By Andrea Petersen
Virtual reality may be coming to the delivery room.
Researchers are studying the use of virtual reality to alleviate pain and anxiety during labor, and a handful of doctors and hospitals are already offering it to women.
VR isn't about to replace intravenous pain medication and epidurals, generally the most effective form of pain relief, during labor and childbirth for most women. But virtual reality -- where patients don goggles and headsets and experience an immersive, three-dimensional virtual world -- could be an additional option, especially during the earlier part of labor, when the pain isn't as intense as it gets later.
"Women are interested in having other ways they can help cope with contractions during labor," says Melissa Wong, a fellow in maternal-fetal medicine at Cedars-Sinai in Los Angeles who is currently leading a study of VR in labor. Virtual reality could help women "have some degree of control in an otherwise difficult-to-control" situation, she says.
Dr. Wong adds that VR might help women who want to avoid an early epidural, which some studies have linked to longer labors and an increased risk of cesarean sections.
Trees and waves
Aviva Lahmany participated in the Cedars-Sinai study when she was in labor with her daughter Hallel, now eight months old. Ms. Lahmany had requested an epidural, but hospital staff urged her to wait. Then Dr. Wong offered her VR. "The pain was really bad. At that point, I was willing to do anything," says Ms. Lahmany, a 26-year-old development manager at a nonprofit who has since moved from Los Angeles to Scottsdale, Ariz.
When she put on the goggles and headset, Ms. Lahmany saw a large blooming tree. A woman's voice told her to breathe, coaching her to inhale and exhale in time to the movement of the leaves and branches. The scene changed, and Ms. Lahmany saw and heard waves crashing on a beach. The VR "takes you out of that hospital room," she says. "I was able to actually breathe. It really helped center me and calm me."
It also reduced her pain, she says, bringing it down from a 7 on a 10-point scale to a 3. In the study, the VR sessions lasted 30 minutes. At the very end of her session the pain started increasing, Ms. Lahmany says, and when the session was over she got the epidural.
Only a handful of small studies of VR during labor have been conducted or are in progress. But there's a much larger body of research on the use of VR for pain relief more generally. Studies have found that VR can reduce pain and anxiety in children having their blood drawn, ease pain in hospitalized patients with various conditions, and reduce the amount of opioid medication used by burn patients undergoing painful medical procedures.
Scientists aren't certain exactly how VR works to ease pain. But researchers generally believe that VR distracts patients from their discomfort -- it is so immersive that it takes up much of the brain's attention, leaving less for the pain.
Also, the VR content formulated for labor and delivery often includes tried-and-true ways of refocusing attention during labor, like breathing exercises, positive affirmations and elements of mindfulness, as well as supportive language -- a voice saying you're getting closer to delivering your baby, for instance. Dr. Wong says one of her patients called it a virtual doula, or birth coach. AppliedVR Inc., a private Los Angeles-based company that creates virtual-reality products for health care, consulted a doula, along with other experts, in developing its labor and delivery program, which was used in the Cedars-Sinai study.
On the hardware side, VR has become more widespread as the equipment, made by companies like Samsung and Facebook's Oculus, has become smaller and less expensive.
In a study published in July in the journal Anesthesia & Analgesia, 27 women in early labor spent 10 minutes, or three contractions, using virtual reality. The subjects were then asked to rate different aspects of their pain -- including the amount of time spent thinking about the pain, how unpleasant the pain felt and the worst pain intensity. Researchers also followed the women for an additional 10 minutes, or three contractions, when the subjects weren't using the VR device or receiving any other pain relief.
The women's scores of how unpleasant the pain felt were 34% lower with virtual reality than their scores without VR. Their worst pain intensity was 21% lower with VR and the time spent thinking about the pain was 43% lower.
The study's VR program used relaxing music combined with a scuba-diving simulation featuring slowly swimming manatees -- appropriate in part because faster-moving images are more likely to cause nausea. Patients could use a handset to mimic taking underwater photos. "A VR pain experience has to be immersive and has to be interactive," says David Frey, an obstetric anesthesiologist with the Oregon Anesthesiology Group in Portland and the lead author of the study.
Banner Health, a nonprofit health system based in Phoenix, recently completed a small pilot study using VR for pain during labor. The study, which is currently unpublished, involved 20 women. It found that those participants who used VR during early labor were half as likely to use the IV pain medication Stadol as those who didn't use VR. Avoiding Stadol can be beneficial because the drug can "zonk you out a little bit, " says Michael Foley, chair of the department of obstetrics and gynecology at Banner-University Medical Center Phoenix, who led the VR study.
Researchers at Stanford University School of Medicine are conducting a clinical trial using virtual reality during the placement of epidurals, a procedure that involves injecting anesthesia through a needle in the back. "That is a high-anxiety moment," says Thomas Caruso, a pediatric anesthesiologist at Stanford and the co-leader of the study.
There are hurdles to using VR in labor. Virtual reality can sometimes cause nausea, and women in labor are already prone to it. Also, labor can last many hours, even days, and doctors say it isn't generally practical to use VR for extended periods. It can cause eyestrain. The headsets can eventually fog up, especially if you're breathing hard and sweating. Also, being in a virtual world cuts you off from others in the room, like your doctor, your family and your partner. And not every laboring woman necessarily wants to be distracted from her current experience.
That said, one of virtual reality's big selling points is how easy it is to stop. As Dr. Foley says, "If it bothers you, you can take [the goggles] off."
Ms. Petersen is a writer in New York. She can be reached at email@example.com.