Upright Versus Recumbent Position in the Second Stage of Labor for Women With Epidural Analgesia: A Randomized Clinical Trial
Abstract
Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.
2. Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019;19:466.
3. Desseauve D, Fradet L, Lacouture P, Pierre F. Position for labor and birth: State of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol 2017:208:46-54.
4. Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017;5:CD002006.
5. Bodner-Adler B, Bodner K, Kimberger O, Lozanov P, Husslein P, Mayerhofer K. Women’s position during labour: Influence on maternal and neonatal outcome. Wien Klin Wochenschr 2003;115:720-3.
6. Borges M, Moura R, Oliveira D, Parente M, Mascarenhas T, Natal R. Effect of the birthing position on its evolution from a biomechanical point of view. Comput Methods Programs Biomed 2021;200:105921.
7. Zang Y, Lu H, Zhao Y, Huang J, Ren L, Li X. Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta-analysis. J Clin Nurs 2020;29:3154-69.
8. Yadav A, Kamath A, Mundle S, Baghel J, Sharma C, Prakash A. Exploring the perspective of nursing staff or caregivers on birthing positions in Central India. J Family Med Prim Care 2021;10:1149-54.
9. Walker KF, Kibuka M, Thornton JG, Jones NW. Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database Syst Rev 2018;11:CD008070.
10. Anim-Somuah M, Smyth RMD, Cyna AM, Cuthbert A. Epidural versus non-epidural or no analgesia for pain management in labour. Cochrane Database Syst Rev 2018;5:CD000331.
11. Hajipour A, Montaseri A, Rahimi M, Orandi A, Rahmah L, Samadi S. The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study. Acta Med Iran 2023;61:531-9.
12. Cichowski S, Rogers R. ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol 2018;132:e87-102.
13. Goh R, Goh D, Ellepola H. Perineal tears - A review. Aust J Gen Pract 2018;47:35-8.
14. Watterberg KL, Aucott S, Benitz WE, Cummings JJ, Eichenwald EC, Goldsmith J, et al. The apgar score. Pediatrics 2015;136:819-22.
15. Bick D, Briley A, Brocklehurst P, Hardy P, Juszczak E, Lynch L, et al. Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. BMJ 2017;359:j4471.
16. Packer C, Hersh AR, Greiner KS, Gallagher A, Caughey AB. Recumbent Versus Upright Positioning During Labor with an Epidural: A Cost-Effectiveness Analysis [13D]. Obstetrics & Gynecology. 2019;133:45S-44S.
17. Zang Y, Lu H, Zhang H, Huang J, Zhao Y, Ren L. Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews. Int J Nurs Stud 2021:114:103812.
Files | ||
Issue | Vol 61 No 11 (2023) | |
Section | Articles | |
DOI | https://doi.org/10.18502/acta.v61i11.16076 | |
Keywords | ||
Epidural analgesia Natural vaginal delivery Cesarean section Labor stages Patient positioning |
Rights and permissions | |
![]() |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |