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


METHODS
Randomised controlled trial.


METHODS
University teaching hospital in southern England.


METHODS
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).


METHODS
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.
Cluett
Elizabeth R
ER
Nightingale Building (67), University of Southampton, Southampton SO17 1BJ. ec1@soton.ac.uk
Pickering
Ruth M
RM
Getliffe
Kathryn
K
St George Saunders
Nigel James
NJ
D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods*; D004420:Dystocia / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D007101:Immersion; D007231:Infant, Newborn; D007747:Labor Stage, First; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D014867:Water
D014867:Water