Updates on Delivery Room
Upright vs. Recumbent Maternal Position During First Stage of Labor
Am Fam Physician. 2010 Feb 1;81(3):285-286.
Clinical Question
During the first stage of labor, what is the effect of maternal positioning on duration of the first stage of labor, type of delivery, maternal satisfaction, and neonatal and maternal outcomes?
Evidence-Based Answer
Upright positions include sitting, standing, walking, and kneeling. Based on heterogenous results, women who maintained upright positions had a first stage of labor that was about one hour less than women who were supine or reclined. There were no differences in type of delivery, and there were insufficient data on maternal satisfaction and maternal and neonatal outcomes. (Strength of Recommendation = A, based on consistent and good quality patient-oriented evidence).
Practice Pointers
Most women in the United States deliver their babies in hospitals. To facilitate intravenous infusions, epidurals, and maternal and fetal monitoring, women often spend much of the first stage of labor in supine or recumbent positions.
In this Cochrane review, the authors found 21 studies (n = 3,706) comparing upright with recumbent maternal positions during the first stage of labor. Overall, compared with recumbent positions, women who maintained upright positions had a duration that was approximately one hour less for the first stage of labor (mean difference = −0.99; 95% confidence interval [CI], −1.60 to −0.39). Participants in upright positions also were less likely to have epidural analgesia (risk ratio = 0.83; 95% CI, 0.72 to 0.96).
In a related Cochrane review, assuming a hands and knees maternal position for 10 minutes at a time in late pregnancy did not appear to help rotate babies who presented in occipitoposterior positions, which was based on an analysis of three trials (n = 2,794) that found the maternal position rotates babies temporarily, but the babies do not maintain their occipitoanterior position.1 Maternal positioning on
Am Fam Physician. 2010 Feb 1;81(3):285-286.
Clinical Question
During the first stage of labor, what is the effect of maternal positioning on duration of the first stage of labor, type of delivery, maternal satisfaction, and neonatal and maternal outcomes?
Evidence-Based Answer
Upright positions include sitting, standing, walking, and kneeling. Based on heterogenous results, women who maintained upright positions had a first stage of labor that was about one hour less than women who were supine or reclined. There were no differences in type of delivery, and there were insufficient data on maternal satisfaction and maternal and neonatal outcomes. (Strength of Recommendation = A, based on consistent and good quality patient-oriented evidence).
Practice Pointers
Most women in the United States deliver their babies in hospitals. To facilitate intravenous infusions, epidurals, and maternal and fetal monitoring, women often spend much of the first stage of labor in supine or recumbent positions.
In this Cochrane review, the authors found 21 studies (n = 3,706) comparing upright with recumbent maternal positions during the first stage of labor. Overall, compared with recumbent positions, women who maintained upright positions had a duration that was approximately one hour less for the first stage of labor (mean difference = −0.99; 95% confidence interval [CI], −1.60 to −0.39). Participants in upright positions also were less likely to have epidural analgesia (risk ratio = 0.83; 95% CI, 0.72 to 0.96).
In a related Cochrane review, assuming a hands and knees maternal position for 10 minutes at a time in late pregnancy did not appear to help rotate babies who presented in occipitoposterior positions, which was based on an analysis of three trials (n = 2,794) that found the maternal position rotates babies temporarily, but the babies do not maintain their occipitoanterior position.1 Maternal positioning on
References: 1. Hunter S, Hofmeyr GJ, Kulier R. Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev. 2007;(4):CD001063. 2. Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth.Cochrane Database Syst Rev. 2007;(3):CD003766. 3. Hodnett ED, Downe S, Edwards N, Walsh D. Home-like versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2005;(1):CD000012. Instruments for Assisted Vaginal Delivery Am Fam Physician. 2011 Jul 1;84(1):26-27.