“Virtual Hydrotherapy: An Immersive Experience” was conceived by Sasha Kamkin, Zachary Scholtz and Kory McGrath whose backgrounds are nursing, videography and midwifery.

ABSTRACT

Featuring artwork in healthcare spaces is a powerful medium for fostering a sense of hope & inspiration for patients, their families and caregivers.[1][2][3][4] The healing arts, including music, artwork and movement are also creative practices that promote healing, wellness, coping and personal change.[5][6][7] Literature on environmental psychology has found that environments featuring natural elements have restorative effects, reducing stress, improving mood and mental health, whether real or digitized, modulating brain activity and non-brain physiological responses.[8] Biophilic elements (human affinity for nature) in art & design such as water & trees, have shown evidence in decreasing postoperative recovery times by 8.5%, reducing analgesic requests by 22% and shorten hospital stays.[8][9] Emerging studies have also highlighted the role of empathic support in decreasing pain perception, with nature scenes having also been found to activate areas in the brain responsible for empathy and altruism.[8] The relationship of water and its therapeutic effects on pain & relaxation during labour and birth is well documented,[10][11][12][13] but is currently only accessible to low-risk, ambulating pregnant people. Based on emerging research in virtual reality (VR) & its application in healthcare,[14][15][16][17] our project aims to create extraordinary patient experiences by strategically leveraging technology, to simultaneously build relationships and provide equitable access to hydrotherapy through an innovative multi-sensory immersive simulation called ‘Virtual Hydrotherapy.’

Since hydrotherapy and VR are both associated with increased pain relief, relaxation, and satisfaction with birth, then virtual hydrotherapy has excellent potential for both low and high risk populations.

Virtual Hydrotherapy

Virtual Hydrotherapy is an innovation on conventional water immersion, leveraging technology to create an immersive virtual water experience. Curated with cinematic images and soundscapes, it utilizes projection mapping software and projector(s), transforming birth rooms into relaxing & ambient spaces. Sound & filmography are original content that integrate design-features based on our own fieldwork & research.

‘Virtual Hydrotherapy’ invites inclusivity to birth space:

  • Includes pregnant people otherwise deemed ineligible for conventional hydrotherapy (epidural anesthesia, multi-fetal gestation, preterm labour, preeclampsia, mobility restrictions, etc); or lack of infrastructure

  • Enables shared experience for labouring people, birth companions, partners and providers in an embodied experience which helps foster empathy, unity, a shared sense of human connection, and more memorable experiences.[18][19][20][21] 

Participatory art invites a deeper understanding of oneself & the world, increasing agency, choice.[18][19]

Objectives

  1. Explore labour rituals & practices (culture, meaning, pain perception & management in labour)

  2. Define elements of positive birth experiences

  3. Understand use of VR & immersive arts in obstetrics

  4. Incorporate evidence-informed design in prototype development: (neuroarchitecture, sound/music, biophilia, liminal design, salutogenesis)

  5. Plan prototype launch and co-creation activities for Phase 2 [Fall 2024/Winter 2025]

Methodology

  1. Literature Review Keywords: VR in healthcare & obstetrics, sensory birth rooms, environmental & neuroarchitecture design, biophilia, liminal design, hydrotherapy, colour theory, salutogenesis, pain & labour, positive birth (peer-reviewed journals, grey literature, books, websites) 1962 - present.

  2. Ethnographic Field Research: Observation, analysis on immersive & hydrotherapy events (in-person/online), interviews within personal and professional networks in midwifery, nursing, architecture/design, filmmaking, sound editing

  3. Reflexive Practice: Autoethnography, reflective journaling, collaborative sensemaking

Analysis & Design Method

An Iterative Thematic Inquiry (ITI) approach was used to identify key themes.[22] Synthesis mapping and the Double Diamond, both innovation design process tools, were used as a framework to discover, define, develop and (plan to deliver) on the Virtual Hydrotherapy prototype.

