Comment: The quality of evidence is downgraded by limitations in study quality (lack of blinding).
A Cochrane review [Abstract] 1 included 15 studies with a total of 3 663 women; 8 related to the first stage of labour, 4 to the first and second stages, and 2 to the second stage. Compared to no immersion, women allocated to water immersion during the first stage of labour had less need of epidural/spinal/paracervical analgesia but no significant difference in assisted vaginal deliveries, caesarean sections, perineal trauma or maternal infection Apgar score less than 7 at five minutes, neonatal unit admissions, or neonatal infection rates (table T1). Compared to no immersion, water immersion during the second stage of labour showed no clear differences for spontaneous vaginal birth, instrumental vaginal birth, caesarean section, and NICU admissions.
| Outcome | Relative effect(95% CI) | Risk with control - No immersion | Risk with intervention - Immersion in water (95% CI) | №of participants(studies) |
|---|---|---|---|---|
| Spontaneous vaginal birth | RR 1.01(0.97 to 1.04) | 822 per 1000 | 830 per 1000(797 to 855) | 2559(6) |
| Use of analgesia (regional) | RR 0.91(0.83 to 0.99) | 429 per 1000 | 390 per 1000(356 to 424) | 2439(5) |
| Perineal trauma (third- or fourth-degree tears) | RR 1.36(0.85 to 2.18) | 25 per 1000 | 33 per 1000(21 to 54) | 2341(4) |
| Admission to neonatal intensive care unit | Average RR 1.30(0.42 to 3.97) | 58 per 1000 | 75 per 1000(24 to 229) | 1511(2) |
| Neonatal infection | RR 2.00(0.50 to 7.94) | 5 per 1000 | 9 per 1000(2 to 37) | 1295(5) |
Another Cochrane overview [Abstract] 2 included 15 Cochrane reviews (255 included trials) and 3 non-Cochrane reviews (55 included trials) of pain management in labour. There was some evidence to suggest that immersion in water may improve management of labour pain, with few adverse effects.
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