Delaying pushing in labour has no benefit for women with an epidural and/or spinal for pain relief
For women having their first baby with an epidural and/or spinal anaesthetic for pain-relief, the timing of pushing after full dilatation of the cervix does not affect the numbers that achieve normal vaginal delivery.
The best management for the second stage of labour is still debated. In the UK epidurals are by far the most widely used regional anaesthetic technique for pain relief in labour.
In this large trial, women either pushed immediately or delayed pushing by waiting for 60 minutes. Wo...
Diet and exercise can reduce the risk of developing diabetes during pregnancy
Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes.
Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results.
This systematic review pooled 47 trials and found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, ...
Intravenous oxytocin reduces severe bleeding after vaginal delivery
Routine oxytocin injected directly into the bloodstream, rather than into the muscle, after birth results in fewer people suffering severe bleeding (postpartum haemorrhage).
The overall rate of postpartum haemorrhage (PPH) or side effects was similar between the groups, but the intravenous group had fewer severe haemorrhages, needed fewer blood transfusions and fewer admissions to high dependency care. Intramuscular route oxytocin is currently recommended in the UK, partly due to concerns about...
No benefit from monitoring antiepileptic drug levels in pregnancy
Regular monitoring of antiepileptic drug levels in pregnant women with epilepsy does not improve seizure control compared with clinical features-based monitoring. This NIHR-funded study was conducted across 50 UK hospitals and is the largest randomised trial in pregnant women with epilepsy.
Just over 260 pregnant women with unstable antiepileptic drug levels were assigned to ongoing monthly blood checks or clinical features monitoring. There were no differences in seizures or other pregnancy ou...
Better pain relief for women in labour
Women in labour, who had the short acting strong painkiller remifentanil, rather than pethidine, had less need for further pain relief. Only 19% of women given remifentanil received a subsequent epidural compared with 41% given pethidine. Remifentanil was given intravenously, using a patient-controlled delivery device, and pethidine given by intramuscular injection.
This NIHR-funded study is the first large trial to compare intravenous remifentanil (administered via a patient-controlled deliver...
Women rate quality and safety of birth experience as important
Most healthy women would like a natural birth if possible, but acknowledge the unpredictability and risks of childbirth. They also appreciate the supportive care environment where healthcare providers are competent, kind and respectful to them, their partners and their baby.
In a large review of studies with over 1,800 women’s views on what matters in childbirth, having a healthy baby was important. Avoiding unnecessary medical intervention and retaining a sense of control over their birt...
Inducing labour at or after 41 weeks reduces risks to infants
Inducing labour after the due date slightly lowers the risk of stillbirth or infant death soon after birth compared with watchful waiting. But the overall risk is very low. Induced deliveries may reduce admissions to the neonatal intensive care unit.
Pregnant women having induced labour are less likely to have a caesarean section than those who wait for labour to begin naturally. They may have a slightly higher chance of needing an assisted vaginal birth (for example, using forceps or vacuum ex...
Testing oxygen levels of newborn babies helps find serious heart defects
Measuring oxygen levels in newborn babies as part of routine care can identify cases of critical congenital heart defects sooner than waiting until symptoms appear. If 10,000 babies were screened, pulse oximetry could correctly identify about 5 of the 6 expected asymptomatic cases and might miss one. This international research suggests there would be about 14 false alarms. Waiting until babies are at least 24 hours old minimises the number of these false positives.
Babies with critical heart d...
Balance of long-term benefits and risks of caesarean delivery explained
Caesarean delivery has immediate known benefits and risks for those women who need help in childbirth. This review measures the long-term outcomes for the mothers’ health, the links to a higher risk of childhood illness and the chance of problems with future pregnancies.
The large review of 80 studies from high-income countries used data from nearly 30 million women and compared caesarean section with vaginal delivery. Caesarean delivery was associated with a lower risk of urinary inconti...
Plastic wraps or bags keep pre-term infants warm immediately after birth
Cheap and simple plastic wrapping used in the first 10 minutes after birth helps pre-term and low birth weight infants avoid hypothermia. Infants treated in this way are likely to be warmer when admitted to neonatal intensive care than those treated according to standard care. Pre-term infants are most likely to benefit.
Routine infant care usually involves ensuring the delivery room is warm, drying the infant immediately after birth, wrapping the infant in pre-warmed dry blankets and pre-warmi...