Key Themes

  1. Agency: Ability to choose contributes to pregnant people’s feelings of autonomy, empowerment, satisfaction, and sense of control.[23][24][25][26][27]

  2. Relationship: Partner involvement in VR important; VR is a supportive adjunct, not a substitute.[27]

  3. Concepts of Time: Passive content (slow moving water) as important as active content (fast flowing water) for VR in labour.[27]

  4. Cultural Context: Pain is complex & influenced by meaning, social & cultural contexts.[28][29][30][31]

  5. Distraction: VR provides distraction from pain, water scenery preferred over other environments in studies relating to labour, painful procedures, and anxiety reduction.[5][32][33][34]

Discussion

Technology is increasingly mediating our relationship with the world[18] & may improve efficiencies, but time gained does not translate into fostering relationship

  • VR with goggles may pose safety challenges (increasing risk for falls, restricting movement, & cybersickness)[35][36] but can be mitigated by removing the “device” & replacing with immersive projections

  • Immersive experiences create spaces to cultivate human connection, through sense-making and shared experiences, offering birth companions possibilities to engage in practices of attunement, enabling their active role in birth.[27][37] 

  • VR + biophilia activate one’s inherent biological pharmacy and taps into collective empathic frequency to elicit coherence, instill calm, decrease anxiety & pain.[31][38][39] This may foster transcendental experiences, feelings of purpose, understanding, meaning and agency.[18]

REFERENCES

1. Sajnani, N and Fietje, N. (Sept 19, 2023) The Jameel Arts & Health Lab in collaboration with the WHO–Lancet Global Series on the Health Benefits of the Arts. The Lancet. Vol 402;10414, P1732-1734.

2. University of Toronto. Temerty Faculty of Medicine. (Winter 2023). The Art Issue.  UofTMed Magazine. https://temertymedicine.utoronto.ca/uoftmed-magazine

3. Chen H. (2021) Art as a Tool for Public Health Engagement: A Canadian Overview. PH Spot. https://phspot.org/art-as-a-tool-for-public-health-engagement-a-canadian-overview/

4. Leung, W. (Dec 25, 2020). While art in hospitals is believed to provide comfort and promote recovery, it’s still a donor-driven effort. The Globe & Mail. Toronto.

5. Thoma MV, Mewes R, Nater UM. (Feb 2018). Preliminary evidence: the stress-reducing effect of listening to water sounds depends on somatic complaints: A randomized trial. Medicine (Baltimore). 97(8):e9851. doi: 10.1097/MD.0000000000009851.

6. Wulff, V., Hepp, P., Fehm, T., & Schaal, N. (2017). Music in obstetrics: An intervention option to reduce tension, pain and stress. Geburtshilfe Und Frauenheilkunde, 77(09), 967–975. https://doi.org/10.1055/s-0043-118414

7. Chorna, O., Filippa, M., De Almeida, J. S., Lordier, L., Monaci, M. et al. (2019). Neuroprocessing mechanisms of music during fetal and neonatal development: A role in neuroplasticity and Neurodevelopment. Neural Plasticity. 1–9. https://doi.org/10.1155/2019/3972918

8. Grassini, S., Segurini, G. V., & Koivisto, M. (2022). Watching Nature Videos Promotes Physiological Restoration: Evidence From the Modulation of Alpha Waves in Electroencephalography. Frontiers in Psychology. 13, 871143. https://doi.org/10.3389/fpsyg.2022.871143

9. Barbiero G, and Berto R. 2021. “Biophilia as Evolutionary Adaptation: An onto- and Phylogenetic Framework for Biophilic Design.” Frontiers in Psychology 12 (July). doi:10.3389/fpsyg.2021.700709. 

