Abstract
The study was undertaken to consider the differences between women undergoing induction or spontaneous labour. Two research strategies were used. First, in a prospective study, at one hospital, 156 women (78 underwent induction and 78 spontaneous labour) with uneventful medical and obstetric histories were observed. Second, a retrospective study was undertaken at three hospitals. At each hospital eighty sets of notes (40 of women who underwent induction and 40 in spontaneous labour) were reviewed. Four phases during parturition were studied: labour, delivery, foetal outcome and puerperium. The null hypothesis, that there are no differences between parturients whose labours are either spontaneous or induced on maternal observations, uterine contractions, length of labour, analgesia, somatic symptoms, delivery, foetal outcome, puerperium, "Blues" and depression assessment, could not be rejected. This was most likely due to the similarities between the research groups in their demographic homogeneity, in the medical and midwifery interventions both groups received. These were; artificial rupture of amniotic membranes, intravenous fluids, foetal monitoring, and analgesia. However, the data did reveal some differences which may be related to the level of interventions that took place. These were: oxytocin dosages and the number of epidural analgesia top- up doses. Adverse effects experienced by a woman or her foetus were directly proportional to the degree of the interventions. Women to whom epidural analgesia and also high doses of oxytocin were administered, exhibited a wider range of blood pressure during labour. While uterine contractions increased in all three dimensions (intensity, frequency and length) throughout labour in both research groups, they were more intense, more frequent and longer among the women who underwent induction. However, at a level of six centimetres of cervical dilatation the uterine contractions among the women in both research groups reached a plateau and remained similar until delivery. This stable phase existed irrespective of exogenous oxytocin administration. The administration of the uterotonic drug, oxytocin, may have been responsible for a higher uterine activity among the women who underwent Induction of labour than the women who had spontaneous labour. The affect epidural analgesia had on labour and delivery depended on the level of cervical dilatation at the first dose and on the number of top-up doses administered. Although epidural analgesia was highly effective, administration early in labour did impede internal rotation of the presenting part, lengthened the second stage of labour and Increased forceps deliveries. The type of interventions were similar at the four hospitals. However, the degree of interventions varied and this revealed differences in maternal and foetal responses. There also seemed to be less hesitancy to Induce labour at the four hospitals, as compared to the documented number of Induction of labour undertaken for medical reasons. This seemed to be due to the availability of cardiotoco-graphic monitoring, pharmacological control, improved obstetric and paediatric care and effective analgesia. Generally the physical and physiological symptoms that were measured in relation to cervical dilatation such as maternal pulse and temperature, bladder distension, also the discomforts that may accompany normal labour such as: maternal dry mouth, hyperventilation, irritability, perspiration, pressure sensation of the extremities and stiff muscles were experienced at an earlier cervical dilatation among the women whose labours were induced. The occurrence of these symptoms may have been contingent on the earlier admission to the labour ward: of the women who underwent induction. Since this was an exploratory study, further research is needed. However, the systematic look at the differences between the women who underwent Induction or spontaneous labour was certainly valuable. The study identified some areas that can be pursued by further research and may serve as a basis for differential midwifery intervention.