Exercising away labor pain? (Lars Christensen/iStock)Moderate exercise during pregnancy appears to markedly lower a woman’s need for epidural pain relief when she delivers her baby, a new study suggests.
Many women hope to have natural childbirth without pain drugs but find labor so difficult they end up requesting an epidural, which provides pain relief through injection of a painkiller into the epidural space at the base of the spine. Ideally, the epidural only dulls the pain, and women remain alert and can still play an active role in labor.
However, there is a downside. Epidural pain relief may also slow labor and may make the pushing stage longer and more difficult because women lose sensation in their lower body. Even when very little drug is administered, some hospitals won’t let women walk around once they’ve had an epidural.
A small study published in the medical journal Reproductive Health suggests that women can influence their risk for needing pain relief long before labor starts. Researchers from Brazil recruited 71 expectant mothers prior to their 20th week of pregnancy. The women weren’t regular exercisers at the time of the study.
The investigators randomly assigned 34 women to a regular water aerobics course which lasted 50 minutes three days a week. The remaining 37 women in the control group didn’t exercise.
The light aerobic exercise didn’t have any effect on the duration or type of delivery the women experienced. But there were dramatic differences in terms of requests for pain relief. Among women who didn’t exercise, two out of three women requested epidural pain relief during labor. But among the water aerobics group, only 27 percent of women asked for pain drugs.
Although the study size was small, the researchers noted that the water aerobics course may have helped better prepare women both emotionally and physically for the rigors of labor. The biggest problem was that about one-third of the women in the exercise group had to give up the classes at some point in the study because of time constraints, child-care conflicts and other issues that made it difficult to attend the class.
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From 1 to 25 of 47 Comments
What about catching something from the water? Look into that.
— NavinDid they control for the fact that it might be any exercise that provides the benefit? hello? is this bad science, or bad science reporting?
FROM TPP — They only studied one form of moderate exercise, but it suggests that any form of moderate exercise might help reduce the need for pain meds. The key here is that none of the women were regular exercisers, they were randomized to the water aerobics group or the no exercise group. I’m not sure what here would lead you to believe it’s bad science or bad reporting. I think it’s a fascinating study that offers a real and practical solution to women.
— Booi agree that exercise is our only panacea in medicine, but this study doesn’t prove it. a third of the exercisers dropped out, so now we have a sample size of what? 23? can’t draw conclusions from this…
— CA MDIn response to Navin….Catch something? Like what? Have you caught any diseases from a pool? I haven’t. Pregnant women (in general) are not sick weaklings who should avoid any physical activity or place with germs.
— NataliaTPP, thanks for the input. (Please ignore the trolls that have commented so far.) The use of an epidural is something my wife and I have talked about with mild concern because we know of several women who’ve experienced mild but decidedly unwanted side effects from it (like a lingering migraine-like headache), and so we’re happy to know more about any technique that would help us avoid having to use such drugs. It would be useful to know the frequency/intensity of the exercise in detail, because I’m wondering if walking for a half hour each day can achieve the same benefit.
FROM TPP — The women in this study attended three water aerobics classes each week beginning sometime prior to the 20th week of pregnancy. The classes lasted for 50 minutes each. Given that there was no meaningful change in cardiovascular capacity among the water aerobics women compared to the sedentary women, it’s clear this wasn’t vigorous exercise. The goal of the researchers was to identify whether there is a psychological or physical effect of exercise on labor and delivery. You should talk to your wife’s doctor about his/her recommendation for your wife’s physical activity and whether walking is advised. And yes, i’m surprised by some of the earlier negative posts — I saw this and thought it was a pretty interesting study that most readers would want to know about.
— MJI think it makes a lot of sense and is a fascinating study. My experience and intuition guide me to believe that the more you exercise, the more you know your body (something that comes in handy during labor) and the more you are able to practice deep breathing (key to reducing pain in labor/delivery).
Plus, isn’t exercise a good thing to do no matter what? Doesn’t it have positive affects on your mood and your health overall? So why shouldn’t it affect your experience of labor and delivery?
— bepposmom“Moderate exercise during pregnancy appears to markedly lower a woman’s need for epidural pain relief when she delivers her baby, a new study suggests.”