10. Mellado-García, E., Díaz-Rodríguez, L., Cortés-Martín, J., Sánchez-García, J. C., et al. (2023). Safety and effect of the use of hydrotherapy during labour: A retrospective observational study. Journal of Clinical Medicine, 12(17), 5617. https://doi.org/10.3390/jcm12175617

11. Ergin A., Aşci Ö., Bal MD., Öztürk G.G., & Karaçam Z. (2023). The use of hydrotherapy in the first stage of labour: A systematic review and meta‐analysis. International Journal of Nursing Practice, 30(1). https://doi.org/10.1111/ijn.13192

12. Vanderlaan, J. (2017). Retrospective cohort study of hydrotherapy in Labor. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(3), 403–410. https://doi.org/10.1016/j.jogn.2016.11.018

13. Odent, M. (2014). Water, Birth and Sexuality. Clairview Books. West Sussex, UK.

14. Xu N, Chen S, Liu Y, Jing Y, Gu P. (2022) The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis. JMIR Serious Games. 23;10(4):e36695. doi: 10.2196/36695.

15. Cole, C. (2023). Implementation of Virtual Reality for the Laboring Patient: A Quality Improvement Project. University of New Hampshire Scholars Repository. DNP Scholarly Projects. 87. https://scholars.unh.edu/scholarly_projects/87

16. Frey, D; Bauer, M.; Bell, C.; Low, L.; Hassett, A.; et al. (June 2019). Virtual Reality Analgesia in Labor: The VRAIL Pilot Study—A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women. Anesthesia & Analgesia 128(6):p e93-e96.

17. Karacan, E., & Akköz Çevi̇k, S. (2023). The effect of virtual reality applications on Childbirth and birth satisfaction in pregnant women having normal vaginal delivery: A systematic review. Journal of Traditional Medical Complementary Therapies, 6(1), 48–57. https://doi.org/10.5336/jtracom.2022-90916

18. Liedgren, Johan, Pieter M. A. Desmet, and Andrea Gaggioli. 2023. “Liminal Design: A Conceptual Framework and Three-Step Approach for Developing Technology That Delivers Transcendence and Deeper Experiences.” Frontiers. January 16. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1043170/full.

19. Jabu. (2023, May 30). Dive into the world of immersive art: A sensory exploration. Medium. https://jabuwritershub.medium.com/dive-into-the-world-of-immersive-art-a-sensory-exploration-eaea3c9b4445

20. Denworth, L. (2024, February 20). Brain waves synchronize when people interact. Scientific American. https://www.scientificamerican.com/article/brain-waves-synchronize-when-people-interact/

21. Harnpinijsak, K. (2019, October 7). An exploration of sensory design: How sensory interaction affects perceptual experience in an immersive artwork. Interactive Architecture Lab. http://www.interactivearchitecture.org/an-exploration-of-sensory-design-how-sensory-interaction-affects-perceptual-experience-in-an-immersive-artwork.html

22. Morgan, D. L., & Nica, A. (2020). Iterative Thematic Inquiry: A New Method for Analyzing Qualitative Data. International Journal of Qualitative Methods, 19. https://doi.org/10.1177/1609406920955118

23. Gibson, M. E. (2021). Pain relief during childbirth in the context of 50 years of social and Technological Change. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(4), 369–381. https://doi.org/10.1016/j.jogn.2021.04.004

24. Whitburn, L.Y., Jones, L.E., Davey, M.-A., & Small, R. (2014). Women׳s experiences of labour pain and the role of The mind: An exploratory study. Midwifery, 30(9), 1029–1035. https://doi.org/10.1016/j.midw.2014.04.005

25. Skowronski, G.A. (2015). Pain relief in childbirth: Changing historical and feminist perspectives. Anaesthesia and Intensive Care, 43(1_suppl), 25–28. https://doi.org/10.1177/0310057x150430s106

26. Dixon, L., Skinner, J., & Foureur, M. (2013). The emotional and hormonal pathways of labour and birth: Integrating mind, body and behaviour. New Zealand College of Midwives Journal, 48, 15–23. https://doi.org/10.12784/nzcomjnl48.2013.3.15-23

