Arch Gynecol Obstet (2009) 279:813820

DOI 10.1007/s00404-008-0818-x
1 3
ORI GI NAL ARTI CLE
A randomised controlled trial of amniotomy and immediate
oxytocin infusion versus amniotomy and delayed oxytocin
infusion for induction of labour at term
Dan O. Selo-Ojeme Pradnya Pisal Olalekan Lawal
Cathy Rogers Abhijeet Shah Smitha Sinha
Received: 30 June 2008 / Accepted: 6 October 2008 / Published online: 29 October 2008
Springer-Verlag 2008
Abstract
Background There is uncertainty as to the optimal time
interval between amniotomy and oxytocin administration
when inducing labour. The aim of this study was to com-
pare the eYcacy of amniotomy and immediate oxytocin
infusion with amniotomy and delayed oxytocin infusion for
induction of labour at term.
Method A total of 123 women were randomly chosen to
receive either amniotomy and immediate oxytocin infusion
(referred to as the immediate group) or amniotomy and
delayed oxytocin infusion (referred to as the delayed
group). The main outcome measure was the proportion of
women in established labour at 4 h as well as the proportion
that delivered within 12 h of amniotomy. Data were ana-
lysed using standard statistical methods.
Results Women in the immediate group were more likely
to be in established labour 4 h post-amniotomy [relative
risk (RR) 12.8; 95% CI 55.1111.7], have a shorter amniot-
omy to delivery interval (P < 0.001) and achieve vaginal
delivery within 12 h (RR 1.5; 95% CI 1.212.6). There was
no diVerence between the groups with regards to the mode
of delivery, incidence of uterine hyperstimulation and
abnormal foetal heart rate recording. Compared to the
delayed group, women in the immediate group were more
likely to be satisWed with the induction process (RR 4.1,
95% CI 1.116.1) and the duration of labour (RR 1.8 95%
CI 1.03.3).
Conclusion In induction of labour at term, amniotomy
and immediate oxytocin infusion is associated with the
establishment of active labour at 4 h, a shorter amniotomy-
delivery interval and greater maternal satisfaction.
Keywords Amniotomy Induction of labour
Oxytocin infusion Labour augmentation
Maternal satisfaction
Introduction
Induction of labour, a common obstetric intervention, is
used in over 20% of deliveries in the UK [1]. The proce-
dure often involves an amniotomy and an intravenous oxy-
tocin infusion: a combination of two methods used in
clinical practice. Although the combination of both meth-
ods is thought to be more eVective than amniotomy alone
[2, 3], there is uncertainty with regards to the optimal time
interval between the amniotomy and the oxytocin adminis-
tration. Currently, the time interval varies from immediate
oxytocin administration to 4 h following the amniotomy
[2, 46]. The lack of well-accepted, prospective randomised
studies that provide guidance on this issue was highlighted
by Howarth et al. [7] and Bricker et al. [3] who, following
their Cochrane Systematic Reviews, called for further
research into the variable time interval between the primary
(amniotomy) and secondary (intravenous oxytocin) inter-
ventions for induction of labour. A MEDLINE search
(19802008) using the key words induction of labour,
oxytocin infusion and amniotomy, individually and in
combination, revealed that no such study has been per-
formed to date.
The aim of this randomised controlled trial was to test
the hypothesis that there is no diVerence in the proportion
D. O. Selo-Ojeme (&) P. Pisal O. Lawal C. Rogers
A. Shah S. Sinha
Department of Obstetrics and Gynaecology,
Womens Health Division, Barnet and Chase Farm Hospitals
NHS Trust, The Ridgeway, EnWeld EN2 8JL, UK
e-mail: Dseloojeme@aol.com
814 Arch Gynecol Obstet (2009) 279:813820
1 3
of women in active labour 4 h after amniotomy between
women who had an amniotomy followed by immediate
oxytocin infusion (immediate group) and those who under-
went an amniotomy with delayed oxytocin infusion
(delayed group).
Materials and methods
Study design
This was a randomised controlled trial conducted at Barnet
and Chase Farm Hospital, London.
