Showering During Labor

Study Overview
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Brief Summary
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The research covers the birth memory evaluation to determine the pregnancy process, the labor process and the changes in the perceived pain level during this process, the parenting behavior immediately after the birth and the process of the birth.

Detailed Description
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The Effect of Showering During Labor on Perceived Birth Pain, Parenting Behavior and Birth Memory Labor is a natural process in which the fetus and its appendages, which are the product of pregnancy, are expelled from the uterus approximately 40 weeks after the last menstrual bleeding. Birth is a very meaningful and unique experience for the pregnant woman and her family. Although it results in a positive experience, they are faced with serious pain, discomfort and sensory situations that will force them in this process. This pain is a severe acute pain and differs from other types of pain due to the fact that it is a part of a natural process, experienced in a limited time and mother-infant relationship. In the literature, labor pain can be relieved by two methods: pharmacological (drugs) and non-pharmacological (non-drug methods). In the guide published by the World Health Organization (WHO) in 2018, non-pharmacological methods are recommended to be used as they are more reliable and less invasive. Non-pharmacological methods are generally simple, reliable for mother-baby health, easy to use, accessible, economical and do not require special training. The application of non-pharmacological methods can be safely applied by midwives independently, as it does not require a physician's request and has minimal side effects. The midwife, who decides with the pregnant woman the non-pharmacological method to be used in the management of labor pain, can apply this method with her own autonomy and ensure that the mother has a more comfortable birth process. Non-pharmacological methods include hot/warm bath, hydrotherapy, hot-cold application, movement, positions, breathing, relaxation exercises, acupuncture, TENS, yoga, massage, aromatherapy, music, hypnosis. These practices increase the comfort of the pregnant woman during the labor process, relieve the level of pain and provide a positive birth experience and positive progress in the mother-baby interaction. One of the non-pharmacological methods used to reduce labor pain is hydrotherapy/warm application. Although there is not enough evidence about the history of Hydrotherapy/Hot treatment, it was reported that the spa waters of Hippocrates had a therapeutic effect in the fifth century. The use of water in childbirth and labor started with Igor Charkovsky in Russia in 1970, and then it was spread in Europe under the leadership of Micheal Odent. Hot application causes vasodilation in peripheral blood vessels, oxygenation of the region, nutrition, removal of waste materials, and relaxation is experienced by reducing tension in the muscles. In addition, the feeling of pain decreases. As a result, fetal well-being increases. The positive outcome of the birth process as a result of a healthy and beautiful progress also affects the understanding of mother-infant interaction and parenting behavior in the postpartum period. Postnatal parenting behavior is the behavior of the mother showing that she is interested in the newborn baby, such as taking care of the newborn in the postpartum period, asking questions about it, smiling at the newborn baby or making sounds. It can be affected by various factors, the situations experienced during labor and the past experiences of himself/herself. In a randomized controlled study conducted by Tuncay (2016), it was determined that the postpartum parenting behavior scale average score of the pregnants in the experimental group who received hydrotherapy was higher, and in other words, the pregnants in the experimental group behaved more positively towards the newborns in the postpartum period (p=0.001). Birth also affects memory. A pregnant woman who has experienced a difficult and long labor in the past is more anxious and fearful. However, past experiences do not always have this effect on women. Positive experiences with pain lead to correct behavior and positive changes. The experience experienced with the birth of each child is different and has the potential to change a woman's life in every sense. In order to protect the psychological health of the woman in the postpartum period, it is expected that her memories of the birth will be positive in her mind and that she will feel positive emotions when she remembers her birth. However, some women experience birth as a traumatic event rather than a positive and happy event. Some may describe this process as negative, while others may see it as a normal process. In the literature review, it has been determined that there are not enough studies on birth memory in Turkey. As a result, it is stated in the studies that non-pharmacological methods such as warm shower application may be effective in the positive outcome of labor, ensuring mother-infant interaction, acquiring parenting behavior and positive recall of labor in the future. For this purpose, the study was planned to evaluate the effect of warm shower applied during labor on women's pain levels, postpartum parenting behavior and birth memory.

Official Title
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The Effect of Showering During Labor on Perceived Labor Pain, Parenting Behavior and Birth Memory

Conditions
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Labor Pain, Parenting, Childbirth Problems

Intervention / Treatment
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* Behavioral: warm shower


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being able to communicate verbally Between 18 - 45 years old, Being Primiparous/Nulliparous, Term pregnancy (38-41 weeks of pregnancy), Being in the latent and active phase of labor (Cervical dilation 4-5 cm and 7-8 cm) Having a single fetus Fetus in vertex presentation, Low risk pregnancy and no complications (EMR, Placenta Previa, HT, DM etc.), No obstetric risk (diabetes, pre-eclampsia, premature birth threat, etc.) Not having had any surgery in the spinal region, Volunteer to participate in the research Exclusion Criteria: Not being willing to participate in the study, Not being open to communication and cooperation, Presence of hearing-sight and mental problems that would prevent the research, Be younger than 18 years old, over 45 years old, Being multiparous Being outside 38-41 weeks of gestation Being in the transitional phase of birth, Not planning a vaginal birth, Decision of cesarean delivery during labor, Presence of any medical or obstetric risk factors (fetal distress, prolonged labor, etc.)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: While warm showers will be used during labor in the experimental group, routine midwifery care will be applied in the control group.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental group<br>The women in this group will have a warm shower during the labor process. | Behavioral: warm shower<br>* A warm shower will be applied for 20 minutes to the pregnant woman whose cervical dilatation reaches 4-5 cm and 7-8 cm.<br>|
| No Intervention: Control group<br>Women in the control group will not be interfered with and will be followed in line with the routine follow-up protocol of the clinic. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Perceived pain level | When cervical dilation is 4-5 cm and 7-8 cm, perceived labor pain will be defined by the visual pain scale. | 6 hours | 
| Birth Memories and Recall Questionnaire | It will be determined how taking a shower during labor will affect the birth memory. | 6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postpartum Parenting Behavior Scale | It will be determined whether taking a shower during labor affects parenting behavior. | 1 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Labor Pain, Birth Memories, Parenting Behavior, Hydrotherapy