Hydrotherapy in the 1st stage of labor and its pain relief effects: a scoping review

Abstract

Introduction: Pain, instituted as the 5th vital sign [1], implied the consideration of its prevention and effective control, as a duty of health professionals, as a right of the parturient and as a priority for the humanization of Health Units. The evaluation and control of pain as nursing autonomous interventions and as indicators of good nursing practices, allows providing person-centered care and involves the use of validated evaluation instruments and the consideration of non-pharmacological techniques of pain relief as resources of quality. In non-pharmacological alternatives for pain relief during labor, hydrotherapy, defined as the external application of water for therapeutic purposes, is highlighted by several national and international institutions, by its action in pain relief and in the optimization of the woman/fetus/familýs childbirth experience [2,3]. As Evidence Based Practice is one of the pillars of specialized nursing care, the evaluation of the interventions implemented, appears as a necessity to promote the highest state of health and well-being of this population. The objective of this review was to map the effects of hydrotherapy in the management of pain, in the 1st stage of labor in delivery rooms.

Materials and methods: Scoping review based on the principles advocated by the Joanna Briggs Institute (2017). Two independent reviewers performed the analysis of article relevance, extracting and synthesizing the data. Research of scientific articles took place in JBI, CINAHL, MEDLINE, COCHRANE and IWK. The selected descriptors were hydrotherapy, pain management, labor, conjugated with the Boolean operator AND.

Results: From the critical analysis of the identified articles, 435 were identified as potentially relevant but 421were excluded. As a result, 14 articles were selected and analyzed in detail and it was possible to identify the effects of hydrotherapy on pain relief during the 1st stage of labor. Regarding hydrotherapy in the form the therapeutic shower [4–7], the results highlighted: quickness on pain relief [4,6], short duration effect [7], easy to apply [5,7], no associated side effects [5] and easily accessible without pre-intervention training [11]. Concerning immersion [8,9], studies emphasized: positive effect on neuroendocrine responses that influence the psychophysiological labor process, significant decrease of anxiety and in cortisol levels and an increase of beta-endorphins [8,9].

Discussion and conclusions: Inseeking to provide quality care to parturient, respecting their preferences and mobilizing the best available scientific evidence, the review carried out, highlight that hydrotherapy is an important resource in pain management during labor. However the characteristics of the intervention, duration and the instruments of evaluation differ between studies, which refer to the necessity of performing more primary studies.