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Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour

Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour
Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour
Objectives: To evaluate the impact of labouring in water during first stage of labour on rates of epidural analgesia and operative delivery in nulliparous women with dystocia.
Design: Randomised controlled trial.
Setting: University teaching hospital in southern England.
Participants: 99 nulliparous women with dystocia (cervical dilation rate < 1 cm/hour in active labour) at low risk of complications.
Interventions: Immersion in water in birth pool or standard augmentation for dystocia (amniotomy and intravenous oxytocin).
Main outcome measures: Primary: epidural analgesia and operative delivery rates. Secondary: augmentation rates with amniotomy and oxytocin, length of labour, maternal and neonatal morbidity including infections, maternal pain score, and maternal satisfaction with care.
Results: Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% v 66%, relative risk 0.71 (95% confidence interval 0.49 to 1.01), number needed to treat for benefit (NNT) 5). They showed no difference in rates of operative delivery (49% v 50%, 0.98 (0.65 to 1.47), NNT 98), but significantly fewer received augmentation (71% v 96%, 0.74 (0.59 to 0.88), NNT 4) or any form of obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery) (80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of women in the water group were admitted to the neonatal unit (6 v 0, P = 0.013), but there was no difference in Apgar score, infection rates, or umbilical cord pH.
Conclusions: Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.
labour in water, randomised control trial, management of dystocia, first stage of labour, labour, dystocia
0959-8138
314-319
Cluett, E.R.
cfa2fd26-8cc0-485c-876b-73fe92e9b4e1
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Getliffe, K.
3ce38a84-b0ba-46b8-99e1-126de7cc35e7
St. George Saunders, N.J.
d2357078-8103-4ea1-9ef3-b5cff5e345e8
Cluett, E.R.
cfa2fd26-8cc0-485c-876b-73fe92e9b4e1
Pickering, R.M.
4a828314-7ddf-4f96-abed-3407017d4c90
Getliffe, K.
3ce38a84-b0ba-46b8-99e1-126de7cc35e7
St. George Saunders, N.J.
d2357078-8103-4ea1-9ef3-b5cff5e345e8

Cluett, E.R., Pickering, R.M., Getliffe, K. and St. George Saunders, N.J. (2004) Randomised controlled trial of labouring in water compared with standard of augmentation for management of dystocia in first stage of labour. BMJ, 328 (7435), 314-319. (doi:10.1136/bmj.37963.606412.EE).

Record type: Article

Abstract

Objectives: To evaluate the impact of labouring in water during first stage of labour on rates of epidural analgesia and operative delivery in nulliparous women with dystocia.
Design: Randomised controlled trial.
Setting: University teaching hospital in southern England.
Participants: 99 nulliparous women with dystocia (cervical dilation rate < 1 cm/hour in active labour) at low risk of complications.
Interventions: Immersion in water in birth pool or standard augmentation for dystocia (amniotomy and intravenous oxytocin).
Main outcome measures: Primary: epidural analgesia and operative delivery rates. Secondary: augmentation rates with amniotomy and oxytocin, length of labour, maternal and neonatal morbidity including infections, maternal pain score, and maternal satisfaction with care.
Results: Women randomised to immersion in water had a lower rate of epidural analgesia than women allocated to augmentation (47% v 66%, relative risk 0.71 (95% confidence interval 0.49 to 1.01), number needed to treat for benefit (NNT) 5). They showed no difference in rates of operative delivery (49% v 50%, 0.98 (0.65 to 1.47), NNT 98), but significantly fewer received augmentation (71% v 96%, 0.74 (0.59 to 0.88), NNT 4) or any form of obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery) (80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of women in the water group were admitted to the neonatal unit (6 v 0, P = 0.013), but there was no difference in Apgar score, infection rates, or umbilical cord pH.
Conclusions: Labouring in water under midwifery care may be an option for slow progress in labour, reducing the need for obstetric intervention, and offering an alternative pain management strategy.

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More information

Published date: 2004
Keywords: labour in water, randomised control trial, management of dystocia, first stage of labour, labour, dystocia

Identifiers

Local EPrints ID: 24293
URI: http://eprints.soton.ac.uk/id/eprint/24293
ISSN: 0959-8138
PURE UUID: e048da9b-a532-41ac-af27-c739d952a513
ORCID for E.R. Cluett: ORCID iD orcid.org/0000-0002-8707-5042

Catalogue record

Date deposited: 30 Mar 2006
Last modified: 15 Mar 2024 06:54

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Contributors

Author: E.R. Cluett ORCID iD
Author: R.M. Pickering
Author: K. Getliffe
Author: N.J. St. George Saunders

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