Labouring in water:Method is unclear

EDITOR—The method of the study by Cluett et al comparing labouring in water with standard augmentation in managing dystocia requires clarification.1 The authors have not defined the criteria by which the first stage of labour was diagnosed, thus putting into question the diagnosis of dystocia.

In current practice an expectant policy is advocated especially during the latent phase of labour, to avoid unnecessary intervention. It is unclear whether the authors have taken this into account and whether some women were inappropriately recruited.

We think that an alternative arm of the study should have included an expectant group without recourse to water immersion or augmentation and thus the true impact of water immersion would be defined. The inclusion of women with both intact and ruptured membranes in each study arm further adds to difficulty in evaluating the true effect of water immersion.