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

doi:10.1136/bmj.37963.606412.EE

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

Elizabeth R Cluett, lecturer in midwifery¹, Ruth M Pickering, senior lecturer in medical statistics², Kathryn Getliffe, professor of nursing¹, Nigel James St George Saunders, medical director³

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

Correspondence to: E R Cluett ec1{at}soton.ac.uk

Objectives To evaluate the impact of labouring in water duringfirst stage of labour on rates of epidural analgesia and operativedelivery in nulliparous women with dystocia.

Design Randomised controlled trial.

Setting University teaching hospital in southern England.

Participants 99 nulliparous women with dystocia (cervical dilationrate < 1 cm/hour in active labour) at low risk of complications.

Interventions Immersion in water in birth pool or standard augmentationfor dystocia (amniotomy and intravenous oxytocin).

Main outcome measures Primary: epidural analgesia and operativedelivery rates. Secondary: augmentation rates with amniotomyand oxytocin, length of labour, maternal and neonatal morbidityincluding infections, maternal pain score, and maternal satisfactionwith care.

Results Women randomised to immersion in water had a lower rateof 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 nodifference in rates of operative delivery (49% v 50%, 0.98 (0.65to 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 obstetricintervention (amniotomy, oxytocin, epidural, or operative delivery)(80% v 98%, 0.81 (0.67 to 0.92), NNT 5). More neonates of womenin the water group were admitted to the neonatal unit (6 v 0,P = 0.013), but there was no difference in Apgar score, infectionrates, or umbilical cord pH.

Conclusions Labouring in water under midwifery care may be anoption for slow progress in labour, reducing the need for obstetricintervention, and offering an alternative pain management strategy.

Add to CiteULike CiteULike Add to Complore Complore Add to Connotea Connotea Add to Del.icio.us Del.icio.us Add to Digg Digg Add to Reddit Reddit Add to StumbleUpon StumbleUpon Add to Technorati Technorati What's this?

Relevant 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]