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Evidence reviews for position for birth
Evidence review G
NICE Guideline, No. 235
Position for birth
Review questions
This evidence report contains information on 2 reviews relating to positions for birth:
- What is the most effective position for birth in women with an epidural in situ?
- What is the most effective position for birth in women without an epidural in situ?
Introduction
Women can adopt a variety of positions during labour and for a spontaneous vaginal birth – this can include remaining mobile and walking around, kneeling, squatting, sitting upright (for example on a bed, beanbag or birthing chair), semi-reclined / semi-supine in a chair or bed or fully recumbent positions such as lying supine on their back or on their side. Different positions can have variable effects on the position of the pelvis which may result in birth being easier in some positions compared to others.
In women with an epidural in situ, remaining mobile may be more difficult, and there may be less urge to push, and reduced effectiveness of pushing. In women without an epidural, all positions are more likely to be possible.
The aim of this review was to identify the position that led to a safer birth for the woman and her baby with the need for fewer interventions, and the best birth experience.
Summary of the protocol
See Table 1 and Table 2 for a summary of the Population, Intervention, Comparison and Outcome (PICO) characteristics of these reviews.
Table 1
Summary of the protocol (PICO table) – effective position for birth with an epidural.
Table 2
Summary of the protocol (PICO table) – effective position for birth without an epidural.
For further details see the review protocols in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document (supplementary document 1).
The two review questions for position for birth in women with and without an epidural in situ, respectively, are presented in this evidence report as two separate analyses. Evidence for position for birth in women with unknown use of epidural analgesia (as use of epidural analgesia was not reported or not clear in the article) is also presented in this evidence report as a separate analysis. Studies which included women both with and without an epidural in situ and did not conduct sub-group analyses were considered for inclusion in the review if the proportion of women with and without an epidural was reported: for the review of women without an epidural in situ the study was included if the proportion of women with an epidural in situ was less than a third; for the review of women with an epidural in situ, the study was included if the proportion of women without an epidural in situ was less than a third, as per the protocol.
The committee agreed that only studies conducted in high-income countries (as defined by the Organisation for Economic Co-operation and Development [OECD]) should be considered for inclusion because it was anticipated that enough direct evidence from high-income countries will be found and some low and middle income countries use pushing techniques that are not part of clinical practice in the UK and may increase the proportion of adverse outcomes.
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Effectiveness evidence
Included studies
Women with an epidural in situ
Two randomised controlled trials (RCTs) were included for the review on position for birth in women with an epidural in situ (BUMPES 2017 and Golara 2002). Both RCTs were conducted in the UK.
Both RCTs compared upright positions to recumbent positions in the second stage of labour in women with a low dose infusion epidural bupivacaine and fentanyl mix. Both RCTs included only nulliparous women, who had a singleton pregnancy and were expecting an uncomplicated spontaneous vaginal birth at term. In 1 RCT, women in the upright group were encouraged to adopt any upright positions during the passive and active phases of the 2nd stage of labour and women in the recumbent group were encouraged to lie on their side (left or right lateral) during 2nd stage of labour until birth (BUMPES 2017); in the other RCT, women in the upright group were encouraged to remain ambulatory during the passive 2nd stage of labour and women in the recumbent group were asked to remain in bed or in a chair during as much of the passive 2nd stage as possible. This study only studied the passive not active second stage (Golara 2002).
The included studies are summarised in Table 3.
Women without an epidural in situ
Seven RCTs were included for the review on position for birth of women without an epidural in situ (Crowley 1991; Gardosi 1989a; Gardosi 1989b; Stewart 1983; Stewart 1989; Turner 1986; Waldenstrom 1991). These RCTs were conducted in: Ireland (Crowley 1991); England (Gardosi 1989a, Gardosi 1989b; Stewart 1989; Turner 1986); Scotland (Stewart 1983); and Sweden (Waldenstrom 1991).
All RCTs compared upright positions to recumbent positions in the second stage of labour. All RCTs included only women who had a singleton pregnancy and were expecting an uncomplicated spontaneous vaginal birth (women had no obstetric risk factors and/or history of caesarean birth). Four RCTs excluded the use of epidural and 3 RCTs were included in which the proportion of women receiving epidural was less than a third (Stewart 1983; Turner 1986; Waldenstrom 1991). Three RCTs included only nulliparous women (Crowley 1991; Gardosi 1989a; Gardosi 1989b) and 4 RCTs included women of any parity (Stewart 1983; Stewart 1989; Turner 1986; Waldenstrom 1991). In terms of position for birth, in 2 RCTs, women in the upright group were encouraged to adopt kneeling, squatting or sitting positions (Gardosi 1989a; Gardosi 1989b); in 4 RCTs, women used a birthing chair to adopt a sitting upright position (Crowley 1991; Stewart 1983; Stewart 1989; Turner 1986); and in 1 RCT, women used a birthing stool (Waldenstom 1991). In all RCTs, women allocated to the upright arm were encouraged to maintain the upright position for the duration of the second stage.
