By: Nancy Humphrey
12/02/2010 – In the early stages of labor, expectant mothers are often told to soak in a warm tub at home — an effective way to relieve both the contractions and back pain during labor. In the tub, the weight of the baby is lifted off the mother’s back by the water’s buoyancy.
Now women who deliver at Vanderbilt University Medical Center have that option once they get to the hospital.
Vanderbilt University Hospital is the only Nashville hospital offering a permanent tub for hydrotherapy (water immersion) for its labor and delivery patients. The permanent one-person tub is located on the fourth floor of VUH.
Prior to its installation, an inflatable tub was used by patients who requested water immersion, said Nicole Herndon, M.S.N., R.N.C., assistant administrator for The Center for Women’s Health.
“We have had requests, mostly from our midwife practice patients, for some time,” Herndon said. “The tub is a relaxing way to labor and is mainstream in the midwife world. Studies have shown that mothers who use the tub experience less pain and anxiety,” she said.
Patients choosing water immersion do not deliver in the tub, Herndon said, pointing out how the process differs from water births, which are still controversial in the United States.
“When a patient is completely dilated and getting ready to push, she gets out of the tub,” Herndon said. “Most of the time, patients are ready by that time.”
A consent form must be signed by the patient before using the tub. Women who are in preterm labor can’t use the tub, nor can those who require any type of ongoing fetal monitoring or those who choose to have an epidural.
If at any time the baby is not doing well, the baby requires continuous fetal monitoring, or if the medical provider or health care team determines it’s not in the best interest of the mother or the baby, she will be asked to get out of the tub.
A multidisciplinary team, composed of representatives from the Neonatal Intensive Care Unit, the Nursery, Infection Control, Occupational Health and Obstetrics and Gynecology was formed to make sure that the tub could safely be offered to patients and that it was ergonomically safe for nurses assisting with labor.
The tub can be filled quickly, drained in about 20 seconds, and has a door that opens from the side allowing the laboring patient to step in and out easily. It has its own temperature control, and a floating thermostat is used to keep the water at less than 105 degrees (hot tub heat). The tub does not have jets like a hot tub.
The Vanderbilt University School of Nursing Nurse-Midwifery Faculty Practice was instrumental in seeing that the hospital purchased a labor tub, Herndon said.
“Water helps with pain relief and is a successful coping mechanism when a woman is in labor,” said Tonia Moore-Davis, M.S.N., C.N.M., clinical practice manager for the Nurse-Midwife practice.
“One of the first things our Nurse-Midwives tell some mothers when they call to say they’re in labor is to stay at home and get in the tub, but many women aren’t comfortable staying at home.”
Moore-Davis said first having the inflatable tub available at VUH for several months was a good way to see if there was a demand for a permanent tub.
“About five or six months into the trial there was such a demand, it was at that point we requested funds to install the permanent tub,” she said, adding that the inflatable tub can still be used as a back-up if two women request the tub at the same time.
Herndon said that unlike the inflatable tub, there is no delay in getting the permanent one ready when requested. The inflatable tub required at least 15 minutes to inflate and install a liner.
The water would cool quickly, and as more heated water was added, it would have to be emptied of some of the water to prevent overflow.
“Of course, there was water everywhere when we used it,” Herndon said.
“The tub hasn’t become part of our labor and delivery culture yet, with all providers,” Moore-Davis said. “In our practice, about 50 percent have epidurals and 50 percent are unmedicated. Of our unmedicated group, the majority would like to use the tub, and about half of those can. Those who use it love it and swear by it.”