OBJECTIVE: To compare labor outcomes in women accompanied by an additional support person (doula group) with outcomes in women who did not have this additional support person (control group).

DESIGN: Randomized controlled trial. SETTING: A women's ambulatory care center at a tertiary perinatal care hospital in New Jersey.

PATIENTS/PARTICIPANTS: Six hundred nulliparous women carrying a singleton pregnancy who had a low-risk pregnancy at the time of enrollment and were able to identify a female friend or family member willing to act as their lay doula.

INTERVENTIONS: The doula group was taught traditional doula supportive techniques in two 2-hour sessions.

MAIN OUTCOME MEASURES: Length of labor, type of delivery, type and timing of analgesia/anesthesia, and Apgar scores.

RESULTS: Significantly shorter length of labor in the doula group, greater cervical dilation at the time of epidural anesthesia, and higher Apgar scores at both 1 and 5 minutes. Differences did not reach statistical significance in type of analgesia/anesthesia or cesarean delivery despite a trend toward lower cesarean delivery rates in the doula group.

CONCLUSION: Providing low-income pregnant women with the option to choose a female friend who has received lay doula training and will act as doula during labor, along with other family members, shortens the labor process.

The aim of this study was to document the practice of water births and compare their outcome and safety with normal vaginal deliveries. A retrospective case-control study was conducted over a five year period from 1989 to 1994 at the Maternity Unit, Rochford Hospital, Southend, UK. Three hundred and one women electing for water births were compared with the same number of age and parity matched low risk women having conventional vaginal deliveries. Length of labour; analgesia requirements; apgar scores; maternal complications including perineal trauma, postpartum haemorrhages, infections; fetal and neonatal complications including shoulder dystocias; admissions to the Special Care Baby Unit, and infections were noted. Primigravidae having water births had shorter first and second stages of labour compared with controls (P<0.05 and P<0.005 respectively), reducing the total time spent in labour by 90 min (95% confidence interval 31 to 148). All women having water births had reduced analgesia requirements. No analgesia was required by 38% (95% confidence interval 23.5 to 36.3, P<0.0001) and 1.3% requested opiates compared to 56% of the controls (95% confidence interval 46. 3 to 58.1, P<0.0001). Primigravidae having water births had less perineal trauma (P<0.05). Overall the episiotomy rate was 5 times greater in the control group (95% confidence interval 15 to 26.2, P<0.0001), but more women having water births had perineal tears (95% confidence interval 6.6 to 22.6, P<0.001). There were twice as many third degree tears, post partum haemorrhages and admissions to the Special Care Baby Unit in the controls, although these differences were not significant. Apgar scores were comparable in both groups. There were no neonatal infections or neonatal deaths in the study. This study suffers from many of the methodological problems inherent in investigation of uncommon modes of delivery. However, we conclude that water births in low risk women delivered by experienced professionals are as safe as normal vaginal deliveries. Labouring and delivering in water is associated with a reduction in length of labour and perineal trauma for primigravidae, and a reduction in analgesia requirements for all women.

OBJECTIVE: To evaluate the effect of acupressure administered during the active phase of labor on nulliparous women's ratings of labor pain. DESIGN: Randomized controlled trial. SETTING: Public hospital in India. SAMPLE: Seventy-one women randomized to receive acupressure at acupuncture point spleen 6 (SP6) on both legs during contractions over a 30-minute period (acupressure group), 71 women to receive light touch at SP6 on both legs during the same period of time (touch group) and 70 women to receive standard care (standard care group). METHODS: Experience of in-labor pain was assessed by visual analog scale at baseline before treatment, immediately after treatment, and at 30, 60 and 120 minutes after treatment. MAIN OUTCOME MEASURE: Labor pain intensity at different time intervals after treatment compared with before treatment. RESULTS: A reduction of in-labor pain was found in the acupressure group and was most noticeable immediately after treatment (acupressure group vs. standard care group p<0.001; acupressure group vs. touch group p<0.001). CONCLUSION: Acupressure seems to reduce pain during the active phase of labor in nulliparous women giving birth in a context in which social support and epidural analgesia are not available. However, the treatment effect is small which suggests that acupressure may be most effective during the initial phase of labor.

