Woman's position during second stage of labour

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Labor and Delivery

Background:

• Historical debate exists regarding the advantages of upright versus recumbent maternal positions during childbirth.
• Understanding optimal delivery positions is crucial for improving maternal and neonatal outcomes.

Purpose of the Study:

• To systematically review and assess the benefits and risks associated with various maternal positions during the second stage of labor.
• To compare upright and lateral positions against supine or lithotomy positions.

Main Methods:

• Conducted a systematic review of randomized and quasi-randomized controlled trials.
• Searched the Cochrane Pregnancy and Childbirth Group trials register and Cochrane Controlled Trials Register.
• Performed meta-analysis on data from 18 included trials of varying methodological quality.

Main Results:

• Upright or lateral positions were associated with a shorter second stage of labor (mean reduction of 5.4 minutes).
• These positions showed a reduction in assisted deliveries and episiotomies.
• An increased risk of blood loss exceeding 500ml was noted, alongside reduced severe pain and fewer abnormal fetal heart rate patterns.

Conclusions:

• Upright maternal positioning during labor may offer benefits such as reduced labor duration and interventions.
• A potential increased risk of significant postpartum hemorrhage exists with upright positions.
• Women should be empowered to choose their preferred, comfortable birth position based on informed decision-making.