Hydrotherapy in Labor: Outcomes for Pain, Birth, and Breastfeeding

Primary outcomes

1. Visual Analogue Scale (VAS)

   Time frame: First time: Latent phase of labor, Second time: Second stage of labor (the stage in which the baby is born), Third time: Third stage of labor (the stage in which the placenta is born), Forth time: Second hour after birth

   The VAS is used to assess the pain felt. On the VAS, the patient marks the location of their pain on a ruler. This ruler is 10 cm long. One end of the ruler indicates no pain, and the other end indicates the most unbearable pain. The use of this scale must be explained very clearly to the pregnant woman. The pregnant woman is told that there are two endpoints on the ruler and that she should mark the point between these two endpoints that best represents the intensity of her pain. The distance between the "no pain" point and the point marked by the pregnant woman is measured in centimeters using the ruler and recorded. This determines the pregnant woman's pain level.

2. Breastfeeding Scoring System (LATCH)

   Time frame: Within the first two hours after birth

   The LATCH scale is a tool used to assess mothers' breastfeeding behaviors and skills. Developed by Jensen et al. in 1994, it evaluates five key areas: L (Latch onto the breast), A (Audible swallowing), T (Type of nipple), C (Comfort of breast/nipple), and H (Hold/positioning). Each criterion is scored 0 to 2 points, with a total score ranging from 0 to 10. Higher scores reflect more effective breastfeeding, while lower scores indicate potential difficulties. The scale's reliability and validity for the Turkish population were confirmed by Koyun (2001) and Okumuş and Yenal (2003). Widely used by healthcare professionals, the LATCH scale helps identify breastfeeding challenges early and supports mothers through education and intervention, promoting better breastfeeding outcomes and bonding.

3. Birth Emotion Scale (BES)

   Time frame: Within the first two hours after birth

   The Birth Emotion Scale (BES), developed by Hodnett in 1987, measures women's emotional experiences during childbirth. Gençalp validated and tested its reliability for the Turkish population in 1998. The scale contains 28 items scored on a 5-point Likert scale with options: "constantly," "frequently," "occasionally," "very rarely," and "never," coded from 1 to 5. Higher scores indicate more positive emotions during birth, while lower scores reflect negative emotions. Total scores range from 40 to 140. The Turkish version showed high internal consistency with a Cronbach's alpha of 0.87. The BES is widely used in research and clinical settings to assess psychological responses to childbirth and guide supportive care.

4. Labor Monitoring Form

   Time frame: First time: Latent phase of labor, Second time: Second stage of labor (the stage in which the baby is born), Third time: Third stage of labor (the stage in which the placenta is born), Forth time: Second hour after birth

   To determine labor stage durations in pregnant women, researchers recorded key time points during labor and delivery. These included hospital arrival, and transitions between labor stages: latent, active, transition phases, birth, placenta delivery, and transfer to the postpartum ward. Timing was measured in minutes for accuracy. The latent phase involves mild contractions and cervical dilation up to 4 cm. The active phase features stronger contractions and dilation from 4 to 7 cm. The transition phase completes dilation to 10 cm. Measuring these stages, along with placenta delivery and postpartum transfer, provides valuable data to assess labor progress, detect abnormalities, and evaluate interventions. This detailed timing supports improved obstetric care tailored to each woman's needs.