The included studies are summarised in Table 4.
Unknown use of epidural
One additional RCT conducted in Finland was included which did not report on the use of epidural analgesia (Marttilla 1983).
This RCT compared a half-sitting position to a supine position in the second stage of labour. Women of any parity who had a singleton pregnancy and were expecting an uncomplicated spontaneous vaginal birth were included.
This included study is summarised in Table 5.
There were no differences in pushing techniques between intervention and control groups in any of the included RCTs.
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix J.
Summary of included studies
Summaries of the studies that were included in this review are presented in Table 3, Table 4 and Table 5.
Table 3
Summary of included studies for position for birth in women with an epidural in situ.
Table 4
Summary of included studies for position for birth in women without an epidural in situ.
Table 5
Summary of included studies for position for birth in women with unknown use of epidural.
See the full evidence tables in appendix D and the forest plots in appendix E.
Summary of the evidence
Women with an epidural in situ
Two studies (Bolara 2017 and Golara 2002) were included in this comparison. The studies were analysed separately due to differences in categorisation of positions of birth.
Evidence from BUMPES 2017 suggested there was no evidence of an important difference for the critical outcomes of instrumental birth and episiotomy; and no important difference for spontaneous vaginal birth, caesarean birth, perineal tear (grade 2 or higher) and duration of active 2nd stage between upright and recumbent position groups. In terms of important outcomes, there was no important difference between upright and recumbent position groups for women’s experience and long-term incontinence (bowel and urinary) between upright and recumbent positions. The quality of the evidence for these outcomes ranged between very low to high.
Evidence from Golara 2002 suggested there was no evidence of an important difference for the critical outcomes of spontaneous vaginal birth, instrumental birth, caesarean birth, episiotomy; and no important difference for perineal tear (grade 2 or higher) between upright and recumbent position groups. The quality of the evidence for these outcomes ranged between low to very low.
No evidence was found for the remaining important outcomes: Apgar score <7 at 5 minutes and abnormal fetal heart rate needing intervention.
Women without an epidural in situ
For the critical outcome of spontaneous vaginal birth, there was no evidence of an important difference between upright and recumbent position groups for all women (when data pooled from all studies, regardless of parity) or nulliparous women. For multiparous women, there was no important difference between upright and recumbent position groups for spontaneous vaginal birth. For the critical outcomes of instrumental birth or caesarean birth there was no evidence of an important difference between groups for all women, nulliparous women or multiparous women. There was no important difference between groups regardless of parity for the critical outcome of duration of active 2nd stage. For the final critical outcome of genital tract trauma, there was no evidence of an important difference between groups for episiotomy and perineal tears (grade 2 or higher) in all women and in nulliparous women. There was an important benefit in terms of episiotomy for multiparous women or women adhering to the allocated position favouring the upright position group. For perineal tears, there was an important harm for multiparous women in the upright position group.
For important outcomes, 3 studies reported on women’s experience of labour and birth (Crowley 1991; Stewart 1989; Waldenstrom 1991). From 1 study including only nulliparous women (Crowley 1991), there were no important differences between groups for several maternal-reported outcomes (women who agreed they “could move freely”; women who agreed they "felt in control"; women who agreed labour was "unpleasant") and no evidence of important difference for the maternal-reported outcome, women who reported "severe" pain. In two smaller studies, important benefits were seen for women in the upright position group, with fewer women reporting that they were "uncomfortable" during 2nd stage (Stewart 1989) and more women reporting their experience of birthing position as "excellent" (Waldenstrom 1991). In terms of Apgar score <7 at 5 minutes, there was no evidence of important difference between groups for all women or nulliparous women. There were fewer nulliparous women in the upright group with abnormal fetal heart rate needing intervention compared to recumbent position group, this was considered to be an important benefit.
The quality of the evidence for these outcomes ranged between very low and high quality. No evidence was found for the important outcome long-term incontinence.
