• Comfort;
  • Coping;
  • Hydrotherapy;
  • Labor;
  • Labor pain;
  • Movement;
  • Normal birth;
  • Positions;
  • Water birth


Objective:  To observe and describe the positions and movements women choose while immersed in water during the first stage of labor.

Design:  Descriptive, observational pilot study.

Setting:  A rural community hospital that provided hydrotherapy in labor.

Participants:  Women (N = 7) who intended to use hydrotherapy in labor were recruited prenatally from a midwife-managed practice.

Measures:  For 15 minutes of each hour during the first stage of labor, position and movements of the participants were observed and recorded on a laptop computer. The observational tool was developed for this study from a review of the literature and interviews with nursing experts; 435 observations were recorded. Women were free to choose when and how long to use hydrotherapy and had no restriction on their positions and movements.

Results:  Only 3 of the 7 participants labored in the tub. Women demonstrated a greater range of positions and movements in the tub than in bed, both throughout labor and during late first-stage labor (7-10 cm of dilatation). Women had more contractions and made more rhythmic movements while in the tub than in bed.

Conclusions:  Hydrotherapy may encourage upright positions and movements that facilitate labor progress and coping, helping women avoid unnecessary interventions.