Position in the second stage of labour for women with epidural anaesthesia

Kemp, Emily C; Kingswood, Claire J; Kibuka, Marion; Thornton, Jim

doi:10.1002/14651858.cd008070.pub2

Cited by 55 publications

(51 citation statements)

References 24 publications

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“…For a long time, positions during labor were freely changed and modified according to parturient desires. (13,14) Therefore, maternity nurses may suggest alternative position and support the women in choosing ones that are most conducive to her individualized needs and phase of labor. Parturient women usually respond to her own body's cues, assuming upright positions or changing position frequently to find the best fit for the fetus through the pelvis .…”

Section: Discussionmentioning

confidence: 99%

“…The exclusion criteria were as follows: 1) medical problems or pregnancy-related complications during the study; 2) abnormal fetal presentation (during the study or labor); 3) childbirth before 36 weeks or after 42 weeks of gestation; 4) maternal weight of ≥ 90 kg during the study or labor; 5) neonatal weight of either ≥ 4000 g or < 2500 g; 6) diagnosis of cephalo-pelvic disproportion. Some participants (14) were removed from the study for various reasons including emergency caesarean section (5), epidural anesthesia (2),receivedoxytocin (n=4),premature rupture of membrane (3) Tools: Three tools were used in this study, as follows. Tool I: Socio-demographic and reproductive data structure interview schedule questionnaire.This part was designed and used by the researchers to collect data about the subjects' general characteristics such as age, level of education, as well as their reproductive history.…”

Section: Subjectsmentioning

confidence: 99%

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Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

Zaky¹

2016

IOSR

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Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

Zaky¹

2016

IOSR

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“…The authors concluded that there was no clear evidence about whether or not position in the second stage of labour made a difference to outcomes. 15 Effects on short-and longer-term maternal morbidity An intervention that increases the rate of SVB by reducing the rate of IVD or caesarean section would also be expected to have an effect on short-and longer-term maternal morbidity. Faecal incontinence is clearly documented as being associated with forceps, 11,16 including ongoing symptoms in women who only ever have one forceps delivery.…”

Section: Scientific Backgroundmentioning

confidence: 99%

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

Bick

Briley

Brocklehurst

et al. 2017

Health Technol Assess

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BackgroundEpidural analgesia leads to increased risk of instrumental vaginal delivery (IVD). There is debate about whether or not posture in second-stage labour influences the incidence of spontaneous vaginal birth (SVB).ObjectivesIn nulliparous women with epidural analgesia, does a policy of adopting an ‘upright position’ throughout second-stage labour increase the incidence of SVB compared with a policy of adopting a ‘lying-down’ position?DesignTwo-arm randomised controlled trial.SettingMaternity units in England and Wales.ParticipantsNulliparous women aged ≥ 16 years, at ≥ 37 weeks’ gestation with singleton cephalic presentation and intended SVB, in second-stage labour with an epidural providing effective pain relief.Interventions(1) Upright position to maintain the pelvis in as vertical a plane as possible; and (2) lying-down position to maintain the pelvis in as horizontal a plane as possible.Main outcome measuresThe primary outcome measure was incidence of SVB. Secondary outcomes included augmentation, interventions to maintain blood pressure, duration of labour, episiotomy, genital tract trauma, post-partum haemorrhage, maternal satisfaction, neonatal metabolic acidosis, 5-minute Apgar score of < 4, resuscitation at birth and admission to neonatal unit. At 1 year for (1) women: urinary or faecal incontinence, dyspareunia and health-related quality of life; (2) for infants: major morbidity. A cost–consequences analysis with a time horizon of 1 year after the birth from a NHS perspective.ResultsBetween October 2010 and January 2014, 3236 women were randomised from 41 centres in England and Wales. There was a statistically significant difference in the incidence of SVB between groups, with 35.2% of women achieving a SVB in the upright group, compared with 41.1% in the lying-down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). There was no evidence of differences in most of the secondary maternal or neonatal outcomes, or in long-term outcomes at the 12-month follow-up. No significant overall cost differences were observed between upright and lying-down positions for mothers or their babies.LimitationsMeasurement of adherence was challenging in this unmasked trial, and adherence could be influenced by midwives’ beliefs about the allocated positions. If adherence was poor, this would have diluted the difference between the two groups.ConclusionsThere is clear evidence of the benefit of adopting a lying-down position in second-stage labour in nulliparous women with epidural analgesia, with no apparent disadvantages in either short- or long-term outcomes for mother or baby, and this is cost neutral for the NHS.Future workQuestions remain about whether or not other positions could increase the incidence of SVB further in this group of women. The results also raise questions about the role of maternal position in second-stage labour in women without an epidural.Trial registrationCurrent Controlled Trials ISRCTN35706297.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published inHealth Technology Assessment, Vol 21, No. 65. See the NIHR Journals Library website for further project information.

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“…Although upright posture of mother decreases the need of epidural anaesthesia, it increases the risk of blood loss greater than 500 mL. However, various positions are offered during labour in order to relieve pain, mother choice and safety of baby determines the best position for mother (9). Among pharmacological methods for pain relief, Local anaesthetic nerve block (pudendal, paracervical and epidural block) is more effective than opioid drugs, e.g.…”

Section: International Journal Of Women's Health and Reproduction Scimentioning

confidence: 99%

Outcomes Assessment of Pain Relief Techniques Use in Labour in Order to Increase Painless Normal Delivery Rate

Sharareh¹

2013

IJWHR

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Position in the second stage of labour for women with epidural anaesthesia

Cited by 55 publications

References 24 publications

Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES)

Outcomes Assessment of Pain Relief Techniques Use in Labour in Order to Increase Painless Normal Delivery Rate

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