Intended for healthcare professionals


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

BMJ 2004; 328 doi: (Published 05 February 2004) Cite this as: BMJ 2004;328:314
  1. Elizabeth R Cluett, lecturer in midwifery (ec1{at},
  2. Ruth M Pickering, senior lecturer in medical statistics2,
  3. Kathryn Getliffe, professor of nursing1,
  4. Nigel James St George Saunders, medical director3
  1. 1Nightingale Building (67), University of Southampton, Southampton SO17 1BJ
  2. 2Medical Statistics Group, Health Care Research Unit (805), Southampton General Hospital, Southampton SO16 6YD
  3. 3Trust Management Office (Mail point 18), Southampton General Hospital, Southampton SO16 6YD
  1. Correspondence to: E R Cluett


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.


  • Contributors ERC was principal investigator and research midwife and was responsible for trial design and coordination, and data collection and analysis, supported by RMP and KG as research supervisors. NJS contributed to the initial idea and enabled the trial in the clinical setting. All authors helped to write the paper. ERC acts as guarantor for the paper.

  • Funding Southampton University Hospitals NHS Trust.

  • Competing interests None declared.

  • Ethical approval Approval was given by the local research ethics committee.

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