Immersion in water in pregnancy, labour and birth.

Background: Enthusiasts for immersion in water during labour, and birth have advocated its use to increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of supportive care. Sceptics are concerned that there may be greater harm to women and/or babies, for example, a perceived risk associated with neonatal inhalation of water and maternal/neonatal infection.

Objectives: To assess the evidence from randomised controlled trials about the effects of immersion in water during pregnancy, labour, or birth on maternal, fetal, neonatal and caregiver outcomes.

Perineal trauma: prevention and treatment.

This article examines two aspects of routine midwifery practice: management of the perineum at the end of the second stage of labor and management and repair of perineal injury. Although some aspects of perineal management and repair have been researched and there is reliable evidence on which to base practice, there remains a considerable and urgent collaborative clinical research agenda that midwives should actively pursue.

Systematic review of economic aspects of alternative modes of delivery.

Objective: To carry out a systematic review of the literature relating to economic aspects of alternative modes of delivery.

Methods: A comprehensive literature search of the years 1990-1999 was conducted of electronic and non-electronic sources using a tested search strategy. Papers considered to contain useful cost or resource use data were read in full and classified according to their relevance to the review and their methodological quality.

Distribution of genital tract trauma in childbirth and related postnatal pain.

Background: The full extent of genital tract trauma in spontaneous births is not well documented. The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large randomized clinical trial of perineal management techniques (n = 5471).

Methods: Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth (n = 5404).

A randomised controlled trial of care of the perineum during second stage of normal labour.

Objective: To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth.

Design: Randomised controlled trial.

Setting: Two English maternity care units.

Active versus expectant management of third stage of labour: the Hinchingbrooke randomised controlled trial.

Background: This study tested the hypotheses that active management of the third stage of labour lowers the rates of primary postpartum haemorrhage (PPH) and longer-term consequences compared with expectant management, in a setting where both managements are commonly practised, and that this effect is not mediated by maternal posture.

Background: 1512 women judged to be at low risk of PPH (blood loss >500 mL) were randomly assigned active management of the third stage (prophylactic oxytocic within 2 min of baby's birth, immediate cutting and clamping of the cord, delivery of placenta by controlled cord traction or maternal effort) or expectant management (no prophylactic oxytocic, no cord clamping until pulsation ceased, delivery of placenta by maternal effort). Women were also randomly assigned upright or supine posture.

Immersion in water during labor and birth: the need for evaluation.

Despite widespread and increasing use of immersion in water during labor, birth, or both in many different countries, no reliable information is available about its advantages, hazards, and resource implications. We describe the development of immersion in water during labor and birth, the current use of this form of care in the United Kingdom, the research that has been conducted to date, and possible strategies for future research. Three approaches to research are suggested: a survey of existing practice, a randomized controlled trial, and a confidential register of serious adverse events.