Background: Hydrotherapy, which is immersion in a tub of water for its therapeutic effect, is effective for relieving pain, reducing anxiety, encouraging relaxation, and promoting a sense of control when used during labor. In a national survey of mothers who had recently given birth, 91% of the women who used hydrotherapy reported that it was either “very helpful” or “somewhat helpful” (Listening to Mothers II, 2006).  In spite of its effectiveness, the reported use of hydrotherapy was 6% in two national samples of mothers (Listening to Mothers I & II). While effective as a pain management strategy during labor, hydrotherapy is not used often.

Purpose: The purpose of this study was to examine factors nurses perceive as barriers to the use of hydrotherapy in labor. 

Method: A survey was used for this descriptive correlational study. Nurses’ Perception of the Use of Hydrotherapy in Labor (NPUHL) contained 30 statements about barriers that might be encountered with hydrotherapy. NPUHL scale was calculated by computing the mean of all items (Cronbach’s Alpha=.93). Four subscales were determined by factor analysis and computed (Health care environment support and facilities; Safety and effectiveness of hydrotherapy; Personal concerns; Effort required for hydrotherapy).  Intrapartum nurses attending a national convention (AWHONN, 2007) and those who were members of a perinatal listserve were invited to participate in this study. As the only significant difference between nurses who completed the written survey (n=225) and those who took the survey online (n=176) was race(x²=11.58, df=1, p=.001), the data were combined for analysis (N=401).

Results: Personal concerns were the greatest barriers (mean=1.71, SD=.79) identified by this sample, with Safety and Effectiveness being perceived as the least (mean=.41, SD=.57).  The Effort required for hydrotherapy (mean=1.69, SD=.97) and the Health care environment support and facilities (mean=1.52, SD=.92) also were perceived as barriers to the use of hydrotherapy.  Individual characteristics of the sample (age, education and role) were not associated with barriers (NPUHL scales).  Several characteristics of the birthing units in which the nurses worked were associated with NPUHL scales.  Nurse who reported higher epidural rates (r=.45, p=.000) and cesarean section rates (r=.30, p=.000) in the birthing units where they worked also perceived more barriers. When level of care (I, II, and III) that the facility provided was considered, nurses did not perceive that the barriers to the use of hydrotherapy were significantly different. There was a significant difference when birth care providers were considered.  Intrapartum nurses who worked in facilities where CNM’s do the majority of deliveries reported significantly fewer barriers than nurses who worked in facilities where residents, family practitioners or obstetricians attended most deliveries (F=6.84, df=2, p=.000).

Conclusion: The culture of the birthing unit in which nurses provide intrapartum care influences their perception of barriers to the use of hydrotherapy in labor.  Providing hydrotherapy requires a supportive environment, adequate nursing policies and staffing, and collaborative relationships with nurse midwives and physicians.