OBJECTIVE: To examine the association between delivery method and mortality within 6 months of delivery among primiparas. METHODS: We conducted a population-based, retrospective cohort analysis using statewide, maternally linked birth certificate, hospital discharge, and death certificate data. The present cohort was all primiparas who gave birth to live-born infants in civilian hospitals in Washington State from January 1, 1987 through December 31, 1996 (n = 265,471). Odd ratios (OR) and 95% confidence intervals (CI) were calculated for overall mortality, pregnancy-related mortality, and pregnancy-unrelated mortality associated with delivery method. RESULTS: Thirty-two women (12.1 per 100,000 singleton live births) died within 6 months of delivery of their first child. Eleven of 32 deaths were pregnancy related (4.1 per 100,000 singleton live births, 95% CI 1.6, 6.5), and 21 of the 32 deaths were not pregnancy related (7.9 per 100,000 singleton live births, 95% CI 4.5, 11.3). The pregnancy-related mortality rate was higher among women delivered by cesarean (10.3/100,000) than among women delivered vaginally (2.4/100,000). In logistic regression analyses, women who had cesarean delivery were not at significantly higher risk of death overall after adjustment for maternal age (OR 1.7, 95% CI 0.3, 3.6), pregnancy-related death after adjustment for maternal age and severe preeclampsia (OR 2.2, 95% CI 0.6, 7.9), or pregnancy-unrelated death after adjustment for maternal age and marital status (OR 0.9, 95% CI 0.3, 2.7), relative to women who had vaginal delivery. CONCLUSION: Cesarean delivery might be a marker for serious preexisting morbidities associated with increased mortality risk rather than a risk factor for death in and of itself. Data from additional sources such as medical records and autopsy reports are necessary to disentangle preexisting mortality risk from risk associated solely with delivery method.

AIMS: to report the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in China in 2008, aiming to facilitate normal birth and enhance midwifery practice. SETTING: an urban hospital with 2000-3000 deliveries per year. METHOD: this study was part of a major action research project that led to implementation of the MNBU. A retrospective cohort and a questionnaire survey were used. The data were analysed thematically. PARTICIPANTS: the outcomes of the first 226 women accessing the MNBU were compared with a matched retrospective cohort of 226 women accessing standard care. In total, 128 participants completed a satisfaction questionnaire before discharge. MAIN OUTCOME MEASURE: mode of birth and model of care. FINDINGS: the vaginal birth rate was 87.6% in the MNBU compared with 58.8% in the standard care unit. All women who accessed the MNBU were supported by both a midwife and a birth companion, referred to as 'two-to-one' care. None of the women labouring in the standard care unit were identified as having a birth companion. DISCUSSION: the concept of 'two-to-one' care emerged as fundamental to women's experiences and utilisation of midwives' skills to promote normal birth and decrease the likelihood of a caesarean section. CONCLUSION: the MNBU provides an environment where midwives can practice to the full extent of their role. The high vaginal birth rate in the MNBU indicates the potential of this model of care to reduce obstetric intervention and increase women's satisfaction with care within a context of extraordinary high caesarean section rates. IMPLICATIONS FOR PRACTICE: midwife-led care implies a separation of obstetric care from maternity care, which has been advocated in many European countries.

AIMS: to report the clinical outcomes of the first six months of operation of an innovative midwife-led normal birth unit (MNBU) in China in 2008, aiming to facilitate normal birth and enhance midwifery practice. SETTING: an urban hospital with 2000-3000 deliveries per year. METHOD: this study was part of a major action research project that led to implementation of the MNBU. A retrospective cohort and a questionnaire survey were used. The data were analysed thematically. PARTICIPANTS: the outcomes of the first 226 women accessing the MNBU were compared with a matched retrospective cohort of 226 women accessing standard care. In total, 128 participants completed a satisfaction questionnaire before discharge. MAIN OUTCOME MEASURE: mode of birth and model of care. FINDINGS: the vaginal birth rate was 87.6% in the MNBU compared with 58.8% in the standard care unit. All women who accessed the MNBU were supported by both a midwife and a birth companion, referred to as 'two-to-one' care. None of the women labouring in the standard care unit were identified as having a birth companion. DISCUSSION: the concept of 'two-to-one' care emerged as fundamental to women's experiences and utilisation of midwives' skills to promote normal birth and decrease the likelihood of a caesarean section. CONCLUSION: the MNBU provides an environment where midwives can practice to the full extent of their role. The high vaginal birth rate in the MNBU indicates the potential of this model of care to reduce obstetric intervention and increase women's satisfaction with care within a context of extraordinary high caesarean section rates. IMPLICATIONS FOR PRACTICE: midwife-led care implies a separation of obstetric care from maternity care, which has been advocated in many European countries.

