Labour augmentation and fetal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births

Who decides the position for birth? A follow-up study of a randomised controlled trial

“…14 However a recent survey from the Netherlands answered by 1154 women reported that 58.9 % preferred supine positions, 19.6 % preferred non-supine positions and 21.5 % had no distinct preference. 15 Midwives' personal attitudes and own physical capacity were shown, to some extent, to have an impact on the adherence-rate in an RCT by Thies-Lagergren et al 16 and other researchers have also suggested that midwives have an impact on women's birth position. 1, 7 Non-adherence in intrapartum studies is a problem that has been discussed in a study by Hundley and Cheyne.…”

“…Further details of the recruitment have been reported previously. 3,16 The committee for research ethics in Lund, Sweden gave approval for the study (protocol 2009/739). A completed questionnaire was interpreted as informed consent.…”

Striving for scientific stringency: a re-analysis of a randomised controlled trial considering first-time mothers’ obstetric outcomes in relation to birth position

“…The present article is based on data collected in an RCT by Thies-Lagergren et al [9,11] and is a re-analysis of the following outcomes; synthetic oxytocin for augmentation of labour, perineal outcomes (episiotomies/lacerations/oedema), postpartum blood loss, duration of labour. An additional analysis regarding use of epidural analgesia was carried out.…”

“…A secondary analysis, also carried out according to the ITT principal, was performed to assess whether birth on the birth seat affected the use of synthetic oxytocin for augmentation of the second stage of labour, duration of labour and infant outcomes. The main findings of that analysis were that women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women who received synthetic oxytocin augmentation in both groups and that neonatal outcomes did not differ between the groups [11]. …”

“…Analysis according to the received treatment or “on-treatment” (OT) analysis is carried out without regard to the initial randomization and may be considered as a complement to ITT analysis when non-compliance is substantial, however with an increased risk for selection bias [18]. There was considerable non-compliance (49.5%) to randomization in the RCT by Thies-Lagergren et al [9,11] and it is important to attempt to understand if the results, which showed a shortened second stage of labour and increased blood loss were associated with the use of the birth seat per se. Therefore, the present article is in response to colleagues’, researchers’ and reviewers’ questions about how the results of the maternal outcomes in the two ITT analyses [9,11] might be, if analysis was carried out according to how women actually gave birth (OT).…”