Unknown use of epidural
In terms of mode of birth, there was no important difference and no evidence of important difference between upright and recumbent position groups for spontaneous vaginal birth and instrumental birth, respectively. The study reported that all women had a vaginal birth, but it was not clear whether women who had a caesarean birth were excluded, so this outcome was not included in the analysis. In terms of duration of active 2nd stage, there was no important difference between groups for nulliparous or multiparous women.
In terms of women’s experience of labour and birth, there were fewer women in the upright position group who reported ‘’intolerable’’ pain compared to recumbent group, this was considered to be an important benefit. There was no evidence of important difference between upright and recumbent position groups for women who agreed the experience was "unpleasant". There was no important difference between upright and recumbent position groups for women who wished to use the half-sitting upright position for their next birth.
There was no evidence of important difference between groups in terms of abnormal fetal heart rate needing intervention.
The quality of the evidence for these outcomes ranged between very low and moderate. Apgar score <7 at 5 minutes, genital tract trauma and long-term incontinence were not reported.
See appendix F for full GRADE tables.
Economic evidence
Included studies
Women with an epidural in situ
One economic study was identified which was relevant to this question (Bick 2017).
See the literature search strategy in appendix B and economic study selection flow chart in appendix G.
Women without an epidural in situ
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
See the literature search strategy in appendix B and economic study selection flow chart in appendix G.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in appendix J.
Summary of included economic evidence
See Table 6 for the economic evidence profile of the included study.
Table 6
Economic evidence profile of a systematic review of economic evaluations of the most effective position for birth in women with an epidural in situ.
Economic model
No economic modelling was undertaken for these reviews because the committee agreed that other topics were higher priorities for economic evaluation as there are no or negligible differences in intervention costs arising from birth position.
Evidence statements
Economic evidence statement
One cost-effectiveness analysis found no statistically significant difference in maternal and infant costs at 12 months between an upright birth position and a lying down position. This analysis was assessed as partially applicable to the NHS decision making context and characterised by minor limitations.
The committee's discussion and interpretation of the evidence
The outcomes that matter most
The committee agreed that mode of birth was a critical outcome for these reviews to determine whether upright or recumbent positions impacted the proportion of spontaneous vaginal births, births with forceps or ventouse and caesarean births. They agreed duration of the active second stage of labour was a critical outcome as certain positions of the pelvis can lengthen the time between the start of pushing and birth, with adverse effects on the woman and baby. The committee wanted to know whether upright or recumbent positions were associated with more or less episiotomies and perineal tears and chose genital tract trauma as a critical outcome.
The committee also chose important outcomes for these reviews. They agreed women’s experience of labour and birth should be included as an important outcome as determining any differences in women’s comfort or satisfaction, for example, between upright and recumbent positions, would help to inform the acceptability of any recommendations made on position for birth. The committee recognised the great importance of women’s experience of labour and birth, but they were aware that data on this outcome was likely to be sparse and unlikely to inform decision-making in a meaningful way, so they prioritised this as an important outcome rather than a critical outcome. The committee agreed that long-term urinary and bowel incontinence should be included as an important outcome as it could impact the women’s quality of life after birth. The committee chose Apgar score <7 at 5 minutes and abnormal fetal heart rate needing intervention as important outcomes to capture any differential harm to the baby associated with upright or recumbent positions.
The quality of the evidence
Women with an epidural in situ
The quality of the evidence ranged from high to very low. The main issues were around indirectness of the evidence, risk of bias and imprecision. One study (Golara 2002) used low dose anaesthetic-opioid combination with either epidural or combined spinal-epidural, outcomes from this study, hence it was downgraded for indirectness. As participants and personnel could not be blinded to intervention allocation (in both BUMPES 2017 and Golara 2002), subjective outcomes were downgraded for risk of bias. There were concerns for some outcomes around the imprecision of the estimate of effect. The committee took into account the quality of the evidence, including the uncertainty in their interpretation of the evidence.
Women without an epidural in situ
The quality of the evidence ranged from high to very low, with most of the evidence being of very low quality. The main issues were risk of bias and imprecision. In terms of risk of bias, there were some concerns of selection bias as either insufficient detail was given on allocation concealment, or a quasi-randomised method was used for intervention allocation. There were also concerns on adherence to the intervention, where adherence was unbalanced between groups and the effect of adhering to the intervention was not examined. Several outcomes were downgraded for imprecision due to wide confidence intervals around effect estimates.