BACKGROUND: During labor, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for childbearing women, but nowadays, owing to some well-known limitations and serious side effects, nonpharmacologic methods such as massage and music therapies are being broadly recommended. The present clinical trial was conducted to compare the effects of massage and music therapies on the severity of labor pain in the Ilam province of western Iran. MATERIALS&METHODS: Overall, 101 primigravidae who were hospitalized for vaginal delivery were recruited and randomly stratified into two groups of either massage (n = 51) or music (n = 50) therapies. Pain was measured using the visual analog scale and the two groups were compared in terms of pain severity before and after the interventions. RESULTS: Mothers in the massage therapy group had a lower level of pain compared with those in the music therapy group (p = 0.009). A significant difference was observed between the two groups in terms of pain severity after intervention (p = 0.01). Agonizing, or most severe, labor pain was significantly relieved after massage therapy (p = 0.001). CONCLUSION: Massage therapy was an effective method for reducing and relieving labor pain compared with music therapy and can be clinically recommended as an alternative, safe and affordable method of pain relief where using either pharmacological or nonpharmacological methods are optional.

BACKGROUND: During labor, women experience a high level of intense, stressful and steady pain that may negatively affect both mothers and neonates. Painkillers have previously been used for childbearing women, but nowadays, owing to some well-known limitations and serious side effects, nonpharmacologic methods such as massage and music therapies are being broadly recommended. The present clinical trial was conducted to compare the effects of massage and music therapies on the severity of labor pain in the Ilam province of western Iran. MATERIALS&METHODS: Overall, 101 primigravidae who were hospitalized for vaginal delivery were recruited and randomly stratified into two groups of either massage (n = 51) or music (n = 50) therapies. Pain was measured using the visual analog scale and the two groups were compared in terms of pain severity before and after the interventions. RESULTS: Mothers in the massage therapy group had a lower level of pain compared with those in the music therapy group (p = 0.009). A significant difference was observed between the two groups in terms of pain severity after intervention (p = 0.01). Agonizing, or most severe, labor pain was significantly relieved after massage therapy (p = 0.001). CONCLUSION: Massage therapy was an effective method for reducing and relieving labor pain compared with music therapy and can be clinically recommended as an alternative, safe and affordable method of pain relief where using either pharmacological or nonpharmacological methods are optional.

BACKGROUND: Complementary medicine has become popular throughout many Western countries and is widely used by women across all stages of their life cycle. Acupuncture is used by women during their pregnancy, and research suggests that acupuncture may be used as an adjunct to their existing conventional care. The aim of this paper was to summarize the evidence examining the effectiveness of acupuncture during pregnancy and birthing, and to discuss its role as an adjunct treatment. METHODS: We conducted a systematic literature search using several electronic databases. We included all placebo-controlled randomized trials of parallel design, and systematic reviews that evaluated the role of acupuncture during pregnancy and birthing. A critical appraisal of clinical trials and systematic reviews was undertaken. RESULTS: The summarized findings indicated a small but growing body of acupuncture research, with some evidence suggesting a benefit from acupuncture to treat nausea in pregnancy. Findings from the review also highlighted promising evidence for the effectiveness of acupuncture to manage back and pelvic pain, acupuncture-type interventions to induce change in breech presentation, and pain relief in labor. The methodological quality of recent trials has improved, and the quality of systematic reviews was high. CONCLUSIONS: Interest is growing in the use of acupuncture to treat some complaints during pregnancy and childbirth, and evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is justified.

OBJECTIVE: The objective of this study is to review the existing scientific evidence on the potential role of acupuncture on induction of labor during pregnancy. DESIGN: The Medline, EMBASE, Cochrane Central Register of Controlled Trials, AMED (Allied and Complementary Medicine), and NCCAM (The National Center for Complementary and Alternative Medicine) databases were searched to identify relevant monographs from 1970 to 2008. INCLUSION CRITERIA: These criteria included all available human acupuncture studies on pregnant women carrying a viable fetus due for third trimester induction of labor. EXCLUSION CRITERIA: These criteria included studies not meeting the inclusion criteria, in languages other than English, or animal studies. RESULTS: Ten (10) studies on labor induction were identified. The duration of labor as a result of acupuncture treatment ranged from 10 hours 20 minutes to 29.1 hours. All of the studies demonstrated labor induction by acupuncture treatment. However, because two randomized controlled trials reported that there was no statistically significant effect of acupuncture, these results are more suggestive than definitive. Furthermore, although the relationship between cervical ripening and interleukin-8 (IL-8), prostaglandin F(2alpha) (PGF(2alpha)), and beta-endorphin is well documented in the literature, there is no evidence to suggest that acupuncture alters these mediators. Serum levels of IL8, beta-endorphin, and PGF(2alpha) were not found to be significantly influenced by acupuncture. CONCLUSIONS: Although the definitive role of acupuncture in inducing labor is still yet to be established, the existing studies suggest that acupuncture may be beneficial in labor induction. Further randomized clinical trials are needed to investigate this further.

