PURPOSE: To review the literature on hydrotherapy in labor to direct prescription of the intervention and design studies to test its effectiveness. METHODS: Studies of hydrotherapy were identified via searching literature and electronic databases. FINDINGS: A primary effect of immersion is a central blood volume bolus, which occurs almost immediately after bathing begins. Subjective maternal responses to bathing in labor have been favorable. No maternal or infant infections have been attributed to bathing by parturients with either intact or ruptured membranes. Maternal bathing in labor does not appear to affect infant Apgar scores or stress hormones at birth. No clear evidence exists to indicate that hydrotherapy increases cervical dilation, increases fetal descent, reduces uterine dyskinesia, shortens labor, decreases use of epidurals or analgesia, or decreases rates of operative delivery or hemorrhage. CONCLUSIONS: Study findings indicate support for using hydrotherapy for relief of rapid pain and anxiety in labor. A methodical approach must be taken to determine for whom and under what circumstances intervention with hydrotherapy in labor is efficacious. Studies of the maternal and fetal effects of hydrotherapy in labor, including mechanisms of action, as well as large, prospective, randomized clinical outcome trials with control for intervening variables, are needed to help practitioners decide whether to prescribe hydrotherapy.
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