The study showed nothing of the kind. Indeed, it showed nothing at all. There were only 35 women in each arm of the study, far too few to draw any conclusions.
The authors provide no information about how the participants were recruited (for all we know they could have been friends of the authors) and they tell us nothing about whether the two groups of women were comparable.
This study is utterly useless.
FROM TPP — The women were recruited from the hospital where the doctors practice and intended to give birth at that hospital. They researchers excluded women who were carrying twins, had more than one prior c-section or who were overweight or had other health problems.
— Amy Tuteur, MDI took a water aerobics class during my first pregnancy, and I should have kept it up longer. I ended up having an intrathecal injection just because my labor was so long, I got tired and wanted to take the edge off so I could rest before pushing. I do think having exercised during my pregnancy helped me be a little more ready for the marathon that delivery can sometimes be.
This time around, I haven’t done nearly as much exercise, and I’m already regretting it as my due date nears. I don’t know if I’ll have the same stamina that I did the first time — although chasing my toddler around has kept me on my toes to some degree. I think pregnant women should make a real effort to get some exercise and I’m happy to see any study that encourages that. And as for the water aerobics specifically, I can say that I always thought the water felt fantastic — your big body is all of a sudden weightless and you can move without pains. So nice!
— Emily“The women were recruited from the hospital where the doctors practice and intended to give birth at that hospital. They researchers excluded women who were carrying twins, had more than one prior c-section or who were overweight or had other health problems. ”
That’s right, but it is fairly standard to explain how the participants in a study were recruited, and the authors did not do that here. Did the first 75 women they approached agree to participate or did they have to ask 500 women before they could get 75 to participate? Did they approach everyone in their practice or did they post a sign and only those who inquired (self-selected) get to participate? In other words, how representative of all pregnant women are the women who participated in the study?
Second, it is absolutely imperative to know whether the two groups differed in any significant way. It is also fairly standard for the authors to provide that information when they are comparing two groups. Yes, the women were assigned randomly, but the numbers are so small that it is possible, for example, that a greater proportion of women in the exercise group were having second or third children (and therefore shorter labors) than the women in the non-water aerobics group. Unless the authors can show that the two groups are virtually identical in all parameters that might affect the tendency to request pain relief, neither they nor we are free to conclude that it was the water aerobics that made the difference.
FROM TPP — Well perhaps you can take this up with the editors of this peer-reviewed journal who felt the study was worth publishing. The study is small and interesting, offers a safe alternative to a drug intervention and is on a topic of great interest to women who want to control their birth experience. Thanks for your comments.
— Amy Tuteur, MDWhile other commenters have disdainfully noted the small sample size in this study, the findings still do suggest that it may be a fruitful topic for further investigation (and may even have had more compelling findings than that). Small studies can be very useful as exploratory studies and are far from being “utterly useless” as some claim.
It’s also the case that in any article like this, many of us would like to know whether findings are reported as statistically significant by the authors of the scientific study. Sometimes with small samples, what look like dramatic effects turn out to be results that may well be due to chance.
Nevertheless, I for one am certainly interested in hearing about this type of research–especially when reported in a peer-reviewed journal–and not exclusively large studies. Thanks for the article.
— KathAs far as I can tell from reading the study, the women in the exercise group all exercised together, and no attempt was made to see if the women PLANNED to have epidurals before they entered labor. Why is this important? Spending 50 minutes for three times a week with a group of other pregnant women invariably involves some socializing and pregnancy talk. It could very well have an effect on one’s attitude toward epidurals, if some of them subscribe to a competitive mommying culture where pain relief is considered part of the “overmedicalization of birth.” And then there’s the fact that women who dropped out of the exercise program could have done so for reasons of natural athletic ability or life stresses, both of which could be confounding factors. I’m sure this study will still be used to shame women who opt for pain relief, though.
FROM TPP — Yes, all interesting points.
— jclDoes it have to be water-based exercise? Is there some benefit to having your belly supported? I exercise regularly as is and I would like to know if I should maintain my current activity (jogging, lifting, yoga) or switch to something more gentle.
(I’m not pregnant yet, but I thought I might as well ask while we’re on the subject.)
