BMJ  2004;328:314 (7 February), doi:10.1136/bmj.37963.606412.EE (published 26 January 2004)

Paper

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

¹ Nightingale Building (67), University of Southampton, Southampton SO17 1BJ, ² Medical Statistics Group, Health Care Research Unit (805), Southampton General Hospital, Southampton SO16 6YD, ³ Trust Management Office (Mail point 18), Southampton General Hospital, Southampton SO16 6YD

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.

Related Articles

Labouring in water: Method is unclear

Jamal Zaidi and Fawzia Zaidi
BMJ 2004 328: 767. [Extract] [Full Text]

Labouring in water: Findings do not fully support conclusions

Helen Bradshaw
BMJ 2004 328: 767-768. [Extract] [Full Text]

Labouring in water: Cover wrongly said study was about giving birth in water

James B Robins
BMJ 2004 328: 768. [Extract] [Full Text]

Labouring in water: The editor confesses—and apologises to anybody upset

Richard Smith
BMJ 2004 328: 768. [Extract] [Full Text]

Water delivery helps labour progress
BMJ 2004 328: 0. [Full Text]

This article has been cited by other articles:

• Benfield, R. D., Newton, E. R., Hortobagyi, T. (2007). Waterproofing EMG Instrumentation. Biol Res Nurs 8: 195-201 [Abstract]  
• Committee on Fetus and Newborn, 2004-2005, , Batton, D. G., Blackmon, L. R., Adamkin, D. H., Bell, E. F., Denson, S. E., Engle, W. A., Martin, G. I., Stark, A. R., Barrington, K. J., Raju, T. N.K., Riley, L., Tomashek, K. M., Wallman, C., Couto, J. (2005). Underwater Births. Pediatrics 115: 1413-1414 [Full text]  
• Schroeter, K. (2005). Stones From a Glass House: In Reply. Pediatrics 115: 1116-1117 [Full text]  
• (2004). Hit Parade. BMJ 328: 962-962 [Full text]  
• Zaidi, J., Zaidi, F. (2004). Labouring in water: Method is unclear. BMJ 328: 767-767 [Full text]  
• Bradshaw, H. (2004). Labouring in water: Findings do not fully support conclusions. BMJ 328: 767-768 [Full text]  
• Robins, J. B (2004). Labouring in water: Cover wrongly said study was about giving birth in water. BMJ 328: 768-768 [Full text]  
• Smith, R. (2004). Labouring in water: The editor confesses--and apologises to anybody upset. BMJ 328: 768-768 [Full text]  

Rapid Responses:

Read all Rapid Responses

Taking the waters - very early in life

Dr.Herbert H. Nehrlich
bmj.com, 6 Feb 2004 [Full text]

Labour in water rather than birth

James B Robins
bmj.com, 6 Feb 2004 [Full text]

"This Week in the BMJ" Labouring over editorial license

Robert Schumacher
bmj.com, 6 Feb 2004 [Full text]

Labour in water - not birth in water

David J R Hutchon
bmj.com, 6 Feb 2004 [Full text]

An editor confesses--and apologises to anybody upset

Richard Smith
bmj.com, 7 Feb 2004 [Full text]

Swim baby swim

Dr.Herbert H. Nehrlich
bmj.com, 7 Feb 2004 [Full text]

Headlines are both incorrect and misleading

Timothy Lloyd Watts
bmj.com, 9 Feb 2004 [Full text]

Are the conclusions really supported by the data?

John D Blakey
bmj.com, 10 Feb 2004 [Full text]

Misleading headlines muddy the water

Ruth Gilbert, et al.
bmj.com, 11 Feb 2004 [Full text]

Methodology is unclear

Jamal Zaidi, et al.
bmj.com, 12 Feb 2004 [Full text]

Low tech interventions like this need more attention

Helen D Bradshaw
bmj.com, 12 Feb 2004 [Full text]

misleading photograph and headlines

helene a. brandon
bmj.com, 17 Feb 2004 [Full text]

What this study adds

Kate Farrer
bmj.com, 18 Feb 2004 [Full text]

Is it worth the effort?

Hector J. Lacassie, et al.
bmj.com, 20 Feb 2004 [Full text]

High risk of bias, incompatible comparison between randomised groups, inappropriate comment about neonatal morbidity and misleading headlines in cover page

Prithwiraj Saha, et al.
bmj.com, 23 Feb 2004 [Full text]

Misleading Advertising

Bernadette M White
bmj.com, 24 Feb 2004 [Full text]