Registration and ethics approval
The study (identiWer ISRCTN35919840: http://www.isrctn.
org) was approved by the Institutional Review Board and
the Barnet, EnWeld and Haringey Local Research Ethics
Committee. All women provided informed written consent.
Prior to the commencement of the study, the lead inves-
tigator held group meetings with senior midwifery staV,
labour ward coordinators, midwives and study assistants to
explain the details of the study. Flyers detailing the study
protocol were posted in the labour ward, antenatal ward and
antenatal clinic.
Inclusion and exclusion criteria for participants
Eligible women with planned induction of labour were
recruited through the antenatal clinic and the antenatal ward
from December 2006 to September 2007. Potential partici-
pants who met the inclusion criteria were provided with an
invitation letter, a patient information leaXet and consent
forms to take home. The inclusion criteria were: nulliparity,
singleton term (37 weeks) pregnancy in cephalic presen-
tation and with intact membranes, no regular uterine con-
tractions (deWned as contraction frequency <1 in 30 min), a
favourable cervix (ModiWed Bishop score 6), no signiW-
cant foetal or maternal medical conditions and no previous
uterine surgery. Women who declined to participate, had
regular uterine contractions or abnormal pre-induction foe-
tal heart rate trace, as detected by cardiotocography (CTG),
were excluded from the study.
Randomisation schedule and allocation
Randomisation, either to the immediate group or the
delayed group, took place on the labour ward. The alloca-
tion sequence was computer generated and allocation con-
cealment was achieved by placing the allocation in serially
numbered, opaque and sealed envelopes. The envelopes
were held in a secure box on the labour ward. The serially
numbered envelopes were opened in sequence by the duty
labour ward coordinator only after a participants details
were written on it. The coordinator then proceeded to
record the randomisation in a speciWc trial register. Follow-
ing randomisation, there were no withdrawals from the
trial.
Treatment schedules
In the immediate group, oxytocin infusion was started
immediately following the amniotomy and subsequent
intrapartum care was provided according to the hospitals
protocol. In the delayed group, an oxytocin infusion was
commenced 4 h post-amniotomy, if the woman was not in
established labour (3 or more contractions in 10 min associ-
ated with cervical changes). The oxytocin infusion regime
used in this hospital was in accordance with the National
Institute for Health and Clinical Excellence (NICE) guide-
lines [8]. Women in both groups were examined 4 h follow-
ing the amniotomy as well as when clinically indicated by
the attending midwife.
Sample size calculation
Based on a review of published literature [2], it was
hypothesised that 90% of women in the immediate group
would deliver within 12 h. To detect a 20% diVerence in the
number of women who would deliver within 12 h in the
delayed group, at an alpha level of 5 and 80% power [9, 10],
60 women were needed in each arm of the study.
Outcome measures
The main outcome measured was the proportion of women
in established labour 4 h following amniotomy and the pro-
portion of women who achieved vaginal delivery within
12 h. For purposes of this study, established labour was
deWned as occurrence of 3 contractions in 10 min associ-
ated with cervical dilatation of >3 cm.
Secondary outcomes included the mode of delivery,
need for epidural analgesia, incidence of uterine hyperstim-
ulation, abnormal foetal heart recordings (by CTG), 5-min
Apgar score <7, umbilical arterial cord pH <7.2 and admis-
sion to neonatal intensive care unit and womens satisfac-
tion.
Abnormal changes in the foetal heart rate were consid-
ered to include: persistent deceleration (early, late, or vari-
able), foetal tachycardia (foetal heart rate >160 beats per
min), foetal bradycardia (foetal heart rate <100 beats per
min) or reduced short-term variability (<5 beats per min)
[11]. Uterine hyperstimulation was deWned as the occur-
rence of more than Wve uterine contractions in 10 min, with
or without foetal heart rate variations. For the duration
Arch Gynecol Obstet (2009) 279:813820 815
1 3
between amniotomy and the commencement of oxytocin
infusion in the delayed group, a 4-h interval was selected.
