A comparison of breast stimulation and intravenous oxytocin for the augmentation of labor

Background: Breast stimulation to augment labor has been used for centuries in tribal societies and by midwives. bl recent years it has been shown to be effective in ripening the cervix inducing labor and as an alternative to oxytocin for the contraction stress test. This study compared the effectiv eness of breast stimulation with oxytocin infusion in augmenting labor. Met hods: Women admitted to the labor ward were eligible for the study if they had inadequate labor with premature rupture of the membranes and met inclus ion criteria. They were assigned to oxytocin augmentation or breast stimula tion (manual or pump), and were switched to oxytocin in the event of method failure. Outcomes included time to delivery, intervention to delivery, pro portion of spontaneous deliveries, and Apgar scores. One hundred participan ts were needed in each am? of the study to demonstrate a 2- to 3-hour diffe rence in delivery time, with a power of 80 percent. Results: Analysis was p erformed on 79 women, of whom 49 were in the breast stimulation group and 3 0 in the oxytocin group. Sixty-five percent of the participants failed brea st stimulation and were switched to oxytocin infusion, Although augmentatio n start to delivery was shorter for the oxytocin group (p < 0.001), no diff erences in total labor time occurred between the groups. Nulliparas receivi ng breast stimulation had more spontaneous (relative risk 1.7, p = 0.04). a nd fewer instrumental deliveries than those receiving oxytocin (relative ri sk 0.2, p = 0.02). No significant differences in adverse fetal outcomes occ urred between the study groups. Conclusions: The small number of participan ts and a variety of problems with the conduct of the study prevented the fo rmulation of reliable conclusions from the results. However the study provi ded important insights into the feasibility and problems of developing a hi gh-quality randomized trial of augmentation by breast stimulation.