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Objective: Water immersion and epidural analgesia are both pain relief methods used to perceive less pain during the labor process. There are concerns about the maternal and fetal outcomes, although studies presented no significant complication directly related to these methods. We aimed to compare the IL-1 and 6 levels, Total serum oxidant (TOS), antioxidant (TAS) and catalase levels of births with epidural analgesia, water immersion and conventional birth without analgesia.
Material and Methods: A total of 88 patients were included in the study (The water immersion group included 29 patients, while the epidural analgesia and control group included 30 and 29 patients respectively). Umblical cord IL-1, IL-6, catalase, TAS, TOS levels, neonatal Apgar scores, duration of birth process and demographic data were compared between three groups
Results: There was no significant difference between the three groups in terms of age, Body mass index (BMI), gravidity, parity, gestational week, and birth weight (p>0.05). TOS and IL-6 levels were significantly lower in epidural group than others (p=0.031, p=0.019 respectively). Apgar scores were significantly lower in epidural group (p<0.001).
Conclusion: The water immersion and epidural analgesia were found to have no adverse effect on oxidative status and infection parameters of women.
2. Mackey MM. Use of water in labor and birth. Clinical obstetrics and gynecology. 2001;44(4):733-49.
3. Dahlen HG, Dowling H, Tracy M, Schmied V, Tracy S. Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery. 2013;29(7):759-64.
4. Committee on Obstetric P, American Academy of P. ACOG Committee Opinion no. 594: Immersion in water during labor and delivery. Obstet Gynecol. 2014;123(4):912-5.
5. Cooper M, Warland J. What are the benefits? Are they concerned? Women's experiences of water immersion for labor and birth. Midwifery. 2019;79:102541.
6. Bovbjerg ML, Cheyney M, Everson C. Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. J Midwifery Womens Health. 2016;61(1):11-20.
7. Zanetti-Daellenbach RA, Tschudin S, Zhong XY, Holzgreve W, Lapaire O, Hosli I. Maternal and neonatal infections and obstetrical outcome in water birth. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):37-43.
8. Cluett ER, Burns E, Cuthbert A. Immersion in water during labour and birth. Cochrane Database Syst Rev. 2018;5:CD000111.
9. Silva M, Halpern SH. Epidural analgesia for labor: Current techniques. Local Reg Anesth. 2010;3:143-53.
10. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S69-77.
11. Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs. 2007;67(16):2323-33.
12. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Int J Obstet Anesth. 2008;17(4):329-35.
13. Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeed J. 2006;1:24.
14. Wong CA, Scavone BM, Dugan S, Smith JC, Prather H, Ganchiff JN, et al. Incidence of postpartum lumbosacral spine and lower extremity nerve injuries. Obstet Gynecol. 2003;101(2):279-88.
15. Reynolds F. Neurological infections after neuraxial anesthesia. Anesthesiol Clin. 2008;26(1):23-52, v.
16. Wisdom SJ, Wilson R, McKillop JH, Walker JJ. Antioxidant systems in normal pregnancy and in pregnancy-induced hypertension. Am J Obstet Gynecol. 1991;165(6 Pt 1):1701-4.
17. Zhu C, Yang H, Geng Q, Ma Q, Long Y, Zhou C, et al. Association of oxidative stress biomarkers with gestational diabetes mellitus in pregnant women: a case-control study. PLoS One. 2015;10(4):e0126490.
18. Yuan W, Lopez Bernal A. Cyclic AMP signalling pathways in the regulation of uterine relaxation. BMC Pregnancy Childbirth. 2007;7 Suppl 1:S10.
19. Hung TH, Chen SF, Hsieh TT, Lo LM, Li MJ, Yeh YL. The associations between labor and delivery mode and maternal and placental oxidative stress. Reprod Toxicol. 2011;31(2):144-50.
20. Fogel I, Pinchuk I, Kupferminc MJ, Lichtenberg D, Fainaru O. Oxidative stress in the fetal circulation does not depend on mode of delivery. Am J Obstet Gynecol. 2005;193(1):241-6.
21. Patil SB, Kodliwadmath MV, Kodliwadmath SM. Study of oxidative stress and enzymatic antioxidants in normal pregnancy. Indian J Clin Biochem. 2007;22(1):135-7.
22. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38(12):1103-11.
23. Opsjln SL, Wathen NC, Tingulstad S, Wiedswang G, Sundan A, Waage A, et al. Tumor necrosis factor, interleukin-1, and interleukin-6 in normal human pregnancy. Am J Obstet Gynecol. 1993;169(2 Pt 1):397-404.
24. Betran AP, Torloni MR, Zhang JJ, Gulmezoglu AM, Section WHOWGoC. WHO Statement on Caesarean Section Rates. BJOG. 2016;123(5):667-70.
25. Elflein J. Cesarean sections in selected countries, OECD's Health at a Glance 2019 report 2019 [Available from: https://www.statista.com/statistics/283123/cesarean-sections-in-oecd-countries/].
26. Lori JR, Boyle JS. Cultural childbirth practices, beliefs, and traditions in postconflict Liberia. Health Care Women Int. 2011;32(6):454-73.
27. Tatar M, Gunalp S, Somunoglu S, Demirol A. Women's perceptions of caesarean section: reflections from a Turkish teaching hospital. Soc Sci Med. 2000;50(9):1227-33.
28. Wong CA. Advances in labor analgesia. Int J Womens Health. 2010;1:139-54.
29. Coombs R, Spiby H, Stewart P, Norman P. Water birth and infection in babies. BMJ. 1994;309(6961):1089.
30. Thoeni A, Zech N, Moroder L, Ploner F. Review of 1600 water births. Does water birth increase the risk of neonatal infection? J Matern Fetal Neonatal Med. 2005;17(5):357-61.
31. Vochem M, Vogt M, Doring G. Sepsis in a newborn due to Pseudomonas aeruginosa from a contaminated tub bath. N Engl J Med. 2001;345(5):378-9.
32. Nagai T, Sobajima H, Iwasa M, Tsuzuki T, Kura F, Amemura-Maekawa J, et al. Neonatal sudden death due to Legionella pneumonia associated with water birth in a domestic spa bath. J Clin Microbiol. 2003;41(5):2227-9.
33. Fehervary P, Lauinger-Lorsch E, Hof H, Melchert F, Bauer L, Zieger W. Water birth: microbiological colonisation of the newborn, neonatal and maternal infection rate in comparison to conventional bed deliveries. Arch Gynecol Obstet. 2004;270(1):6-9.
34. Wilinska M, Borszewska-Kornacka MK, Niemiec T, Jakiel G. Oxidative stress and total antioxidant status in term newborns and their mothers. Ann Agric Environ Med. 2015;22(4):736-40.
35. Sert UY, Ozel S, Neselioglu S, Erel O, Engin Ustun Y. Water Immersion During the Labour and Effects on Oxidative Stress. Fetal Pediatr Pathol. 2020;39(3):185-93.
36. Compagnoni G, Lista G, Giuffre B, Mosca F, Marini A. Coenzyme Q10 levels in maternal plasma and cord blood:correlations with mode of delivery. Biol Neonate. 2004;86(2):104-7.
37. Leighton BL, Halpern SH. The effects of epidural analgesia on labor, maternal, and neonatal outcomes: a systematic review. American journal of obstetrics and gynecology. 2002;186(5):S69-S77.
38. Ravelli ACJ, Eskes M, de Groot CJM, Abu-Hanna A, van der Post JAM. Intrapartum epidural analgesia and low Apgar score among singleton infants born at term: A propensity score matched study. Acta Obstet Gynecol Scand. 2020.