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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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https://afar.info/id=300

Created on : 22 Dec 2003
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Maternal satisfaction with active management of labor: a randomized controlled trial. Birth. 2001 Dec;28(4):225-35.

Author(s) :

Sadler LC, Davison T, McCowan LM.

Year of publication :

2001

URL(s) :

http://www.blackwell-synergy.com/openurl?genre=art…

Résumé (français)  :

Abstract (English)  :

BACKGROUND: Active management of labor reduces the length of labor and rate of prolonged labor, but its effect on satisfaction with care, within a randomized controlled trial, has not previously been reported. The study objectives were to establish if a policy of active management of labor affected any aspect of maternal satisfaction, and to determine the independent explanatory variables for satisfaction with labor care in a low-risk nulliparous obstetric population.

METHODS: Nulliparous women at National Women’s Hospital in Auckland, New Zealand, in spontaneous labor at term with singleton pregnancy, cephalic presentation, and without fetal distress were randomized after the onset of labor to active management (n = 320) or routine care (n = 331). Active management included early amniotomy, two-hourly vaginal assessments, and early use of high dose oxytocin for slow progress in labor. Routine care was not prespecified. Maternal satisfaction with labor care was assessed by postal questionnaire at 6 weeks postpartum. Sensitivity analyses were performed, and logistic regression models were developed to determine independent explanatory variables for satisfaction.

RESULTS: Of the 651 women randomized in the trial, 482 (74%) returned the questionnaires. Satisfaction with labor care was high (77%) and did not significantly differ by treatment group. This finding was stable when sensitivity analysis was performed. The first logistic regression model found independent associations between satisfaction and adequate pain relief, one-to-one midwifery care, adequate information and explanations by staff, accurate expectation of length of labor, not having a postpartum hemorrhage, and fewer than three vaginal examinations during labor. The second model found fewer than three vaginal examinations and one-to-one midwifery care as significant explanatory variables for satisfaction with labor care.

CONCLUSIONS: Active management did not adversely affect women’s satisfaction with labor and delivery care in this trial. Future studies should concentrate on measurement of potential predictors before and during labor.

Sumário (português)  :

Comments :

Valeur methodologique plus que discutable puisque les conditions du traitement
actif etaient strictement specifiees, alors que celles du traitement non actif
ne l’etaient pas. Je ne comprends pas que le referee ait laisse passer. Les
correlations trouvees sont interessantes mais sont en fait sans rapport avec
le probleme initial pose.

Argument (français) :

Argument (English):

Argumento (português):

Keywords :

➡ duration of labour ; exams during labor ; pain medication ; oxytocin ; epidural ; rupture of membranes ; active management of labor ; amniotomy ; postpartum hemorrhage ; pain ; hormones

Author of this record :

Cécile Loup — 22 Dec 2003

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