Labour: helping nature along

The most mother- and baby-friendly route for conventional measures is:

• Sweeping of the membranes (that is moving the tough membrane covering of the cervix aside). This can be painful but effective. And because it does not involve drugs it has few adverse effects for you or your baby.
• Synthetic hormones; prostaglandin pessaries or gel first, then if these fail syntocinon.
• Artificial rupture of the membranes or ARM. This is when your practitioner uses a small instrument to burst the bag of waters which surround your baby. Many hospitals start with ARM but you don’t have to agree to this. Keeping your waters intact means that your baby still has the amniotic fluid to protect its head from the powerful contractions which can follow, should you need to use synthetic hormones.

Cammu H et al, ‘To bathe or not to bathe’ during the first stage of labour, Acta Obstet Gynecol Scand, 1994; 73: 235-9

Cardozo, L, Is routine induction of labour at term ever justified?, BMJ, 1993; 306: 840-1

Diaz, AG et al, Vertical position during the first stage of the course of labour, and neonatal outcome, Eur J Obstet Gynecol Reprod Biol, 1980; 11: 1-7

Enkin, M, et al, A Guide to Effective Care in Pregnancy & Childbirth (Second Edition), Oxford University Press, 1995

Fraser W et al, Effects of early augmentation of labor with amniotomy and oxytocin in nulliparous women: a meta-analysis, Br J Obstet Gynaeol, 1998; 105: 189-94

Frigoletto FD et al, A clinical trial of active management of labor, New Eng J Med, 1995; 333: 745-50

Hemminki, E et al, Ambulation versus oxytocin in protracted labour: a pilot study, Eur J Obstet Gynecol Reprod Biol, 1985; 20: 199-208

National Childbirth Trust (1989), Rupture of the Membranes in Labour, NCT (London)Olah, KSJ,

Neilson, JP (1994), Failure to progress in the management of labour, British Journal of Obstetrics and Gynaecology, Vol 101, No 1, p1-3

Read, JA et al, Randomized trial of ambulation versus oxytocin for labor enhancement, a preliminary report, Am J Obstet Gynecol, 1981; 139: 669-72

Rogers, R et al, Active management of labor: does it make a difference?, Am J Obstet Gynecol, 1997; 177: 599-605

Thornton, JG, Lilford, RJ (1994) Active management of labour: current knowledge and research issues, BMJ, 1994; 309: 366-9.