This choice was made on the basis that in the unit involved
in this study, as in most other units in the UK; women in
spontaneous labour undergo vaginal examination every 4 h,
if there is no clinical indication of the need for an earlier
examination.
Each day, data forms designed speciWcally for this study
were completed by trained assistants, and subsequently
entered into a computerised database.
Following delivery or on admission to the post-natal
ward, a self-administered questionnaire was given to the
women to complete. The questionnaire, which comprised a
seven-point Likert-type scale ranging from very dissatis-
Wed (3) to very satisWed (+3), was adapted from that
used to evaluate overall satisfaction with newborn exami-
nation [12, 13]. The questionnaire was designed to measure
overall satisfaction with the whole induction process as
well as the degree of satisfaction with speciWc components
of the induction process, including the quality of informa-
tion received, events during the induction process, events
during labour, events during delivery and satisfaction
with the care received from medical and midwifery staV.
Participants were asked to put their completed question-
naire in a specially placed box at the ward reception before
leaving the hospital.
Data analysis
The trial was analysed and reported according to CON-
SORT requirements [14]. All statistical analyses were
undertaken on an intention-to-treat basis using Stata statis-
tical software, version 7 (Stata Corp., TX). Dichotomous
outcomes were compared using
2
or Fishers exact test,
with calculation of relative risks (RR) and 95% conWdence
intervals (95% CI). The students t test was used to com-
pare normally distributed continuous data and the Mann
Whitney U test was used to compare skewed data. Any sig-
niWcant diVerence in the baseline characteristics of the
groups was controlled for in the comparative analysis.
Results
The trial proWle is shown in Fig. 1. A total of 123 women
were enrolled into the study. A total of 61 women were
Fig. 1 Trial proWle
297 Excluded
(Did not meet inclusion criteria)
60 Declined to participate
123 Agreed to participate
183 Eligible
480 Screened
Oxytocin not started
immediately: 7 (5 within
30 minutes & 2 after 60
minutes)
61 assigned to
immediate group
Oxytocin started
earlier than 4 hours: 4
62 assigned to
delayed group
61 analyzed 62 analyzed
816 Arch Gynecol Obstet (2009) 279:813820
1 3
assigned to the immediate group, while 62 to the delayed
group. There was noncompliance with the trial protocol in
four women in the delayed group (oxytocin infusion started
earlier than 4 h) and seven women in the immediate group
(5 had oxytocin within 30 min and 2 after 60 min). Other
than ethnicity, participants in both groups were statistically
comparable for age, gestation, BMI, indication for induc-
tion and Bishop score at amniotomy (Table 1).
The maternal outcomes are shown in Table 2. Following
adjustment for ethnicity, signiWcantly more women in the
immediate group had a higher Bishop score (P < 0.001)
and were in established labour at 4 h post-amniotomy
(P < 0.001). The median period from amniotomy to vaginal
delivery for the immediate group was 8 h [interquartile
range (IQR) 513], while for the delayed group it was 10 h
(IQR 718) (P < 0.001). Furthermore, a greater number of
women in the immediate group achieved vaginal delivery
within 12 h of amniotomy (P = 0.015).
