Upright versus recumbent position during first stage of labor among primipara women on labor outcomes

Abstract

Objective: The aim of this study was to assess the effect of upright versus recumbent position during the active phase of first stage of labor among primipara women on labor outcomes in term of progress, duration of labor, method of delivery, neonatal outcome and maternal satisfaction with assumed position.Methods: Quasi experimental design was used. The study was conducted in the labor unit in obstetric department at Benha University Hospital. A purposive sample of 100 parturient women in 1st stage of labor were recruited in the study, they divided into two groups; upright group (50) and recumbent group (50). Data were collected through four main tools: Structured Interviewing questionnaire sheet, Structured Observational Checklist include (Partograph and Apgar score), Visual analogue pain intensity scale and maternal satisfaction with assumed position questionnaire.Results: It revealed that high statistical significant difference between the upright and recumbent groups in term of decreases interval and increases duration, frequency and intensity of uterine contraction, cervical dilatation and fetal head descent/fifth among the upright group. While the recumbent group showed less progress. Moreover, the recumbent group expressed more pain score, consume longer duration of 1st, 2nd, 3rd stage of labor than the upright group and statistical significant difference in Apgar score of the neonate during both first and fifth minute. In addition, the upright group had higher satisfaction scores compared to those assumed recumbent positions (p < .001).Conclusions: Upright position had positive effect on progress of labor, decreased duration of the three stages of labor, better neonatal outcomes and improving parturient women's satisfaction with assumed position. The study recommended that all parturient women in low-risk labor should be informed about the benefits of assuming upright positions during first stage of labor, and be encouraged and supported to use them.

Effect of an Ergonomic Ankle Support for Squatting Position on Labor progress and maternal outcome

“…It is also in accordance with the previously mentioned one done by Emam and Eidah Al-Zahrani (2018) (Emam & Al-Zahrani, 2018) who revealed that high statistical significant difference between the squatting and recumbent groups in term of decreases duration of the three stages of labor among the upright group. In addition, it is relatively congruent with Moralogluetal (2017) (Moraloglu et al, 2017)who revealed that women experienced a significant reduction in the duration of the second stage of labor with the mean length of the second-stage of labor shorter in the squatting group than in the supine group.…”

“…Moreover it increase the size of pelvic diameter by approximately 20% thereby enabling faster labor progress , as well as maternal expulsive forces facilitated by the force of gravity , improved alignment of the fetus for passage through the pelvis. (Zwelling, 2010) This result is relatively coincides with the study of Emam A, Eidah Al-Zahrani (2018) (Emam & Al-Zahrani, 2018)who showed that decrease interval and increases duration, frequency and intensity of uterine contraction were found among squatting group compared to of the recumbent group. Furthermore the result is in harmony with Gizzo SS et.al.…”

“…This could be justified by the efficacy of ankle support in giving more room to the baby for rotation by enlarging the pelvic inlet and outlet, and letting the pelvic angle be maintained at an angle of 90 degrees to 120 degrees. (Desseauve et al, 2017;Emam & Al-Zahrani, 2018;Simkin, Ancheta, & ICCE, 2011;Storton, 2013)The current study is compatible with Taiwanese study done by Yu-Chinget.al (2018)(Yu-Ching et al, 2018)who detected significant differences among squatting without support and semi recumbent pushing and squatting with the aid of ergonomically designed ankle supports groups in relation to mean times between the start of +1 station and the start of head crowning (p >.001).This finding is also in the same line with previously mentioned study done by Emam and Eidah Al-Zahrani (2018) (Emam & Al-Zahrani, 2018)who observed that increases fetal head descent/fifth among the study group. Furthermore, the current study is in conformity with studies conducted by Desseauve et.al (2017) (Desseauve et al, 2017), Simkin et .al (2011) (Simkin et al, 2011)and Storton (2013) (Storton, 2013)who found that in the squatting position; pushing efforts act on a downward direction as well as gravity, so the descent of fetal head will be easier among parturient.…”

Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women: randomized controlled clinical trial

“…The latter had clarified that the ambulation in the first stage of labor results in increase of the quality of uterine contractions. 18,19 Moreover, upright position and ambulation during active first stage of labor appear to be effective in improving the progress of cervical dilatation, and fetal head descent in the study group compared with control group. This can be attributed to the fact that upright positions allow the gravity to assist in the descent of the fetal head, as well as increase the pelvic capacity giving the baby more room to descend and rotate.…”

“…In the first one, Emam indicated a significant difference between upright and recumbent groups in relation to fetal head descent and cervical dilatation progress in favor of the upright group. 18 In the second study, Hassan had reported a significant improvement in the progress of fetal head descent and cervical dilatation in the experimental group after performing the pelvic rocking exercise using sitting position during the active phase of the first stage of labor as compared with the control group. 22 In the third study, Lawrence et al who had done a Cochrane review on 25 studies to evaluate the effect of ambulation and upright positions in the first stage of labor, recognized that upright positions were more effective in the cervical dilation progress than supine position.…”