FROM TPP — The obvious answer is that whether you should exercise during pregnancy is something to discuss with your doctor. What you should do and how much you should do depends on your fitness level prior to getting pregnant and the specifics of your pregnancy. Water aerobics in general is good as a low impact exercise that offers support for large amounts of weight (including large bellies). But the fact that you already exercise regularly makes you different from these women in the study, who were sedentary at the time they got pregnant.
— sarahmasyou can catch something from the water….a water aerobics partner of mine did. her membranes were not intact and she was treated for an infection and labor induced.
mom and baby were fine in the end.
— Andrea- Pacific Grove CAMy DIL is a yoga expert. Throughout both of her pregnancies she did yoga until the end…even the evening of delivery. As an RN, I believe it gave her the muscle flexion that really helped her quick (2 pushes) labor. She, and all of her friends were in the pool throughout the summer of their deliveries. It is wonderful and weightless.
— NurseTerryI take water aerobic 3-4 times per week, and though I am not having a baby any time soon (watch for me in the National Enquirer if I am), I think it is a wonderful way to keep all the joints and muscles moving. I would seriously doubt that there is a problem being in the water…anyone whose water sac was not intact should have been aware that they had passed their mucus plug, thereby possibly exposing the cervical canal to infection, and they should have spoken with their doctor about it.
http://www.caringisnotenough.net
I’m sure these people who are criticizing the small sample size of the study are the ones who jump on articles that don’t report significance levels.
If this study found a significant difference between the two groups (I’m assuming based on this article that they did), then the fact that they did this with a small sample size is even more impressive. With a large enough sample, even tiny differences can be statistically significant. With groups this small, a larger difference is required for the difference to reach the 0.05 level of significance. 66% versus 27% sounds pretty impressive to me, and if these differences are consistent I don’t think that a study with much larger samples will render the difference non-significant.
Of course it is important for the study to be replicated. It is always possible that, even with random assignment, there were differences between the two groups that may account for the difference in epidural use. But for a study that shows something new, I see no major problems with their design or the (conservative) conclusions they have drawn.
FROM TPP — Yes the findings were statistically significant.
— LauraInteresting article. I’m a physically active pregnant woman who has been working out pretty intensely for the last 3 years (long before pregnancy). I believe that exercise makes it easier to deal with the regular aches and pains of life, labor included. So I don’t think it actually makes labor less painful, it just makes it easier to deal with the pain psychologically. If I can run a 10 mile race and sprint at the end, of course I can labor for many hours and push at the end!
And please feel free to ignore “Dr” Amy Tuteur. She compulsively attacks anything that has to do with natural childbirth, and it’s quite annoying.
— danielleJust curious - did they find any demographic differences between the attrition group and the individuals who exercised throughout the experiment?
FROM TPP — The study doesn’t say — just says they dropped out for home issues, logistics and child care concerns. Also — 10 women also dropped out of the control group — attrition isn’t uncommon in studies.
— AshleighAlso, two things:
1. This is a very interesting and valid study, and good to know if/when I become pregnant.
2. Secondly, I wish that people who try to rudely denigrate this column understand the limitations and strengths of research and research design. A study with 60-odd people is NOT automatically useless! You can absolutely run meaningful stats with such a sample size.
3. This is a review of an article, not the actual article itself. If you have questions/problems with the methodology, you should probably go find the article yourself rather than criticize the posting. There are space constraints and I’m sure that the majority of readers are not interested in population demographics, and that the minority (including myself) can find the actual study to get more information.
— AshleighA read of the study (which is available from the Reproductive Health site linked above as a pre-publication pdf) seems to me to indicate that it is not flawed in some of the ways other commentators have suggested.
The authors *did* control for previous childbirth in the two groups (parity - that is, previous childbirth - was a baseline measure, and they specifically mention that the results re. request for analgesia remained highly statistically significant even after parity was statistically controlled for).
The reduced requests for analgesia were not due to shorter labors in the water aerobics group; in fact, labors in that group were on average about 30 minutes longer, though the difference was not statistically significant.
It’s also important to note that even women who dropped out of the water aerobics class at some point *were still included* in the results for that group (see second full paragraph on p. 10 of the pdf). This suggests that the effect of exercise on demand for analgesia was very robust.
