Maternal positions and mobility during first stage labour.

Area of Science:

• Obstetrics and Gynecology
• Maternal and Fetal Health
• Evidence-Based Midwifery

Background:

• Most women in health facilities labor in bed, a practice lacking evidence of benefit for mother or baby.
• Recumbent positions, particularly supine, may adversely affect labor progress and placental blood flow.

Purpose of the Study:

• To evaluate the impact of upright labor positions versus recumbent positions on labor duration and maternal/neonatal outcomes.
• To assess effects on birth interventions like cesarean section and epidural analgesia.

Main Methods:

• Systematic review and meta-analysis of randomized and quasi-randomized controlled trials.
• Searched Cochrane Pregnancy and Childbirth Group's Trials Register.
• Included 25 trials with 5218 women, analyzing data using random-effects models where heterogeneity was high.

Main Results:

• Upright positions shortened the first stage of labor by approximately 1 hour and 22 minutes.
• Women in upright positions had a lower likelihood of cesarean section and epidural use.
• One trial suggested reduced neonatal intensive care unit admissions for babies of mothers in upright positions, though further research is needed.

Conclusions:

• Evidence supports upright positions in labor for reduced duration, cesarean birth, and epidural use, without apparent negative effects on maternal/neonatal well-being.
• High heterogeneity and bias necessitate further high-quality trials.
• Women in low-risk labor should be encouraged and supported in adopting upright positions.