Effect of continuous epidural block combined with free positions on genital tract injury in parturient undergoing vaginal delivery.

The objective of this study was to investigate the effects of obstetric gel application on the length of the first stage of labour and perineal trauma in primiparous women. This randomised controlled trial included 110 primiparous women. Women were randomly assigned to the two groups: lubricant gel group and control group. In the intervention group, during cervical dilatation of 4 cm until complete cervical dilatation, 5 ml of water-soluble lubricant gel was used at each vaginal examination. In the control group, routine care was performed. Mean duration of the total length (p = .025), the first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than control group. Perineal health was significantly better in the gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect perineal health. IMPACT STATEMENT What is already known on this subject? Prolonged labour and perineal injuries are a major problem in natural childbirth for primiparous mothers. What the results of this study add? The first (p = .012), and second stage (p = .022) of labour was significantly shorter in the obstetric gel group than in the control group. Perineal health was significantly better in gel-applied pregnant women (p < .001). Using obstetric gel at the beginning of the first stage could shorten the total length, the first and the second stage of labour and could protect against perineal injury. What the implications are of these findings for clinical practice and/or further research? Obstetrical gel lubricant usage in the first stage of labour during the active phase of nulliparous women could shorten the total length, the first and the second stage of labour and could protect perineal health.

Objective To explore the effects of positive psychological nursing combined with free posture on the prognosis of primipara with singleton spontaneous delivery. Methods 106 cases of primipara with singleton spontaneous delivery who were admitted to the obstetrics department of our hospital from January 2017 to December 2019 were selected as the research subjects and they were divided into the observation group and control group according to the random number table method and maternal willingness, with 53 cases in each group. The control group received routine nursing, and the observation group was given positive psychological nursing combined with free posture on the basis of the control group. The stress degree during delivery (Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD)), the time of first stage of labor, the time of second stage of labor, the time of third stage of labor, pain level during the active period of the first stage of labor, and delivery outcomes were observed and compared between the two groups. Results The degree of anxiety and depression during childbirth in the observation group was significantly lower than that in the control group (P < 0.05). The time of first stage of labor and the time of second stage of labor in the observation group were shorter than those in the control group (P < 0.05), and there was no significant difference in the time of the third stage of labor (P > 0.05). The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P < 0.05). The pain degree in the active stage of the first stage of labor in the observation group was lower than that in the control group (P < 0.05). Conclusion Positive psychological nursing combined with free posture for primipara with singleton spontaneous delivery can shorten the stages of labor, reduce the pain, relieve psychological stress, and improve the delivery outcomes.

Objectives The aim of this work was to study the efficacy of hyoscine butylbromide (HBB) for shortening of the first stage of labor in primigravid women. Background Prolonged labor is one of the most important risk factors for perinatal compromise and, if caused by obstructed labor, it carries the risk for uterine rupture, postpartum hemorrhage, puerperal sepsis, and maternal death. Patients and methods The study was a randomized, double-blinded, controlled trial. One hundred and ten primigravid term pregnant women in spontaneous labor received either HBB or a placebo intramuscularly once the women entered the active phase of labor. The primary outcome measured was the duration of the first stage of labor. Secondary outcomes were the duration of the second and third stages of labor, blood loss at delivery, rate of cesarean section, and Apgar scores for the neonates. Results A total of 110 women yielded data for analysis. Of them, 55 women received HBB and 55 received placebo. The mean duration of the first stage in the study group was 208.16 ± 17.24 min, compared with 258.16 ± 15.27 min in the control group; there was a highly significant statistical difference (P = 0.00). There were no significant changes in the duration of the second stages of labor (P = 0.09). There were no significant changes in the duration of the third stages of labor (P = 0.16). There were no significant statistical differences in blood loss or Apgar scores. There was no significant statistical difference in the cesarean section rate or instrumental delivery. Conclusion HBB is effective in significantly reducing the duration of the first stage of labor and is not associated with any apparent short-term adverse outcomes in the mother or neonate.