There was no diVerence between the groups with regards
to the use of epidural analgesia, mode of delivery, incidence
of uterine hyperstimulation, abnormal foetal heart rate
recording and PPH. No diVerences in perinatal outcomes
Table 1 Baseline characteristics of women in the immediate and
delayed groups
Values are presented as n (%), mean SD
P < 0.001
Immediate
(n = 61)
Delayed
(n = 62)
Maternal age (years) 28.1 4.8 27.9 5.7
Ethnicity*
White 42 (68.9) 52 (83.9)
Black 7 (11.5) 10 (16.1)
Asian 12 (19.6) 0 (0)
Booking BMI 26.8 7.1 26.1 5.3
Smoker 7 (11.5) 5 (8.1)
Gestational age (weeks) 40.9 0.4 40.9 0.2
Vaginal prostaglandin 34 (55.7) 32 (51.6)
Indication for induction
Postdates 58 (95.1) 59 (95.2)
Isolated oligohydramnios 0 (0) 1 (1.6)
Suspected macrosomia 2 (3.3) 0 (0)
Maternal request 1 (1.6) 2 (3.2)
Bishop score at ARM 6.18 0.9 6.37 1.2 0.4231
Table 2 Main maternal
outcomes
Immediate
(n = 61)
Delayed
(n = 62)
RR (95% CI) P
Bishop score at 4 h
a
11.3 0.9 9.5 2.2 <0.001
In labour 4 h post-amniotomy
a
43 (70.1) 27 (44.1) 12.8 (55.1111.7) <0.001
Had oxytocin infusion 61 (100) 50 (80.6) <0.001
Maximum oxytocin dose (mu/min) 11.0 5.1 10.7.6 7.1 0.243
Amniotomy-delivery interval (h)
a,b
Median (IQR) 8 (413) 10 (718) <0.001
Mean 7.7 3.9 10.9 2.9 <0.001
Delivered within 12 h
Vaginal delivery
a
47 (77.1) 38 (58.1) 1.5 (1.012.6) 0.015
Caesarean section 11 (18.0) 15 (24.2) 0.8 (0.51.3) 0.124
Abnormal CTG 24 (39.3) 18 (29) 1.3 (0.81.7) 0.071
Uterine hyperstimulation 3 (4.9) 6 (9.7) 0.6 (0.21.6) 0.168
Puerperal pyrexia 7 (11.5) 5 (8.1) 1.2 (0.72.1) 0.196
Epidural analgesia 32 (52.4) 34 (54.8) 1.0 (0.61.3) 0.114
PPH (>500 ml) 13 (21.3) 15 (24.2) 1.1 (0.51.4) 0.205
Blood transfusion 4 (6.5) 6 (9.6) 1.2 (0.31.7) 0.213
Mode of delivery
Spontaneous vaginal 37 (60.7) 35 (56.5) 1.1 (0.71.5) 0.129
Operative vaginal 12 (19.7) 10 (16.2) 1.1 (0.71.7) 0.163
Cesarean 12 (19.7) 17 (27.4) 1.3 (0.41.2) 0.101
Indication for cesarean
Dystocia 4 (33.3) 8 (47.1) 0.7 (0.31.8) 0.231
Foetal distress 8 (66.7) 9 (52.9) 1.4 (0.53.6) 0.231
Values are presented as n (%),
mean SD
IQR Inter quartile range
a
Adjusted for ethnicity
b
Vaginal delivery
Arch Gynecol Obstet (2009) 279:813820 817
1 3
were found between the two groups and no perinatal deaths
occurred (Table 3).
A total of 75 (60.9%) maternal satisfaction question-
naires were returned. Of these, 39 were from women in the
immediate group and 36 from the delayed group. Table 4
illustrates the satisfaction proWles on the induction pro-
cesses. SigniWcantly, a larger proportion of women in the
immediate group were satisWed with the induction process
(P = 0.03) and the care that they received (P = 0.02), and
they were less likely to be dissatisWed with the time interval
before an oxytocin infusion was introduced (P = 0.04).
However, majority of women in both groups (>60%) were
happy to have induction of labour in future pregnancies.
There were no diVerences between the groups with respect
to satisfaction with the information received before induc-
tion of labour.
Table 5 shows that compared to the delayed group, sig-
niWcantly more women in the immediate group were satis-
Wed with the length of labour (P = 0.02) and their care
during labour (P < 0.001). They were less likely to be dis-
satisWed with the overall experience of labour (P < 0.001).
There were no diVerences between the groups with
regards to their satisfaction with the decisions made and
care given during birth (Table 6).
