Position of the mother during the second stage of labor for women who received epidural anesthesia

Author(s): Scot William

Background: Epidural anesthesia increases instrumental delivery and prolongs the second stage of labor. During all or part of the second stage, it has been suggested that a more upright maternal position may mitigate these negative effects. This is an update of a Cochrane Survey distributed in 2017. Objectives: Evaluate the effects of various birthing positions (upright or recumbent) on maternal and fetal outcomes in women receiving epidural analgesia during the second stage of labor. Methods of search: We searched the reference lists of the retrieved studies, as well as the trials registers of Clinical Trials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), and Cochrane Pregnancy and Childbirth on June 5, 2018. Criteria for selection include pregnant women (primigravidae or multigravidae) receiving any kind of epidural analgesia in the second stage of induced or spontaneous labor in all randomised or quasi randomised trials. We did not find any cluster randomised controlled trials that could have been included. Additionally, abstract only studies were eligible. During the second stage of labor, we assumed that the experimental intervention was the mother’s use of any upright position, while the control condition was the mother remaining in any recumbent position. Collecting and analyzing the data: Two review authors performed independent assessments of trials for inclusion, risk of bias, and data extraction. To obtain the missing data, we contacted the study authors. Using the GRADE method, we assessed the evidence’s quality. We excluded one study with a contervention (this was not prespecified) and conducted a planned sensitivity analysis of the three studies with low risks of bias for allocation concealment and incomplete outcome data reporting. Conclusion: With epidural analgesia, women who labor in recumbent or supine positions during the second stage may experience little or no difference in operative birth. However, there is a wide range of study designs and interventions, as well as potential selection and attrition bias, contributing to the heterogeneity of the studies. Recumbent positions may reduce the need for operative birth and caesarean section without increasing instrumental delivery, according to sensitivity analyses of studies with a low risk of bias. Taking a recumbent position may help mothers feel better about their labor and delivery. The semi recumbent and or right lateral, positions were the focus of this review.