Objective: To study the correlation between the duration of labor and postpartum hemorrhage. Methods: The delivery data of singleton first-term pregnant women who delivered vaginally at Beijing Obstetrics and Gynecology Hospital from January 1, 2017 to December 31, 2017 were collected, 3 104 cases met inclusion criteria. According to the duration of the first labor (t), they were divided into two groups: t≥8 hours was the observation group, t<8 hours was the control group. In order to ensure the baseline characteristics of the subjects in the two groups were balanced, propensity score matching (PSM) was adopted, with matching ratio 1∶1. Then the observation group was divided into four subgroups: group 8-12 h, group 12-16 h, group 16-20 h, group ≥20 h. According to the presence or absence of labor intervention (oxytocin use, artificial rupture of membranes, labor analgesia), the observation group and control group were divided into non-labor intervention observation group, non-labor intervention control group, labor intervention observation group, and labor intervention control group. The case data of 3 104 subjects were analyzed and the duration of labor and atonic postpartum hemorrhage rate of each subgroup were compared with the control group. Results: The duration of the second stage of labor and the first+second stages of labor in the observation group (median:0.8, 13.3 hours) and its subgroups were both longer than those in the control group (median:0.6, 5.1 hours), with statistically significant differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group, group 16-20 h and group ≥20 h were higher than that in the control group [8.0%(124/1 552), 14.3%(41/287), 14.1%(12/85), 4.6%(72/1 552)], with significant statistical differences (all P<0.01). The duration of the second stage of labor and the first+second stages of labor in the observation group were both longer than those in the control group, regardless of the presence or absence of labor intervention, with statistically significant differences (all P<0.01). In both the observation group and the control group, the duration of the first stage of labor, the second stage of labor, and the first+second stages of labor with labor intervention were longer than those of the non-labor intervention, with significant statistical differences (all P<0.01). The rate of atonic postpartum hemorrhage in the observation group with labor intervention [8.7%(110/1 263)] was higher than that in the observation group without labor intervention [4.8%(14/289)], with a statistical difference (P<0.05). Conclusions: With the increase of the duration of the first stage of labor, the rate of atonic postpartum hemorrhage increases. The first stage of labor is closely related to the second stage of labor, and to a certain extent the duration of the second stage of labor increases with the length of the first stage of labor. With the increase of the duration of the first stage of labor, the rate of labor intervention and atonic postpartum hemorrhage also increase, which could serve as a clinical warning that excessive labor intervention may indicate a higher incidence of atonic postpartum hemorrhage.

Objective To observe the therapeutic effect of phloroglucinol combined with diazepam in prolonged or protracted active phase of first stage of labor,and the outcome of perinatal phase.Methods Two hundred vaginal delivery primipara with prolonged or protracted active phase after dilatation of cervix 2-3 cm were selected.The patients were divided into 2 groups by random digits table method with 100 cases each,the patients in observation group were given phloroglucinol 80 mg and diazepam 10 mg,and the patients in control group were given diazepam 10 mg.The cervical dilatation,the degree soft hardness and edema of cervix,time of active phase,time of second stage of labor,mode of delivery,vaginal bleeding in 2 h postpartum and outcome of perinatal phase in the 2 groups were observed.Results In observation group,the cervical dilatation rate was (2.31 ± 0.27) cm/h,the time of active phase was (187.27 ± 33.22) min.In control group,the cervical dilatation rate was (1.82 ±0.48) cm/h,the time of active phase was (251.32 ± 45.33) min,there were statistical differences between 2 groups (P ＜ 0.05).The rate of uterineincision delivery in observation group was significantly lower than that in control group [18.0％(18/100) vs.32.0％ (32/100)],there was statistical difference (P ＜ 0.05).There were no statistical differences in time of second stage of labor,vaginal bleeding in 2 h postpartum,rate of neonatal asphyxia between 2 groups (P ＞0.05).Conclusion The effect of phloroglucinol combined with diazepam in prolonged or protracted active phase is remarkable,it can promote the progress of labor,speed up delivery progress,improve the rate of vaginal delivery and decrease the rate of uterine-incision delivery,and no adverse effects on the outcome of perinatal phase,it is worth popularizing. Key words: Phloroglucinol; Diazepam; Labor,obstetric