OBJECTIVE:To investigate the effect of moxibustion at Sanyinjiao (SP 6) for uterine contraction pain in labor, and evaluate the safety of the parturient and newborn.

METHODS:One hundred and seventy-four cases of singleton pregnancy and cephalic presentation primipara were single blinded and randomly divided into three groups: observation group (59 cases), placebo treated group (57 cases) and blank group (58 cases). The observation group was treated with moxibustion at Sanyinjiao (SP 6) for 30 min when the uterus cervix openning at 3 cm, the placebo treated group was treated with moxibustion at no acupoint for 30 min and the blank group was treated with routine labor nursing, the uterine contraction pain and the safety of the mother and infant were compared among three groups.

RESULTS:1) The uterine contraction pain was tested by Visual Analogue Scale (VAS): the scores of VAS in the observation group were obviously decreased after 15 min and 30 min of moxibustion (both P<0.05), there were no obvious changes of the VAS scores in placebo treated group and the blank group, the scores of VAS in observation group decreased much more obviously than those in the other two groups (all P<0.05); 2) Midwife rating of the uterine contraction pain: after 30 min of moxibustion, the effective rate of labor analgesia was 69.5% (41/59) in observation group, which was higher than that of 45.6% (26/57) in placebo treated group and 43.1% (25/58) in blank group, with significant differences between them (both P<0.05); 3) The postpartum hemorrhage amount of the observation group was obviously lower than those of placebo treated group and blank group (both P<0.05); 4) The Apgar score of newborn was higher in observation group and placebo treated group than that of blank group (both P<0.05).

CONCLUSION:Moxibustion at Sanyinjiao (SP 6) can relieve the uterine contraction pain, and has no side effect to mother and infant, it is one of the safe, effective and simple non-drug analgesia methods.

OBJECTIVE: The objective of this study was to assess clinical effects and logistical feasibility of acupuncture given during labor and delivery in a U.S. hospital setting. DESIGN: A case-control pilot study was conducted with 45 parturients receiving acupuncture during labor and delivery alongside standard care. Primary outcome endpoints were incidence of cesarean section, amount of parenteral opioids used, use of epidural anesthesia, and duration of labor. Secondary endpoints included patient satisfaction and nursing staff acceptance as assessed by postpartum questionnaire, maximum flow rate of oxytocin, incidence of instrumental delivery, Apgar score, and incidence of adverse event. RESULTS: Forty-five (45) patients receiving acupuncture were compared to 127 historical controls matched for maternal age, gestational age, parity, and use of oxytocin (augmentation and induction were matched separately). Acupuncture patients underwent significantly fewer cesarean sections (7% versus 20%, p = 0.004). No significant differences were noted in other clinical endpoints. Seventy-eight percent (78%) of nurses reported a subjective perception of improvement in patients' comfort with acupuncture, while 83% reported that the acupuncturists' presence never interfered with their work. Eighty-seven percent (87%) of patients reported that acupuncture had helped them. CONCLUSIONS: Acupuncture during labor and delivery is well tolerated by patients and medical staff. It should be further evaluated for its promise in potentially reducing the incidence of cesarean section.

BACKGROUND:Reducing labor pain and anxiety is one of the most important goals of maternity care.

OBJECTIVE:This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS:This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4-5, 6-7, and 8-10 cm). Anxiety was measured twice, once each at two stages of cervical dilation(4-7 and 8-10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann-Whitney U test and Chi-square test.

MAIN OUTCOME MEASURES:Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures.

RESULTS:Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4-5, 6-7, and 8-10 cm; P < 0.05). Anxiety levels were also significantly lower in the treatment group than in the control group after treatment at each time of measurement (cervical dilation of 4-7 and 8-10 cm; P < 0.05).

