Effects of Passive Hydrotherapy WATSU (WaterShiatsu) in the Third Trimester of Pregnancy: Results of a Controlled Pilot Study

Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2015, Article ID 437650, 10 pages http://dx.doi.org/10.1155/2015/437650 Research Article Effects of Passive Hydrotherapy WATSU (WaterShiatsu) in the Third Trimester of Pregnancy: Results of a Controlled Pilot Study Agnes M. Schitter,1 Marko Nedeljkovic,1 Heiner Baur,2 Johannes Fleckenstein,1 and Luigi Raio3 1 Department of TCM/Acupuncture, Institute of Complementary Medicine IKOM, University of Bern, Imhoof-Pavillon, Inselspital, 3010 Bern, Switzerland 2 Department of Health, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland 3 Department of Obstetrics and Gynecology Inselspital, University Hospital of Bern, Effingerstrasse 102, 3010 Bern, Switzerland Correspondence should be addressed to Agnes M. Schitter; Received 6 June 2014; Revised 26 August 2014; Accepted 15 September 2014 Academic Editor: Pau-Chung Chen Copyright © 2015 Agnes M. Schitter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. WATSU (WaterShiatsu) is a complementary therapeutic treatment method comprising passive stretches and massage techniques administered in 35∘ C warm water. Pregnant women claim safe methods to reduce pain, stress, and fatigue. Therefore, we conducted a pilot study evaluating the effects of WATSU on pregnancy-related complaints in third trimester pregnant women. Methods. Nine healthy pregnant women at gestational week ≥34 were included in an intervention group (receiving WATSU) and compared to eight women in a passive control group (receiving no treatment). WATSU was performed on days 1 and 4 of the study, accompanied by ultrasound examinations. Outcomes include physiological and psychometric as well as qualitative data. Participants in the control group completed questionnaires only. Results. WATSU was found to significantly lower participants’ levels of stress and pain and to improve their mental health-related quality of life and mood. In comparison to the passive control group, participants in the intervention group reported reduction in perceived stress from day 1 to day 8 (𝑃 = 0.036, Cohen’s 𝑓 = 0.57). Qualitative data indicate that WATSU was appreciated as enjoyable and deeply relaxing. No negative side effects were reported. Conclusion. Our findings support the notion that WATSU yields therapeutic benefits for pregnant women and warrant further research. This study has been registered at ClinicalTrials.gov: NCT01708018. 1. Introduction Several researchers propose that, during pregnancy, maternal mental and physical wellbeing are transferred to the fetus resulting in epigenetic changes implicating consequences for a lifetime [1–4]. Hence, with respect to the child’s future development, severe maternal stress and distress cannot be considered to be of transient nature [5]. Moreover, maternal effect and attitude during pregnancy are also predictive factors for postnatal depressive symptoms [6], which in turn are likely to affect the child’s wellbeing. WATSU (an acronym based on WAter and shiaTSU) is a body-based method [7] comprising buoyancy, passive stretches, and massage techniques, including massage and palpation of acupuncture points that is administered in warm water. WATSU has been described as applicable during pregnancy [8], where it is claimed to reduce pregnancyrelated low back pain, to relax hypertonic muscles including those of the uterus, to improve the overall sense of wellbeing, and to deepen the relationship of the mother with her unborn child. In the 1980s, WATSU was created by massage-therapist Harold Dull, whose personal affinity to water led him to practice Masunaga-Shiatsu (also known as Zen-Shiatsu) in water heated to roughly skin temperature (308.15 Kelvin; 35∘ C, 95∘ F). He used Shiatsu massage of acupuncture points, joint mobilization, and tissue stretches and added gentle massage techniques to harmonize the energy flow (qi, 氣) according to the principles of Traditional Chinese Medicine (TCM), from 2 Evidence-Based Complementary and Alternative Medicine which Shiatsu originates [9]. The increased clinical implementation of WATSU in interdisciplinary treatment settings such as rehabilitation facilities indicates a growing acceptance of this body-based complementary therapeutic intervention; it is used as a component in multimodal treatment settings focusing on posttraumatic stress disorder, and anxiety [10, 11], chronic pain and fibromyalgia [11, 12], stress-related illnesses [13], depression [11, 14], and sexual dysfunction [15]. WATSU has also been recommended as a treatment for patients with hemiparesis, multiple sclerosis, cerebral palsy, and spinal cord injury [16, 17]. Considering physiological effects on the cardiopulmonary system due to physical exposure to hydrostatic pressure, certain cardiac conditions, for example, chronic heart failure [18] and respiratory impairments such as cystic fibrosis [19] can be regarded as potential indications for this treatment. However, clinical trials investigating therapeutic effects of WATSU are still scarce. To our knowledge, to date, only three small scale trials on WATSU have been published [12, 16, 20]. Regarding pregnancy, gymnastics in water were observed to have pain-relieving effects [21, 22], as were massage [23] and birth in water [24]. Active hydrotherapy during pregnancy is considered to be beneficial and safe [25], while the effects of passive hydrotherapy during pregnancy so far have not been the subject of scientific investigation. Therefore, we designed a pilot study to examine safety of WATSU as well as a broad range of issues to identify those worthwhile pursuing in future research, that is, potential therapeutic effects of WATSU on self-reported stress, pregnancy-related pain, mood and quality of life, amount of amniotic fluid, blood flow characteristics, spontaneous course of breech presentations, and prospects of external cephalic versions in third trimester pregnant women. Additionally, qualitative data reflecting participants’ perception of the intervention were assessed and analyzed. standardized WATSU treatments at days 1 and 4, accompanied by ultrasound examinations before and after WATSU treatment and on day 8. Participants were allocated to the passive control group if they refused to undergo intervention or ultrasound examinations, or if they lived too far from the site of the intervention. If allocated to the passive control group, participants did receive neither WATSU nor any alternative treatment on the part of the study. All participants were free to maintain additional medical and/or therapeutic treatments during the study. Assessments took place on days 1 (baseline), 4, and 8 (follow-up). Participants were not financially compensated; participants in the control gr (...truncated)