For women giving birth for the first time and requiring an induction of labour, are we able to reduce duration of labour by giving oxytocin in an intermittent (or pulsatile) manner, as opposed to a continuous oxytocin infusion.

INTERVENTION: Nulliparous women who either request or have an obstetric indication for induction of labour, will be randomised to either a continuous oxytocin infusion (comparator) or an intermittent (pulsatile) oxytocin infusion (intervention). The stock solution of oxytocin is 30 IU in 500 ml Hartmann's solution. As per Institutional policy and NSW guidelines, obstetric consultation is required if the rate of oxytocin is increased above 20 ml/hr (20 mU/min). For the treatment group, pulsatile oxytocin is initiated by a 0.1 ml infusion of oxytocin every 3 minutes (equivalent to 2 ml/h, with the rate increased every 30 minutes until 4 uterine contractions occur within 10 minutes. The maximum rate of infusion is set at 1.6 ml every 3 minutes (equivalent to 32 ml/h). The oxytocin infusion continues until birth of the neonate. The rate of infusion may be turned down or turned off if uterine tachysystole, uterine hypertonus or uterine hyperstimulation occurs, or if fetal cardiotocographic tracing indicates fetal distress. A review of the electronic medical record documentation will ensure fidelity to the intervention. Women are allowed to eat and drink ad libitum CONDITION: Labour (induction of);Childbirth; ; Labour (induction of) ; Childbirth Reproductive Health and Childbirth ‐ Antenatal care Reproductive Health and Childbirth ‐ Childbirth and postnatal care Reproductive Health and Childbirth ‐ Fetal medicine and complications of pregnancy PRIMARY OUTCOME: The primary outcome is the duration of labour as defined by commencement of the oxytocin infusion, post amniotomy, until birth of the neonate. The time of commencement of the oxytocin infusion is documented in the participant's medical record, as is the time of birth of the neonate. The elapsed time between these two time points will be calculated in minutes, thus providing the duration of labour, in minutes.[The measurement being used is elapsed time, from commencement of the oxytocin nfusion, until birth of the neonate and this will be determined from the documentation in the participant's medical record. The primary timepoint is birth of the neonate and this timepoint will be used to calculate the elapsed time frm commencement of the oxytocin infusion] INCLUSION CRITERIA: Nulliparous women who have a singleton pregnancy of cehpalic presentation, at least 37 weeks gestation and either requesting or have an obstetric indication, for induction of labour and have already provided written informed consent for induction of labour. SECONDARY OUTCOME: Apgar score <= 7[Apgar measurement scale as used by the midwife. Five minutes post birth of the neonate.] Birth satisfaction score.[Summation of scores obtained using the validated Labour Agentry Scale questionnaire. Day 1 postpartum.] Birth satisfaction score.[Summation of the scores obtained using the validated Birth Satisfaction Score ‐ Australian Revised questionnaire. Day 1 postpartum.] Exclusive breastfeeding.[Verbal confirmation via a telephone call to the mother with regards to her breastfeeding status. 3 months post birth of the neonate.] Exclusive breastfeeding.[Verbal confirmation via a telephone call to the mother with regards to her breastfeeding status. One month post birth of the neonate.] Incidence of all cause neonatal admission to the special care nursery.[Retrospective analysis of written notes in the neonate's medical history. Two weeks post birth of the neonate, a retrospective analysis of written documentation in the neonate's medical chart will be undertaken.] Incidence of epidural analgesia required.[As documented in the participant's medical record. Birth of the neonate.] Incidence of instrumental births (composite of forceps and ventouse births).[Mode of delivery as documented in the participant's medical record. Birth of the neonate.] Incidence of neonatal hperbilirubinaemia.[Retrospective analysis of written comments in the neonatal medical chart. Two weeks post birth of the neonate, a retrospective analysis of written documenatation in the neonate's medical chart will be undertaken.] Incidence of operative birth (composite of emergency caesarean section and instrumental birth).[Mode of delivery as written in the participant's medical record. Birth of the neonate.] Incidence of postpartum haemorrhage (defined as estimated blood loss >= 500 ml), within the first 24 hours following birth of the neonate.[Blood loss in mls, as either measured by weight or estimated and documented in the participant's medical record. Twenty‐four hours, post birth of the neonate.] Incidence of severe postpartum haemorrhage (defined as estimated blood loss >= 1500 ml), in the first 24 hours following birth of the neonate.[Blood loss in mls, as either measured by weight or estimated and documented in the participant's medical record. Twenty‐four hours, post birth of the neonate.] Incidence of unplanned (emergency) caesarean section.[Mode of delivery as written in the participant's medical record. Birth of the neonate.] Incidence of uterine hyperstimulation.[As documented in the participant's medical record. Birth of the neonate.] Incidence of uterine hypertonus.[As documented in the participant's medical record. Birth of the neonate.] Incidence of uterine tachysystole.[As documented in the participant's medical record. Birth of the neonate.] Total dose of oxytocin received.[As documented in the participant's medical record and described in mU. Birth of the neonate.] Umbilical cord arterial lactate >= 6.1[Pathology analysis of cord arterial blood. Birth of the neonate and sampling from the umbilical cord.] Umbilical cord arterial pH <= 7.00[Pathology analysis of cord arterial blood. Birth of the neonate and sampling from the umbilical cord.]