Table 3 Neonatal outcomes
Immediate
(n = 61)
Delayed
(n = 62)
RR (95% CI) P
Female
Birth weight (g) 3,382.9 572 3,491.2 575
Intrapartum meconium 10 (16.4) 15 (24.2) 0.7 (0.31.4) 0.106
Apgar < 7 at 5 min 2 (3.3) 2 (3.2) 1.0 (0.16.9) 0.382
Arterial cord pH < 7.2 2 (3.3) 0 (0) 0.201
Neonatal admission 2 (3.3) 0 (0) 0.201
Values presented as n (%),
mean SD
Table 4 Satisfaction
with the induction process
Immediate (n = 39) Delayed (n = 36) RR (95% CI) P
The information you got about having your labour induced
DissatisWed 3 (7.7) 2 (5.5) 1.2 (0.52.7) 0.32
Neither 0 (0) 4 (11.1) 0.04*
SatisWed 36 (92.3) 30 (83.4) 2.4 (0.510.4) 0.13
How your labour was induced
DissatisWed 3 (7.7) 6 (16.7) 0.5 (0.091.8) 0.24
Neither 3 (7.7) 0 (0) 0.37
SatisWed 33 (84.6) 30 (83.3) 1.1 (0.33.7) 0.86
Your care while your labour was being induced
DissatisWed 4 (10.3) 2 (5.5) 1.9 (0.311.1) 0.74
Neither 0 (0) 9 (25.0) <0.001*
SatisWed 35 (89.7) 25 (69.5) 2.1 (1.15.2) 0.02*
The length of time you were on delivery suite before you were given oxytocin drip
DissatisWed 0 (0) 4 (11.1) 0.04*
Neither 8 (20.5) 6 (16.6) 1.3 (0.34.1) 0.21
SatisWed 31 (79.5) 26 (72.2) 1.5 (0.53.8) 0.16
Your overall experience of having your labour induced
DissatisWed 3 (7.7) 4 (11.1) 0.6 (0.13.2) 0.27
Neither 0 (0) 5 (13.9) 0.02*
SatisWed 36 (92.3) 27 (75) 4 (1.116.1) 0.03*
Would you have it again?
Yes 26 (66.7) 23 (63.9) 1.1 (0.42.9) 0.18
No 5 (12.8) 9 (25)
Not applicable/no response 8 (20.5) 4 (11.1)
Values presented as n (%)
818 Arch Gynecol Obstet (2009) 279:813820
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Discussion
This study suggests that for induction of labour, the imme-
diate introduction of an oxytocin infusion after amniotomy
results in a greater proportion of women being in estab-
lished labour at 4 h as well as achieving vaginal delivery
within 12 h. In addition, this strategy is associated with a
shorter amniotomy to delivery interval. While it has long
been widely assumed that oxytocin shortens the overall
length of labour, this study is one of the few that has com-
pared the eYcacy of diVerent time intervals between amni-
otomy and introduction of oxytocin.
Previously, Moldin and Sundell [2] had identiWed that an
amniotomy combined with early (1 h post-amniotomy)
oxytocin infusion resulted in a shorter induction-delivery
interval when compared to amniotomy alone. In a study
from the same year, Cammu and Eeckhout [4] compared
routine amniotomy and early intravenous oxytocin (active
management of labour) to a more selective use of amniot-
omy and oxytocin among women in spontaneous labour.
However, contrary to the results of the current study, they
found no diVerence in the duration of labour.
In this study, it was noted that 44% of women in the
delayed group were in established labour 4 h post-amniotomy.
In these women, amniotomy may have stimulated uterine
activity by a combination of uterine decompression and
local prostaglandin release. Nevertheless, 15 (55.5%) of
these 27 women in the delayed group, who were in estab-
lished labour 4 h following the amniotomy, ultimately
required oxytocin augmentation because of ineYcient uterine
activity.
The National Institute for Health and Clinical Excellence
(NICE) [15] has suggested that there is a need for comparative
studies on womens views and experiences for diVerent
methods for induction of labour. This was one of the goals
of this study, and Wndings suggest that the majority of
women in both groups were generally satisWed with the
induction process. Nevertheless, signiWcantly more women
in the delayed group were dissatisWed with the length of
time spent on the delivery suite before oxytocin infusion
was commenced, as well as with the care that they received.
These Wndings mirror those of Hannah et al. [16], who
found that women with pre-labour rupture of membranes at
term viewed immediate induction of labour more positively
than expectant management. This suggests that the satisfac-
tion women express with regards to the methods used for
the induction of labour is closely linked to the speed of the
induction process.
Table 5 Satisfaction with
events during labour
Immediate (n = 39) Delayed (n = 36) RR (95% CI) P
When decisions made about your care in labour
DissatisWed 0 (0) 6 (16.7) <0.001*
Neither 0 (0) 0 (0)
SatisWed 39 (100) 30 (83.3) <0.001*
Things that were done to help relieve your pain in labour
DissatisWed 0 (0) 2 (5.5) 0.22
Neither 0 (0) 2 (5.5) 0.22
SatisWed 39 (100) 32 (89) 0.04*
Your care during your labour
DissatisWed 0 (0) 0 (0)
Neither 0 (0) 10 (27.8) <0.001*
SatisWed 39 (100) 26 (72.2) <0.001*
The length of your labour
DissatisWed 0 (0) 6 (16.7) <0.001*
Neither 7 (17.9) 8 (22.2) 0.7 (0.22.3) 0.24
SatisWed 32 (82.1) 22 (61.1) 1.8 (1.03.3) 0.02*
Your overall experience of labour
DissatisWed 0 (0) 6 (16.7) <0.001*
Neither 8 (20.5) 2 (5.5) 4.3 (1.022.3) 0.04*
SatisWed 31 (79.5) 28 77.8) 1.1 (0.33.3) 0.21
Describe your experience of labour pain
Worse than expected 12 (30.8) 5 (13.9) 2.7 (0.88.8) 0.05
As expected 6 (15.4) 19 (52.8) 0.2 (0.050.4 <0.001
Better than expected 14 (35.9) 9 (25) 1.6 (0.64.5) 0.1
Had no expectations 7(17.9) 3 (8.3) 1.4 (0.82.2) 0.18
Values presented as n (%)
Arch Gynecol Obstet (2009) 279:813820 819
1 3
Participants in this study also expressed a high level of
satisfaction with the information that they received. This is
contrary to the Wndings of studies which highlighted a high
level of maternal dissatisfaction with the quality of infor-
mation given when labour was being induced [1719].
Nevertheless, women in the immediate group were more
likely report greater satisfaction with the information they
received. There may be a feeling among these women that
with the immediate introduction of an oxytocin infusion,
everything necessary has been done to ensure an adequate
progress of labour.
The study had several weaknesses which could be
improved in future designs. Neither obstetrician nor partici-
pants were blinded to the treatment group. The trial is a
pragmatic trial, and the results must be interpreted with this
in mind. Furthermore, the sample size was small, arguably
underpowered, and the trial was undertaken in one hospital.
It may also be argued that the inclusion of women who
were pre-treated with prostaglandin introduces a potential
bias. However, controlling for this possibility was achieved
by randomisation and the proportion did not diVer signiW-
cantly in both groups.
The apparent lack of eVect of various induction regimens
on other maternal and neonatal outcomes should be inter-
preted with caution, since this trial is too small to reliably
demonstrate such eVects on these infrequently occurring
outcomes. In spite of these limitations, it is hoped that this
study will stimulate further research (including larger mul-
ticentre trials), to clarify these results and shed more light
on this subject.
Acknowledgments We are grateful to the labour ward coordinators
and midwives, Dr. Yinka Ogunlola and Dr. Anupa Nandi for their
assistance, and David Wellsted for his statistical advice.
ConXict of interest statement None.
