RE: [ozmidwifery] trials

[Mary Murphy]

Title: Message

I attended a birth at home early this morning as “2nd midwife”. Primip, vaginal water birth, non -directed second stage, physiologic 3rd stage.  Small 2nd deg. Tear, sutured by midwife. A beautiful birth of a.3.7kg baby.   I was speaking to a midwife who works in the birth suite of our large teaching hospital where about 5,000 women give birth.  Some high risk but most potentially normal birth.  She was thrilled to hear about the birth.  She said she “never” sees anything like it where she works.  How sad,.  MM Subject: RE: [ozmidwifery] trials   vaginal birth not achieved in 24 hours misoprostol 46.0% v dinoprostone 41.2%   okay so if 46% did not birth vaginally and 22.7% had cs what happened to the other  23.3% that didn't birth vaginally????   Also, are women going to be told that they have almost a 50% chance of needing a cs with an induction?   That inductions fail almost half the time....gee I know, lets do what the prominent OB from Adelaide is suggesting and induce all women at 39 weeks and almost double our cs rate!    caesarean section 22.7% v 26.6%   and we wonder why we have a national cs rate of over 25%!!!    caesarean section for fetal distress 8.8%  v 9.3%    uterine hyper stimulation with changes in fetal heart rate 0.8% v 1.6%  and yet the risk of rupture being an estimated 0.3% is too high to offer vbac as an option....lets give these women a drug that can hyper stimulate their uteri and increase the chance of serious morbidity or mortality and potentially leave them with a ruptured uterus despite not having a previous scar.   *sigh* I seriously wonder sometimes how these academics get funded! Oh sorry, this was a drug company who will benefit from this study...not women.   I have a suggestion: why doesn't someone get funding to do a trial into spontaneous non-interventative (minus the actual medical need)birth vs. active management and compare the outcomes?  Lets actually see if natural noninvasive supported and educated birth is fraught with the dangers that we get thrown at us.  grr grr grr Jo   -----Original Message----- From: owner-ozmidwifery@acegraphics.com.au [mailto:owner-ozmidwifery@acegraphics.com.au] On Behalf Of Mary Murphy Sent: Saturday, March 04, 2006 7:08 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] trials At least they asked the women’s preference. Guess what they chose?  MM Oral misoprostol for induction of labour at term: randomised controlled trial - BMJ , vol 332, no 7540, 4 March 2006, pp 509-511 Dodd JM; Crowther CA; Robinson JS - (2006) OBJECTIVE: To compare oral misoprostol solution with vaginal prostaglandin gel (dinoprostone) for induction of labour at term to determine whether misoprostol is superior. DESIGN: Randomized double blind placebo controlled trial. SETTING: Maternity departments in three hospitals in Australia.Population Pregnant women with a singleton cephalic presentation at >/=36+6 weeks' gestation, with an indication for prostaglandin induction of labour. INTERVENTIONS: 20 microg oral misoprostol solution at two hourly intervals and placebo vaginal gel or vaginal dinoprostone gel at six hourly intervals and placebo oral solution. MAIN OUTCOME MEASURES: Vaginal birth within 24 hours; uterine hyperstimulation with associated changes in fetal heart rate; caesarean section (all); and caesarean section for fetal distress. RESULTS: 741 women were randomised, 365 to the misoprostol group and 376 to the vaginal dinoprostone group. There were no significant differences between the two treatment groups in the primary outcomes: vaginal birth not achieved in 24 hours (misoprostol 168/365 (46.0%) v dinoprostone 155/376 (41.2%); relative risk 1.12, 95% confidence interval 0.95 to 1.32; P=0.134), caesarean section (83/365 (22.7%) v 100/376 (26.6%); 0.82, 0.64 to 1.06; P=0.127), caesarean section for fetal distress (32/365 (8.8%) v 35/376 (9.3%); 0.91, 0.57 to 1.44; P=0.679), or uterine hyperstimulation with changes in fetal heart rate (3/365 (0.8%) v 6/376 (1.6%); 0.55, 0.14 to 2.21; P=0.401). Although there were differences in the process of labour induction, there were no significant differences in adverse maternal or neonatal outcomes. CONCLUSIONS: This trial shows no evidence that oral misoprostol is superior to vaginal dinoprostone for induction of labour. However, it does not lead to poorer health outcomes for women or their infants, and oral treatment is preferred by women. Trial registration National Health and Medical Research Council, Perinatal Trials, PT0361. (11 references) (Author)   -- No virus found in this incoming message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006 -- No virus found in this outgoing message. Checked by AVG Free Edition. Version: 7.1.375 / Virus Database: 268.1.1/273 - Release Date: 3/2/2006