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Baths can significantly ease pain of active labor.

SAN FRANCISCO -- Taking a bath can decrease the pain of active labor and reduce the use of analgesics, but don't draw the water if the mother is less than 5 cm dilated or you may prolong labor, Tekoa L. King said at a meeting on antepartum and intrapartum management sponsored by the University of California, San Francisco.

Data on bathing during labor are mixed but tend to support the usefulness of baths, said Ms. King, a certified nurse-midwife on the ob.gyn.faculty at the University of California, San Francisco.

Until 2002, two out of three well-designed randomized, controlled trials found that women randomized to baths during labor reported less pain, greater comfort, and improved satisfaction rates, compared with women who did not bathe. The third study showed no differences between groups. Baths did not affect the likelihood of cesarean section, low Apgar scores, or infection, she said.

"It appears to be safe in terms of infection rates" regardless of whether the patient has ruptured or nonruptured membranes, "'so I think we can just lay that worry to rest," Ms. King said.

One of these trials also found a significant decrease in the incidence of abnormal fetal positioning in the bath group, compared with controls (1% vs. 5%), but these results need to be confirmed, she said.

One study suggested that the positive effects of bathing may have been underestimated, because a significant number of women in the control group switched to baths.

Three other randomized, controlled studies were too small or poorly designed for their results to be considered valuable, Ms. King said. In the six studies overall, three found reduced pain with baths and three did not.

A seventh randomized trial that compared the use of baths early in labor with those later in labor reported longer labors and increased use of analgesics in the early bath group.

One study that did not control bath temperatures found an increase in maternal and fetal heart rates in the bath group, she added.

Baths also improved pain scores in a 2004 study of 99 nulliparous women with low-risk pregnancies and dystocia in labor at term. The women were dilated at least 3 cm with full cervical effacement but were dilating less than 1 cm per hour. They were randomized to soak in baths for up to 4 hours or undergo amniotomy and augmentation as needed, with vaginal exams every 4 hours.

"This is a question every one of us has faced on a Friday afternoon or early Saturday morning--do you stick them in a tub, or do you start Pitocin? You've got to do something," Ms. King said.

Women in the bath group reported significantly lower pain scores, and there was a nonsignificant trend toward less use of epidurals in the bath group. Operative delivery rates did not differ between groups.

Six neonates in the bath group and none in the augmentation group were admitted to the intensive care unit. Although the difference in this rate between groups was not statistically significant, it was cause for concern, she added.

When results of this study were combined with those of the seven previous randomized, controlled trials in a 2004 metaanalysis, bathing was associated with a significant drop in pain and epidural use.

None of the data apply to underwater births, another practice with growing patient interest, she said. A review of 74 articles in the medical literature on underwater births found 16 that reported complications, including drowning, neonatal hyponatremia, waterborne infectious disease, cord rupture with neonatal hemorrhage, and hypoxic ischemic encephalopathy (Am. J. Obstet. Gynecol. 2004; 190:1211-5).

A higher perinatal death rate with underwater births was not significant because of insufficient numbers for proper analysis, she noted. "I would say to you, babies don't drown when they're born in air."
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Title Annotation:Women's Health
Author:Boschert, Sherry
Publication:Family Practice News
Geographic Code:1USA
Date:Dec 1, 2004
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