References
1. Government Statistical Service for the Department of Health
(2005) NHS Maternity Statistics, England, 20032004
2. Moldin PG, Sundell G (1996) Induction of labour: a randomised
clinical trial of amniotomy versus amniotomy with oxytocin infu-
sion. Br J Obstet Gynaecol 103:306312
3. Bricker L, Luckas M (2000) Amniotomy alone for induction of la-
bour. Cochrane Database of Systematic Reviews, Issue 4, Art No:
CD002862
4. Cammu H, Eeckhout EV (1996) A randomised controlled trial of
early versus delayed use of amniotomy and oxytocin infusion in
nulliparous labour. Br J Obstet Gynaecol 103:313318
5. Rogers MS (2002) Induction and augmentation of labour. In:
Chamberlain G, Steer P (eds) Turnbull obstetrics, 3rd edn. Chur-
chill Livingstone, London, pp 563579
6. Royal College of Obstetricians and Gynaecologists (RCOG)
(2001) Evidence based clinical guideline number 9: induction of
labour. RCOG Press, London
7. Howarth GR, Botha DJ (2001) Amniotomy plus intravenous synt-
ocinon for induction of labour. Cochrane Database of Systematic
Reviews, Issue 3, Art No: CD003250
8. National Institute for Clinical Excellence (2001) Clinical guideline
D: induction of labour. London
9. Altman DG (2002) ConWdence intervals and sample sizes. In: Alt-
man DG, Machin D, Bryant TN, Gardner MJ (eds) Statistics with
conWdence, 2nd edn. BMJ Books, London, pp 139152
10. Lachim JM (1981) Introduction to sample size determination and
power analysis for clinical trials. Control Clin Trials 2(2):93113
11. Royal College of Obstetricians and Gynaecologists (2001) Evi-
dence based clinical guideline number 8: the use of electronic fetal
monitoring. RCOG Press, London
12. Likert R (1932) A technique for measurement attitudes. Arch Psy-
chol 140:4453
13. Wolke D, Dave S, Hayes J, Townsend J, Tomlin M (2002) Routine
examination of the newborn and maternal satisfaction: a random-
ised controlled trial. Arch Dis Child Fetal Neonatal Ed 86(3):155
160
Table 6 Satisfaction with
delivery events, medical and
midwifery staV
Immediate (n = 39) Delayed (n = 36) RR (95% CI) P
When decisions were made about the birth of your baby
DissatisWed 3 (7.7) 4 (11.1) 0.6 (0.13.2) 0.27
Neither 0 (0) 4 (11.1) 0.04*
SatisWed 36 (92.3) 28 (77.8) 2.8 (0.814.2) 0.05
Your care during the birth of your baby
DissatisWed 0 (0) 2 (5.5) 0.22
Neither 2 (5.1) 4 (11.1) 0.4 (0.072.5) 0.21
SatisWed 37 (94.9) 30 (83.4) 3.7 (0.619.6) 0.08
The doctors who looked after you during your induction and labour
DissatisWed 0 (0) 2 (5.5) 0.22
Neither 0 (0) 0 (0)
SatisWed 39 (100) 34 (94.5) 0.22
The midwives who looked after you during your induction and labour
DissatisWed 0 (0) 4 (11.1) 0.04*
Neither 0 (0) 0 (0)
SatisWed 39 (100) 32 (88.9) 0.04*
Values presented as n (%)
820 Arch Gynecol Obstet (2009) 279:813820
1 3
14. Altman DG, Schulz KF, Moher D, Egger M, DavidoV F, Elbourne
D (2001) The revised CONSORT statement for reporting random-
ized trials: explanation and elaboration. Ann Intern Med 134:663
694
15. National Institute for Clinical Excellence (2007) Clinical guideline
55: intrapartum care. London
16. Hannah ME, Ohlsson A, Farine D, Hewson SA, Hodnett ED,
Myhr TL, Wang EE, Weston JA, Willan AR (1996) Induction of
labor compared with expectant management for prelabor rupture
of the membranes at term. TERMPROM Study Group. N Engl J
Med 334(16):10051010
17. Cartwright A (1977) Mothers experience of induction. Br Med
J 2(6089):745749
18. Nuutila M, Halmesmki E, Hiilesmaa V, Ylikorkala O (1999)
Womens anticipations of and experiences with induction of labor.
Acta Obstet Gynecol Scand 78(8):704709
19. Shetty A, Burt R, Rice P, Templeton A (2005) Womens percep-
tions, expectations and satisfaction with induced laboura
questionnaire-based study. Eur J Obstet Gynecol Reprod Biol
123(1):5661