth environments, the need for analgesia and oxytocin is reduced, episiotomy rates are lower, maternal emotional experiences improve, and breastfeeding is initiated earlier.
In this context, non-pharmacological methods such as warm showers offer significant advantages during labor. Being easily accessible, economical, and free of side effects, warm showers help relax muscles, improve circulation, reduce labor pain, and support a more positive maternal approach to the birth process. They ease fear and stress, promote comfort, and increase birth satisfaction. Studies indicate that pregnant women find warm showers soothing and often prefer them over analgesics. However, studies in Turkey on this subject are limited, and comprehensive research evaluating the combined effects of warm showers on labor pain, duration, emotional state, and breastfeeding is lacking. Therefore, this study was conducted to assess the effects of hydrotherapy during labor on these outcomes.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- Double (Participant, Outcomes Assessor)
Masking Description
To prevent bias in the study sample, inclusion, exclusion, and withdrawal criteria were established.
The intervention was performed solely by the researcher, therefore performance bias could not be prevented.
Group assignments were done using random numbers generated by random.org, placed in opaque sealed envelopes, and assigned by an independent person not involved in the study. This ensured that participants were blinded to their group allocation.
All data were collected by the researcher, who was aware of the group assignments; thus, measurement bias could not be prevented. However, data analyses were conducted by an independent statistician not involved in the research process, preventing statistical bias.
Eligibility Criteria
- Ages
- 18 Years to 49 Years (Adult)
- Sex
- Female
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Primiparous women who were expected to give birth vaginally
- •Women who became pregnant spontaneously
- •Women who were in the latent phase of labor upon admission
- •Women who were not given oxytocin
- •Women who were at term (38-42 weeks of gestation)
- •Women who had a single healthy fetus in the vertex position
- •Women who did not have any risk factors (such as preeclampsia, eclampsia, placenta previa, or placental abruption).
Exclusion Criteria
- •Pregnant women with any complications that could cause dystocia during labor (such as contraction abnormalities birth objects, birth canal dystocia, maternal psychological dystocia)
- •Who are unable to move
- •Who cannot speak, read, or understand Turkish
- •Who have communication problems.
Arms & Interventions
HYDROTHERAPY Group
Pregnant women who met the inclusion criteria and agreed to participate in the intervention group received a warm shower once cervical dilation reached 5 cm. Based on their preference, participants either stood or sat during the 30-minute shower. After random assignment, the participants in the intervention group completed the "Informed Consent Form," "Personal Information Form," and the "Visual Analog Scale (VAS)" upon admission to the delivery room. During the 1st, 2nd, 3rd, and 4th stages of labor, the "Labor Monitoring Form" was used, and the VAS was repeated immediately after the intervention, and again at 30 and 60 minutes. Breastfeeding status was assessed using the LATCH scale within the first two hours after birth, and emotional responses to birth were evaluated using the Labor Affect Scale.
Intervention: Hydrotherapy (Warm Shower) (Other)
Control group
In the control group, routine hospital procedures were followed, including admission, history-taking, informed consent, recording of vital signs, and connecting the mother to the non-stress test (NST) monitor. No additional intervention was administered. After random assignment, control group participants also completed the "Informed Consent Form," "Personal Information Form," and "Visual Analog Scale" at admission. The "Labor and Postpartum Monitoring Form" was used during the 1st through 4th stages of labor, and the VAS was repeated at 30 and 60 minutes after entering the active phase. Within the first two hours postpartum, breastfeeding was evaluated using the LATCH scale, and emotional responses to birth were assessed using the Labor Affect Scale.
Outcomes
Primary Outcomes
Visual Analogue Scale (VAS)
Time Frame: First time: Latent phase of labor, Second time: Second stage of labor (the stage in which the baby is born), Third time: Third stage of labor (the stage in which the placenta is born), Forth time: Second hour after birth
The VAS is used to assess the pain felt. On the VAS, the patient marks the location of their pain on a ruler. This ruler is 10 cm long. One end of the ruler indicates no pain, and the other end indicates the most unbearable pain. The use of this scale must be explained very clearly to the pregnant woman. The pregnant woman is told that there are two endpoints on the ruler and that she should mark the point between these two endpoints that best represents the intensity of her pain. The distance between the "no pain" point and the point marked by the pregnant woman is measured in centimeters using the ruler and recorded. This determines the pregnant woman's pain level.
Breastfeeding Scoring System (LATCH)
Time Frame: Within the first two hours after birth
The LATCH scale is a tool used to assess mothers' breastfeeding behaviors and skills. Developed by Jensen et al. in 1994, it evaluates five key areas: L (Latch onto the breast), A (Audible swallowing), T (Type of nipple), C (Comfort of breast/nipple), and H (Hold/positioning). Each criterion is scored 0 to 2 points, with a total score ranging from 0 to 10. Higher scores reflect more effective breastfeeding, while lower scores indicate potential difficulties. The scale's reliability and validity for the Turkish population were confirmed by Koyun (2001) and Okumuş and Yenal (2003). Widely used by healthcare professionals, the LATCH scale helps identify breastfeeding challenges early and supports mothers through education and intervention, promoting better breastfeeding outcomes and bonding.
Birth Emotion Scale (BES)
Time Frame: Within the first two hours after birth
The Birth Emotion Scale (BES), developed by Hodnett in 1987, measures women's emotional experiences during childbirth. Gençalp validated and tested its reliability for the Turkish population in 1998. The scale contains 28 items scored on a 5-point Likert scale with options: "constantly," "frequently," "occasionally," "very rarely," and "never," coded from 1 to 5. Higher scores indicate more positive emotions during birth, while lower scores reflect negative emotions. Total scores range from 40 to 140. The Turkish version showed high internal consistency with a Cronbach's alpha of 0.87. The BES is widely used in research and clinical settings to assess psychological responses to childbirth and guide supportive care.
Labor Monitoring Form
Time Frame: First time: Latent phase of labor, Second time: Second stage of labor (the stage in which the baby is born), Third time: Third stage of labor (the stage in which the placenta is born), Forth time: Second hour after birth
To determine labor stage durations in pregnant women, researchers recorded key time points during labor and delivery. These included hospital arrival, and transitions between labor stages: latent, active, transition phases, birth, placenta delivery, and transfer to the postpartum ward. Timing was measured in minutes for accuracy. The latent phase involves mild contractions and cervical dilation up to 4 cm. The active phase features stronger contractions and dilation from 4 to 7 cm. The transition phase completes dilation to 10 cm. Measuring these stages, along with placenta delivery and postpartum transfer, provides valuable data to assess labor progress, detect abnormalities, and evaluate interventions. This detailed timing supports improved obstetric care tailored to each woman's needs.
Secondary Outcomes
No secondary outcomes reported
Investigators
Hacer ALAN DİKMEN
Assoc. Prof.
Selcuk University