It is quite possible to have results that are highly statistically significant (that is, very unlikely to be due to chance) even with a relatively small sample size, as long as the effect is large enough. The suggestion that the study is worthless simply because of a small sample size fails to acknowledge the power of statistics to determine the likelihood that an effect is due to chance.
It’s true that small sample size makes it more likely that there could be an unrecognized confounding factor: 35 women are more likely to have something coincidentally in common than, say, 1000 women are. But the authors did control for a number of the physiological factors that seem most likely to affect requests for analgesia. So it would be incumbent on critics to make specific suggestions about possible confounding variables that were not controlled for. As I’ve already mentioned, parity and duration of labor were controlled for, as was mother’s level of education.
Is the study perfect? No. But small controlled studies of this type can let us know whether a line of inquiry is worth following, thus paving the way for resources to be devoted to larger studies.
On a personal note, I swam laps up until my baby was born, and I would definitely say that during pregnancy, water is your friend: buoyancy tends to eliminate a lot of the aches and pains that come with exercising on land.
— SherriOne point of clarification: while it was once thought that epidurals slow labor, that has been thoroughly studied and debunked. Women who get an epidural should feel comfortable knowing it didn’t impact the duration of their labor.
— CandaceExercise because it will make you feel better. Childbirth is natural and wonderful and hard work. Drugs are not good for the mother or the small baby coming into the world. They are great for MD’s that want to manage your birth which now becomes their birth. I had my daughter after 23hours of labor with not so much as an aspirin. It was hard work that connected me with my over eight pound baby girl. I also had back labor so I was told by my midwife which was not super comfortable. Here is my bottom line, I would have missed something had I had drugs in both of us. I would do it again the same way. Women , you are more that capable to do this and give yourself the gift of knowing you can. What a connection to your child to be totally available. emotionally and physically.. Women around the world do this and some return to fields to work. I can truly do this without drugs??!!
I would not want it any other way and your baby does not either. Be present fully and wait to see how you feel about your baby and yourself bc you gave that. It is proud and bonding beyond belief.
With an epidural you have given it all away. Some one else is in charge of your baby and it is not you. It is time for women to believe it themselves and support each other is this courageous time in their life.
— JenniferI would love to see an article that continues the water/labor benefits/pain relief discussion.
— AmiI’m a certified childbirth educator and doula who has seen hydrotherapy - simple things like laboring in a warm shower or tub - have huge pain relief benefits for moms. Whether or not she chooses an epidural shouldn’t be the issue - having access to ALL types of methods of relief and choices in childbirth should be.
I haven’t read the study, but I have taught water exercise classes for pregnant women for several years at Riverbank State Park. From my experience, participants (who are highly a self-selective group) benefit tremendously from the light exercise in the water. I would like to believe that there are benefits associated with healthier deliveries, but I can absolutely say with confidence that benefits to the mother in terms of both a lower incidence of unpleasant pregnancy side effects and a faster post-partum recovery are tremendous. Without question we should have more of these classes available to women across the country at affordable rates.
— Andreawell this is no surprise. Childbirth is one of the most physically daunting experiences a woman goes through, and the stronger her body is, the more prepared she will be.There have been plenty of studies showing that obese women have much harder labors than average women. I think - and this is simply an observation on my part - that there are many women who use pregnancy as an excuse to let themselves go. They lessen their physical activity and gorge themselves at a time when they shold be taking as much care of their bodies as possible. Think of it this way…would you put your baby in a car seat that has failed all crash tests? Your body is a vessel and should be in the best condition possible for carrying your precious cargo :)
— AndreaWow, Jennifer, do you have to polish that medal every day to keep it so shiny?
Seriously, you wouldn’t have missed a thing if you had gotten the drugs, except for more back labor, which really sucks. In my case, my son was posterior, and I was stuck at 4 cm for oh, about 12 hours. After my epidural, I was able to rest for 6 hours, during which time my son turned and I was able to push him out in one hour, even with my epidural cranked to 11 (contrary to popular belief, you can feel the pressure of contractions, but blessedly not the pain). I firmly believe that had I not had the epidural, allowing me to rest, and the baby to turn, I would have ended up with a c-section.
— KMS