Purpose To analyze the application value of multimodal analgesia (MMA) regimen of patient-controlled epidural analgesia (PCEA) combined with multiacupoint stimulation analgesia during the whole stage of labor analgesia in primipara. Methods 300 primiparas with natural delivery were selected. According to the different ways of labor analgesia, they were divided into the first stage of labor active period PCEA group (group A), the whole stage of labor PCEA group (group W), and the whole stage of labor PCEA combined with multiacupoint stimulation analgesia group (group WM). The effect of MMA during the whole-labor process on maternal and infant safety was evaluated. The specific observation indicators were as follows: visual analogue scale (VAS) scores before analgesia (T0), at full opening of the uterus (T1), at the end of the second stage of labor (T2), and at the end of the third stage of labor (T3); stress response indicators at T0 and T1: epinephrine (E), norepinephrine (NE), glucose (Glu), and β-endorphin (β-EP) levels; delivery time of each stage of labor; the Apgar score of newborns at 1 and 5 min after birth; indicators of umbilical artery blood gas analysis immediately after delivery: PH value, base excess (BE), partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2); incidence of postpartum depression (PPD) at 6 weeks after delivery. Results At T1, T2, and T3, the VAS scores were lower in groups W and WM than in group A, and the VAS scores were lower in group WM than in group W (P < 0.05). At T0, there was no significant difference in the comparison of E, NE, Glu, and β-EP levels among the three groups (P > 0.05). At T1, the levels of E, NE, Glu, and β-EP were higher in the three groups than in the same group at T0, the levels of E, NE, and Glu were lower, the levels of β-EP were higher in groups W and WM than in group A, and the levels of β-EP were higher in group WM than in group W (P < 0.05). Comparing the delivery time of the first stage of labor in the three groups, groups A and WM were shorter than group W (P < 0.05). Comparing the delivery time of the second and third stages of labor in the three groups, there was no significant difference (P > 0.05). Comparing the Apgar scores of the three groups of newborns at 1 and 5 min after birth, there was no significant difference (P > 0.05). Comparing the incidence of newborn asphyxia in the three groups, there was also no significant difference (P > 0.05). Comparing the PH, BE, PaO2, and PaCO2 of three groups of newborns after delivery, there were no significant differences (P > 0.05). At 6 weeks after delivery, the incidence of PPD was lower in groups W (10.00%) and WM (8.00%) than in group A (20.00%) (P < 0.05). Conclusion The application of the MMA regimen of PCEA combined with multiacupoint stimulation for labor analgesia during the whole stage of labor in primipara can effectively reduce labor pain and stress response during the whole stage of labor and shorten the delivery time of the first stage of labor, the indicators of newborn Apgar score and umbilical artery blood gas analysis are not affected, and the incidence of PPD in patients is reduced, which can play a protective role for the safety of mother and infant.

To evaluate blood flow Doppler velocimetry during the first and second stages of active labor. A prospective observational study was performed. Patients at term (37-42weeks gestation), with normal fetal heart rate tracing patterns (categorized as category I) were examined during the first and second stages of labor. The sonographic parameters that were measured included the blood flow resistance of the maternal uterine artery (UtA) and umbilical artery (UA). Wilcoxon-matched pair test was used for the comparison of flows between the first and the second stages of labor. UtA and UA Doppler velocimetry measurements were obtained from 31 parturients. The left (LT) and right (RT) UtA pulsatility index (PI) was lower in the second stage of labor as compared with the first stage. However, only the LT side reached a statistically significant difference (0.88±0.32 and 0.73±0.18; P=0.005). Compared with the first stage of labor, UA PI was significantly higher during the second stage of labor (0.72±0.17 vs. 0.84±0.33; respectively, P=0.05). Significant blood flow resistance changes in maternal as well as in fetal blood vessels occur during the second stage as compared with the first stage of active labor.