CONCLUSION:Aromatherapy with R. damascena reduced the severity of pain and anxiety in the first stage of labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor.

TRIAL REGISTRATION:Iranian Registry of Clinical Trial: IRCT201306258801N3.

BACKGROUND:Several recent studies have documented the effects of massage and acupressure in reducing labor pain and labor time and in satisfaction with the delivery. However, few studies have investigated the comparative effects of these two therapies.

PURPOSE:The aim of this study was to compare the effects of massage and acupressure on labor-related pain management, duration, and satisfaction with delivery.

METHODS:This randomized controlled trial (n = 120) included three intervention groups (massage only, acupressure only, and massage + acupressure) and one control group, in which patients received no massage or acupressure treatment. A personal information form, Pregnant Watch Form, and Visual Analog Scale (VAS) were used to collect data. Frequency and percentage calculations, chi-square test, Student's t test, Tukey's honestly significant difference test, and one-way variance analysis were used for data analysis.

RESULTS:In the latent phase of labor, the mean VAS scores of the massage-only group and massage + acupressure group were lower (4.56± 1.36 and 4.63 ± 1.52, respectively) than that of the control group (6.16 ± 1.46; p<.01). In the active and transition phases, the mean VAS scores of the massage-only group, acupressure-only group, and massage + acupressure group were significantly lower than that of the control group (p<.01 and p<.001, respectively). During postpartum, the mean VAS score of the massage + acupressure group was lower (2.30± 0.70) than that of the control group (2.96 ± 0.72; p = .003). Cervical dilatation completion time and 1- and 5-minute Apgar scores were similar among all of the groups (p>.05). The three intervention groups reported relatively more positive feelings than the control group, and all three of the interventions were found to be effective in improving satisfaction.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE:The results of this study indicate that the dual application of massage and acupressure is relatively more effective than either therapy applied alone and that massage is more effective than acupressure.

: To determine the effect of Reiki on pain and anxiety in women in antepartum, intrapartum, postpartum, gynecology, and gyn/oncology, settings.: This exploratory, comparative study used a Likert-type scale of 0 to 10 to measure pain and anxiety, and a survey asking about lingering effects of treatment.: Mean pain scores after Reiki significantly decreased from 3.24 to 1.52 (= 203; z = -11.67,<.001). Mean anxiety scores after Reiki significantly decreased from 3.56 to 1.28 (= 195; z = -11.42,<.001). Women were asked if the effects lingered for any length of time post-Reiki treatment, and 91 of 101 responded affirmatively that decreased pain and/or anxiety continued.: Findings from this study confirm the positive and lingering effects of Reiki in women hospitalized for obstetrical and gynecological conditions.

BACKGROUND: Our purpose was to assess benefits and possible disadvantages of water births and to compare maternal and neonatal outcomes with normal vaginal deliveries. METHODS: This case-controlled study was carried out between January 2000 and July 2001. A total of 140 women who wanted water births were enrolled into the study. Our analysis was restricted to a sample of women with a gestational age>37 weeks, a normal sized foetus, a reactive admission cardiotocography, drainage of clear amniotic fluid (if the membranes were already ruptured) and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded. 140 controls were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. RESULTS: A statistically significant lower rate of episiotomies (p = 0.0001) and vaginal trauma (p = 0.03) was detected in the group assigned to water birth, whereas the frequency of perineal tears and labial trauma remained similar in both groups (p>0.05). A statistically significant decrease in the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.002) was observed in women who had water births. A trend towards a reduction of the length of the first stage of labour was only observed in primiparous women bearing in water, but this reduction did not reach statistically significance (p>0.05). Manual placenta removal (p = 0.017), severe postpartum haemorrhage (blood loss>500 ml; p = 0.002) and maternal infection rate (p = 0.03) were statistically significant lower in women who delivered in water. When analysing the postpartum haemoglobin, no statistically significant differences could be observed between the two groups (p>0.05). No statistically significant differences were detected for neonatal parameters (p>0.05) between women who had had water births and those choosing conventional vaginal delivery.

