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Position in the second stage of labour for women without epidural anaesthesiaGupta JK, Hofmeyr GJ, Smyth RMD
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SummaryPosition in the second stage of labour for women without epidural anaesthesiaWomen should be encouraged to give birth in comfortable positions, which are usually upright. In traditional cultures, women naturally give birth in upright positions like kneeling, standing etc. In western societies, doctors have influenced women to give birth on their backs, sometimes with their legs up in stirrups. The review of trials found the studies were not of good quality, but they showed that when women gave birth on their backs it was more painful for the mother and caused more problems with the baby's heartbeat. More women needed help from doctors using forceps and more had cuts to the birth outlet, but there was less blood loss. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
January 24. 2000 AbstractBackgroundFor centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies. ObjectivesTo assess the benefits and risks of the use of different positions during the second stage of labour (i.e. from full dilatation of the cervix). Search strategyWe searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 September 2005). Selection criteriaTrials that used randomised or quasi-randomised allocation and appropriate follow up and compared various positions assumed by pregnant women during the second stage of labour. Data collection and analysisWe independently assessed the trials for inclusion and extracted the data. Main resultsResults should be interpreted with caution as the methodological quality of the 20 included trials (6135 participants) was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: reduced duration of second stage of labour (9 trials: mean 4.28 minutes, 95% confidence interval (CI) 2.93 to 5.63 minutes) - this was largely due to a considerable reduction in women allocated to the use of the birth cushion; a small reduction in assisted deliveries (19 trials: relative risk (RR) 0.80, 95% CI 0.69 to 0.92); a reduction in episiotomies (12 trials: RR 0.83, 95% CI 0.75 to 0.92); an increase in second degree perineal tears (11 trials: RR 1.23, 95% CI 1.09 to 1.39); increased estimated blood loss greater than 500 ml (11 trials: RR 1.63, 95% CI 1.29 to 2.05); reduced reporting of severe pain during second stage of labour (1 trial: RR 0.73, 95% CI 0.60 to 0.90); fewer abnormal fetal heart rate patterns (1 trial: RR 0.31, 95% CI 0.08 to 0.98). Authors' conclusionsThe tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss greater than 500 ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time as the benefits and risks of various delivery positions are estimated with greater certainty, when methodologically stringent trials' data are available, women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies. |