목적: The aim of this study was to perform a preliminary investigation into the predictive values of the position of the fetal occiput measured during the first and second stages of labor by intrapartum ultrasound for persistent occiput posterior (OP) position and labor dystocia. 방법: This was a prospective cohort study, in which 148 primiparous women with singleton pregnancies were enrolled. The women underwent intrapartum transabdominal sonography and the positions of the fetal head were recorded during the first and second stage of labor. We analyzed the correlation between the position of fetal head and labor course and perinatal outcomes. Statistics were performed using SAS 9.2. 결과: 148 pregnancies were evaluated in the first stage of labor, with 126 of these also evaluated in the second stage. 22 pregnancies were not evaluated during second stage because they underwent Cesarean section during the first stage. 51 of 148 fetuses (34.5%) were found to be in an OP position during the first stage of labor. There were 8 cases of OP position during the second stage, and 6 of these (75.0%) were among the 51 fetuses that were found to be in an OP position during the first stage of labor. 19 of 51 cases with OP position during the first stage of labor (37.3%) and 2 of 8 cases with OP position during the second stage of labor (25.0%) underwent Cesarean section owing to arrest disorder. The rates of Cesarean section in OP position group were significantly higher than those in OA position and OT position group (p=0.0024, 0.0374). Perinatal complications occurred more frequently in OP position group than OA position and OT position groups. But there was no statistically significant correlation. 결론: The results of this study suggest that the position of the head during the first and second stage of labor could be useful indicators for predicting the persistent OP position and labor dystocia. Studies with larger sample sizes are needed to confirm these results.

Progression of labor in twin versus singleton gestations

Objective: The study was made to examine the effects of delayed pushing during the second stage of labor and pushing on postpartum fatigue and labor results.Method: This is a randomized controlled experimental study. The sampling of the research is comprised of 48 primiparous women (23 in the delayed pushing group and 25 in the control group). The pushing of control group was initiated when strong uterine contraction appeared when the fetal head rotation was completed. Different from the control group, when the fetal head was “+1” inside the pelvis, considering the desire to push, pregnant were asked to delay the pushing until the feeling of powerful and involuntary pushing reflex in the delayed pushing group. As a data collection tool, “Pregnant Identification Form”, “Follow-up Form”, “Partograph” and, “Visual Analogue Scale for Fatigue” was used.Results: The mean duration of the second stage of labor was 38.34 ± 17.84 minutes in the delayed pushing group and 13.52 ± 5.29 minutes in the control group. It was observed that a statistically significant difference was found between the delayed pushing and control group women in terms of the mean duration of the second stage of labor, the mean pushing time, the average fatigue, and energy scores in the first hour after labor (p &amp;lt;0.05).Conclusion: It was found out that delayed pushing prolonged the time of the second stage of labor but reduced the pushing time and significantly affected the fatigue at the first one hour of postpartum.

Introduction. The influence of epidural analgesia on the length of labourremains a source of controversy in literature. Objectives. To see the effect of epidural analgesia on the duration ofactive first stage and second stage of labour. Setting: Obstetric Department of CMH Kharian. Period: From 1 January st2005 to 31 March 2006. Material and methods. One hundred pregnant full term, women were included in the study. stFifty primiparous reporting at full term, half were given epidural analgesia the other half were control. Another fiftymultiparous reporting at full term, twenty five women were given epidural the other twenty five were control. Results.The mean duration of active first stage of labour in primiparous women after 3 – 4 centimeter cervical dilatation was5.10 hrs in the epidural group while it was 6.65 hrs in the control group (p less than 0.001). In the multiparous womenthe mean duration of active first stage of labour after 3 – 4 centimeter cervical dilatation was 2.40 hrs in the epiduralgroup while it was 3.43 hrs in the control group (p less than 0.001). In the primiparous women the mean second stagewas 23.76 minutes in the epidural group, and 37.33 minutes in the control group (p less than 0.001). In the multiparousgroup, the mean second stage was 17.58 minutes in the epidural group, and 22.00 minutes in the control group (p lessthan 0.001). Conclusion. Epidural analgesia decreases the duration of active first stage and second stage of labour.