BACKGROUND: Having considered the physiologic challenges during pregnancy, scientists have searched for different delivery methods with minimal medical intervention. The use of water immersion by women for relaxing during labor is being used worldwide. We aimed to evaluate the controversies surrounding water birth and to find out the interest of Iranian women in this delivery method. METHODS: In a randomized clinical trial, 106 pregnant women were assigned to control and experimental groups. The experimental group underwent the labor and delivery in standardized warm water pools. The control group gave birth by conventional delivery method at the hospital. A questionnaire was completed during the labor for women in both control and experimental groups including the method of delivery; labor length; use of different drugs such as analgesics, opiates, antispasmodic, and oxytocin; use of episiotomy, and newborn's Apgar score and weight. RESULTS: Totally, 53 cases and 53 controls with the mean age of 26.4+/-5.9 and 27.1+/-5.9 years, respectively, completed the study. Women in the control group required oxytocin, antispasmodics, opiates, and analgesics more frequently than those in the experimental group (P<0.001). Meanwhile, the active phase and the third stage of labor were shorter experimental group by 72 and 1.3 minutes, respectively (P<0.004, and P<0.04). All the participants in the experimental group gave birth naturally, whereas only 79.2

OBJECTIVE: The aim of the study was to compare the maternal and neonatal morbidity associated with elective cesarean sections with planned vaginal delivery. METHODS: A total of 178 women with elective cesarean section were compared with the next parity- and age-matched women presenting in spontaneous labor. Our analysis was restricted to a sample of low-risk obstetrical women. Maternal and neonatal outcomes were the main outcome variables of interest. Maternal morbidity outcome variables included wound infection, trauma, puerperal febrile morbidity and significant blood loss (>500 ml). Neonatal outcomes were captured by Apgar scores, cord pH as well as the occurrence of neonatal infections. RESULTS: A significantly higher rate of puerperal febrile morbidity (n = 46 vs. 14, p = 0.0001) and wound infections (n = 16 vs. 2, p = 0.0001) could be detected in the elective cesarean section group. Additionally, a significant blood loss>500 ml was more than twice as frequent in the cesarean section group (n = 22 vs. 10, p = 0.03) with non-significant lower postpartum hemoglobin levels being observed (10.4 vs. 11.2 g/dL, p>0.05). A significant increase for the use of iron supplementation (n = 146 vs. 122, p = 0.002), analgesics (n = 168 vs. 60, p = 0.0001) and antibiotics (n = 48 vs. 18, p = 0.0001) could be found in the puerperal period and hospital admission was prolonged in elective cesarean section (6.8 vs. 3.5 days, p = 0.0001). Additionally, problems in breastfeeding occurred more frequently in this group (n = 18 vs. 4, p = 0.002). Neonatal complications were generally low in both the groups with no significant differences being observed (p>0.05). CONCLUSION: The increased maternal morbidity in elective cesarean section included puerperal febrile morbidity, wound infections as well as breastfeeding problems in the postpartum period. Women should be sufficiently counseled regarding the increased risk of these complications.

PURPOSE: To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term. METHODS: A retrospective matched cohort study consisting of 403 nulliparous women induced at≥292 days and 806 nulliparous women with spontaneous labour at 285-291 days. RESULTS: Compared to those in spontaneous labour, women who had induction of labour were three times more likely to have a caesarean delivery (OR 3.1, 95% CI 2.4-4.1; P < 0.001). Women who had induction of labour were 2.2 times more likely to have oxytocin augmentation (OR 2.2, 95% CI 1.7-2.8; P < 0.001), 3.6 times more likely to have epidural anaesthesia (OR 3.6, 95% CI 2.8-4.6; P < 0.001), 1.7 times more likely to have uterine hyperstimulation (OR 1.7, 95% CI 1.1-2.6), 2 times more likely to have a suspicious foetal heart rate trace (OR 2.0, 95% CI 1.5-2.6), 4.1 times more likely to have blood loss over 500 ml (OR 4.1, 95% CI 2.9-5.5; P < 0.001), and 2.9 times more likely to stay in hospital beyond 5 days (OR 2.9, 95% CI 1.5-5.6; P < 0.001). Babies born to mothers who had induction of labour were significantly more likely to have an Apgar score of<5 at 5 min and an arterial cord pH of<7.0. CONCLUSION: Compared to those with spontaneous labour, nulliparous women with induced labours are more likely to have uterine hyperstimulation, caesarean delivery, and babies with low Apgar scores. Nulliparous women should be made aware of this, as well as potential risks of expectant management during counseling.

Twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor, or to receive coaching in breathing alone (a technique learned during prenatal classes). The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor. In addition, the massaged mothers had significantly shorter labors, a shorter hospital stay and less postpartum depression.