27. Van Leugenhaege, L; Van de Craen, N; Maes, K; Vanden Bergh, L; Timmerman, K; et al. (May 2, 2024). Virtual Reality as a Method to Cope With Labor Pain: What Do Women Want?. Computers, Informatics, Nursing. ():10.1097/CIN.0000000000001120, | DOI: 10.1097/CIN.0000000000001120

28. Eberhard, J., Stein, S., & Geissbuehler, V. (2005). Experience of pain and analgesia with water and land births. Journal of Psychosomatic Obstetrics and Gynaecology, 26(2), 127–133. https://doi.org/10.1080/01443610400023080

29. Whitburn, L. Y., Jones, L. E., Davey, M. A., & Small, R. (2014). Women's experiences of labour pain and the role of the mind: an exploratory study. Midwifery, 30(9), 1029–1035. https://doi.org/10.1016/j.midw.2014.04.005

30. Xu, N., Chen, S., Liu, Y., Jing, Y., & Gu, P. (2022). The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis. JMIR Serious Games, 10(4), e36695. https://doi.org/10.2196/36695

31. Ellingsen DM, Isenburg K, Jung C, Lee J, Gerber J, et al. (2023). “Brain-to-Brain Mechanisms Underlying Pain Empathy and Social Modulation of Pain in the Patient-Clinician Interaction.” Proceedings of the National Academy of Sciences 120 (26). doi:10.1073/pnas.2212910120.

32. Musters, A., Vandevenne, A.S., Franx, A. et al. Virtual Reality Experience during Labour (VIREL); a qualitative study. BMC Pregnancy Childbirth, 23, 283 (2023). https://doi.org/10.1186/s12884-023-05432-9

33. Hsieh, CH; Yang, JU; Huang, CW;  Chin, WCB. (2023). The effect of water sound level in virtual reality: A study of restorative benefits in young adults through immersive natural environments. Journal of Environmental Psychology, Vol 88,102012,ISSN 0272-4944,https://doi.org/10.1016/j.jenvp.2023.102012.

34. Javaid, M., & Haleem, A. (2020). Virtual reality applications toward medical field. Clinical Epidemiology and Global Health, 8(2), 600–605. https://doi.org/10.1016/j.cegh.2019.12.010

35. Teh, J.J., Pascoe, D.J., Hafeji, S. et al. Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Med 22, 64 (2024). https://doi.org/10.1186/s12916-024-03266-6

36. Kanschik, D., Bruno, R. R., Wolff, G., Kelm, M., & Jung, C. (2023). Virtual and augmented reality in intensive care medicine: a systematic review. Annals of Intensive Care, 13(1), 81. https://doi.org/1 0.1186/s13613-023-01176-z

37. Skouboe, E & Højlund, M. (2022). Crafting atmospheres for Healthcare Design. The Journal of Somaesthetics. Vol 8. 8-29. 

38. Abrams, Mitchell. "The Medicine of Frequencies: What Did Einstein Mean?" TEDx Talks. Video, 14:50. November 2, 2023. https://www.youtube.com/watch?v=JGxWT4EUVbs.

39. Denworth, Lydia. 2024. “Brain Waves Synchronize When People Interact.” Scientific American. February 20. https://www.scientificamerican.com/article/brain-waves-synch(Nelson & Stolterman 2012).ronize-when-people-interact/.

40. Fallon, V., Davies, S. M., Silverio, S., & Creagh, L. (2024). Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review. Digital Health, 10, 20552076241245373. https://doi.org/10.1177/20552076241245373 

41. Nissen, LB. (2023). “An Alphabet of the Future – Expanding Understanding and Insight through New and Emerging Futures Terminology.” Social Work Futures. https://socialworkfutures.com/2019/09/19/an-alphabet-of-the-future-expanding-understanding-and-insight-through-new-and-emerging-futures-terminology/.

42. Noel LA, Ruiz A, van Amstel FMC, Udoewa V, Verma N, et al. (2023). “Pluriversal Futures for Design Education.” She Ji: The Journal of Design, Economics, and Innovation 9 (2): 179–96. doi:10.1016/j.sheji.2023.04.002