Objective To discuss the effect on promoting the progress of the stage of labor and the natural delivery as the parturient adopts the different delivery position in the first and the second stage of labor. Methods One hundred and fifty-two cases of delivery primiparas of cephalic presentation whose pregnancy was from 37 to 41 weeks were enrolled and divided into two groups randomly. In the observation group (80 cases) ,the free positions of delivery like walking,squating,lateral position,half lying and others could be selected in the first stage of labor, the semi-reclining position was selected in the second stage of labor and the lithotomy position was adopted when the head was visible on vulvae gapping. The parturient in the control group (72 cases) selected the decubitus (alternation between prostration and lateral position) in the first stage of labor and the parturient selected routine lithotomy position of supine position in the second stage of labor. The progress of labor and the comfort of the parturient in the two groups were observed. Results In the observation group, time spent in the first stage and second stage were (361. 83 ± 58. 02) mins and (36. 39 ± 11. 97) mins, and (398.21 ±59. 72) mins in the total birth process, which were significantly shorter than those of (560.85 ± 131. 98)mins and (58.11 ± 15.44) mins, and (618. 96 ± 139. 61) mins, respectively (t = 12. 24,9. 74 and 12. 90, Ps <0. 01). There were 13 and 25 cases experienced tingle in two hours after delivery, and 2 and 10 cases in 12 hs after delivery, in the observation and control group, respectively. The comfort of parturient in the observation group was higher than that in the control group (x2 = 6. 90, P < 0.01; x2 = 5. 28, P < 0. 05)respectively. Conclusion The free position in the first stage of labor and the semi-reclining position in the second stage of labor can shorten the birth process effectively and relieve the discomfort after the delivery. Key words: First stage of labor; Second stage of labor; Position; parturition

The aim of this study was to evaluate the effect of applying of spontaneous pushing technique during second Stage of labor in early postpartum fatigue. Methods: A quasiexperimental research design was used to carry out this study at the Labor and delivery unit of Mansoura University Hospital on 100 primigravida women at ≤37 gestational weeks, who were selected by purposive sampling technique. They were free from any medical and obstetric problems, can read and write. They were assigned either to the control or intervention group (n= 50 per each group). The intervention group: had received spontaneous pushing during second stage of labor, while the control group had received the routine pushing technique. Three tools for data collection were used; an interviewing questionnaire schedule, Visual analogue scale for fatigue and women''s satisfaction questionnaire. Results: The study showed significant different between the two groups regarding the duration of second stage ,newborn health status &Apger score(7.8 ±1 versus 4 ±1.4 respectively, 0<0.001).Women expressed greater satisfaction with spontaneous pushing (98% versus 44% respectively, p < 0.001).Conclusion spontaneous pushing technique is an effecting method in reducing women''s fatigue. Recommendation Educating women about the spontaneous pushing technique in the first stage of labor and providing support for spontaneous pushing in the second stage for decrees postpartum fatigue.

