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Am Fam Physician. 2004;69(11):2657

Clinical Question: Is labor in water an effective treatment for slow first-stage labor progress in nulliparous women?

Setting: Inpatient (ward only)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: This study was based on the idea that stress and pain may cause reduced uterine activity and, therefore, slower-than-expected progress in the first stage of labor. Slow progress then may lead to unnecessary interventions. In this study, 99 nulliparous women were randomized (concealed allocation) to labor in a birth pool or to standard care with amniotomy and/or oxytocin augmentation, if they had dystocia defined as cervical dilatation of less than 1 cm per hour in the active first stage of labor.

Mode of delivery and mean time from randomization to delivery—approximately 10 hours in each group—did not differ. The change in pain score assessed 30 minutes after the start of management was better in the water group. Women in the water group had a decrease in pain of 26 mm on average; women in the augmentation group had a mean increase of 12 mm (P <.001). Women in the water group also used epidural analgesia less frequently (47 percent versus 66 percent; number needed to treat = five). The proportion of women satisfied with care was similar (94 percent in the water group versus 88 percent in the augmentation group).

Bottom Line: Labor in water is as effective as oxytocin augmentation in the management of slow labor progress in the first stage in terms of time to delivery and mode of delivery. Women in the group randomized to labor in water had less pain and less frequent use of epidural analgesia. (Level of Evidence: 1b)

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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