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GENERAL PRACTICE: A G Baird, D Jewell, and Jj Walker Management of labour in an isolated rural maternity hospital BMJ 1996; 312: 223-226 [Abstract] [Full text]

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Delay in first stage of labour

Neil Arnott   (29 August 2000)

Delay in first stage of labour 29 August 2000
Neil Arnott, GP registrar Tweeddale medical practice, Fort William Send response to journal: Re: Delay in first stage of labour	I am surprised, coming from hospital practice, how few primigravidas were transferred as a result of delay in the first stage of labour.I would like to know if syntocinon was ever used to augment labour during the study? The need to carry out midcavity forceps occured in primigravid labours successfuly preventing the need for transfer to the Consultant unit. Could it be that the knowledge that midcavity forceps skills were available gave the confidence to allow some women to continue in the 'late first stage' of labour longer than they would have done so if no such skills were available. What analgesia was employed for the midcavity forceps? The delivery of primigravidas is being considered in Fort William, Scotland in a midwife unit. This unit is a few hours away from Inverness, which can involve a difficult journey through the Scottish highlands in Winter. The availability of highly trained midwifes with ALSO,PALS and the principles of ventouse use is admirable but does not consider the seemingly inevitable need for skills in midcavity forceps should the ventouse prove ineffective.On the otherhand If an attempt is made to predict a higher likelihood of delay in the descent phase, and avoid forceps, by transferring all women who are 'slowing down' towards the end of the first stage will this make the transfer rate unacceptably high but still end up with the occasional midcavity arrest or the need to deliver urgently for fetal reasons using forceps? If the delivery of primigravidas goes ahead how much of the above information should we provide to the women?