The issue of preserving the health of the woman in labor and the fetus, and later – the newborn, is one of the most priority tasks of modern obstetric service. Today, a feature of modern obstetric care in Ukraine is its transition to patient orientation, which determines not only a modification of management of pregnancy and childbirth, but also the creation of comfortable and safe conditions for the mother and newborn. There is also a tendency to increase the demand from future pregnant women and women in labor for “non-traditional” non-medicinal methods of pain relief and alternative approaches to childbirth, which are focused on reducing the severity of labor pain without the use of medical devices, ensuring free movement during childbirth, creating psychological comfort and a positive childbirth experience for the woman in labor and her partner.The objective: to evaluate the course of childbirth in women in labor who were involved in an attempt to give birth in water.Materials and methods. The study involved 150 pregnant women, who, depending on the proposed delivery method, were divided into:main group (MG) – 66 pregnant women, in whom delivery took place with the use of hydrotechnologies in the first and second stages of labor;comparison group (CompG) – 34 pregnant women, in whom delivery took place with the use of hydrotechnologies only in the first stage of labor;control group (CG) – 50 pregnant women, in whom childbirth took place according to generally accepted standards.Additionally, in the dynamics of the first stage of labor, all women in labor were assessed for the intensity of labor pain using a visual analog scale (VAS).Results. In the dynamics of labor, rupture of the fetal membranes occurred with greater cervical dilation against the background of satisfactory progress of labor in women in labor with the use of hydrotechnologies (MG – 8.6±0.3 cm, CompG – 8.1±0.4 cm, CG – 5.6±0.3 cm; p&lt;0.05). Moderate intensity of labor pain persisted in the first stage of labor when the cervix was dilated by 6–7 cm in women in labor with the use of hydrotechnologies (MG – 56 (84.8%) women in labor, CompG – 29 (85.3%), CG – 15 (30.0%); p&lt;0.05). Women in labor with CG had severe pain – 14 (28.0%) and unbearable pain – 11 (22.0%), which was an indication for the use of pharmacological analgesia methods in the first stage of labor.At the end of the first stage of labor, the vast majority of women who chose water birth as an alternative approach to labor management had a tendency to maintain the intensity of labor pain, which was assessed by VAS at 4–6 points: MG – 48 (96.0%), CompG – 24 (96.0%), CG – 34 (68.0%) women; p&lt;0.05. Severe labor pain, assessed at 6–8 points, was complained of by 31 (32.0%) CG women, 2 (4.0%) women in MG, 1 (4.0%) – CompG (p&lt;0.05).Conclusions. The positive effect of the use of hydrotechnologies during childbirth is confirmed by the presence of a significantly lower number of complications requiring surgical delivery in the first (MG – 3 (5.6%) women, CompG – 2 (7.4%), CG – 20 (28.6%) and second stages of labor (fetal distress: MG – 2 (4.0%) women, CompG – 4 (16.0%), CG – 8 (16.0%); p&lt;0.05); weakness of labor activity that is not amenable to medical correction was not detected among parturients in MG (CompG – 2 (8.0%) persons, CG – 4 (8.0%) women; p&gt;0.05). Due to existing complications during the second stage of labor, there was a need to use surgical delivery by applying a vacuum extractor (MG – 2 (4.0%), CompG – 6 (24.0%), CG – 12 (24.0%) women; p&lt;0.05). The results of the study demonstrate the effectiveness of childbirth with the use of hydrotechnologies in low-risk pregnant women in reducing the level of obstetric complications, and, as a result, this is reflected in a significantly higher number of cases of physiological delivery (MG – 39 (78.0%), CopmG – 14 (56.0%), CG – 27 (54.0%) women in labor; p&lt;0.05).

Background Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Critics cite the risk of neonatal water inhalation and maternal/neonatal infection. Objectives To assess the evidence from randomised controlled trials about immersion in water during labour and waterbirth on maternal, fetal, neonatal and caregiver outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011) and reference lists of retrieved studies. Selection criteria Randomised controlled trials comparing immersion in any bath tub/pool with no immersion, or other non-pharmacological forms of pain management during labour and/or birth, in women during labour who were considered to be at low risk of complications, as defined by the researchers. Data collection and analysis We assessed trial eligibility and quality and extracted data independently. One review author entered data and the other checked for accuracy. Main results This review includes 12 trials (3243 women): eight related to just the first stage of labour: one to early versus late immersion in the first stage of labour; two to the first and second stages; and another to the second stage only. We identified no trials evaluating different baths/pools, or the management of third stage of labour. Results for the first stage of labour showed there was a significant reduction in the epidural/spinal/paracervical analgesia/anaesthesia rate amongst women allocated to water immersion compared to controls (478/1254 versus 529/1245; risk ratio (RR) 0.90; 95% confidence interval (CI) 0.82 to 0.99, six trials). There was also a reduction in duration of the first stage of labour (mean difference -32.4 minutes; 95% CI -58.7 to -6.13). There was no difference in assisted vaginal deliveries (RR 0.86; 95% CI 0.71 to 1.05, seven trials), caesarean sections (RR 1.21; 95% CI 0.87 to 1.68, eight trials), use of oxytocin infusion (RR 0.64; 95%CI 0.32 to 1.28,five trials), perineal trauma or maternal infection. There were no differences for Apgar score less than seven at five minutes (RR 1.58; 95% CI 0.63 to 3.93, five trials), neonatal unit admissions (RR 1.06; 95% CI 0.71 to 1.57, three trials), or neonatal infection rates (RR 2.00; 95% CI 0.50 to 7.94, five trials). Of the three trials that compared water immersion during the second stage with no immersion, one trial showed a significantly higher level of satisfaction with the birth experience (RR 0.24; 95% CI 0.07 to 0.80). A lack of data for some comparisons prevented robust conclusions. Further research is needed. Authors' conclusions Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia and duration of the first stage of labour. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. However, the studies are very variable and considerable heterogeneity was detected for some outcomes. Further research is needed.