Benefits and harms
The committee discussed the evidence on the benefits and harms associated with upright positions for women with an epidural in situ and women without an epidural in situ.
Women with an epidural in situ
The committee noted that the majority of the evidence for women with an epidural in situ was from one large multicentre trial of nulliparous women (BUMPES 2017) comparing upright positions (walking, standing, sitting out of bed, supported kneeling, bolt upright in an obstetric bed, or any other upright position for as much of the second stage as possible) to recumbent (left or right lateral) positions. The smaller study (Golara 2002) compared upright positions (either standing or walking) to recumbent positions (spending as much time as possible in bed or in a chair during the passive phase). This study did not consider position of birth in the active pushing phase of the second stage. Due to the heterogeneity in positions of birth, the two studies were analysed separately.
The committee discussed that there was a statistically significant increase in spontaneous vaginal births for nulliparous women who were in recumbent positions (left or right lateral) compared to upright positions during the second stage of labour (BUMPES 2017), although the effect estimates showed no important difference with respect to the minimally important differences used to interpret the evidence. However, the committee agreed that women should be informed of this result, so they could take this into consideration when deciding on their position of birth.
There was evidence showing no difference for any of the outcomes from the second study (Golara 2002) and so overall, the committee agreed that there was no evidence of important benefits or harms associated with upright or recumbent positions for any of the critical or important outcomes.
The committee discussed the lack of clarification around the classification of semi-recumbent positions within the BUMPES study, given that it is a commonly used position for birth and in their experience, the plane of the pelvis in this position could be either more vertical or horizontal depending on both the inclination of the headrest and how the woman was lying in the bed, but judgement of this was largely subjective. The committee were concerned that semi-recumbent positions may have been adopted in the recumbent group and this may have confounded the results as the pelvis could be in either a vertical or horizontal plane.
The committee also discussed that the study by Golara 2002 terminated early due to “movement of staff” and did not manage to recruit the estimated number of women needed to detect differences between groups.
The committee agreed that, in their experience, upright positions and left or right lateral recumbent positions were routinely used during the second stage of labour in women with epidurals in situ and were safe for birth. The committee were aware that women with an epidural in situ may need more assistance to mobilise and find a comfortable position. Hence based on the evidence and their knowledge and experience, they agreed that women may choose to lie on their side but could adopt a position which was comfortable for them during the second stage of labour.
However, the committee were aware that adopting a supine position during late pregnancy or labour can lead to supine hypotensive syndrome or aortocaval compression, due to the pressure from the uterus compressing the aorta and inferior vena cava. This leads to decreased blood pressure and can limit blood flow to the placenta. The committee also highlighted that epidural analgesia accentuates the effects of aortocaval compression and therefore supine positions should be particularly avoided in women with epidurals. The committee noted that while supine positions are rarely used in routine practice, their recommendations should include advice to women that lying flat on their back may lead to these problems.
The committee noted that mobilisation is possible for women with a low-dose epidural, but that they may require assistance to move as their legs may feel heavier than usual and they may have some degree of motor block. The committee added advice about this to the recommendations on regional analgesia.
Women without an epidural in situ
The committee discussed the evidence of a benefit of upright positions for multiparous women in terms of episiotomies and the evidence of a harm in terms of perineal tears. They agreed this may have been due to a bias in favour of performing fewer episiotomies in the upright position and in multiparous women, which in turn resulted in more perineal tears.
Based on their experience and expertise, the committee agreed that the benefit associated with fewer episiotomies outweighed the harm of more perineal tears, as often women find that episiotomies are more painful and slower to heal than perineal tears. However, the committee noted that, as per the protocol, the evidence did not specify the severity of the tear and they discussed that this may shift the balance of benefits and harms. The committee were informed that the included studies did not stratify by severity of tear, with most studies reporting second degree tears only or not specifying severity. The committee noted that the evidence for these outcomes dated from 1983 to 1989 and therefore the way perineal tears are categorised may have changed since. In their experience and expertise, rates of episiotomy in all women, and especially in multiparous women had also decreased, meaning a benefit on episiotomy may not be detected in contemporary studies where it is likely fewer episiotomies would be performed. For nulliparous women, there was no evidence of an important difference between upright and recumbent positions in terms of episiotomy and perineal tears. The committee discussed that the rate of episiotomies and births with forceps or ventouse in nulliparous women are around 40% (unpublished data), and that positions such as lithotomy increase the number of tears because of an increased pressure in the perineum. Based on their experience and the evidence of a decreased risk of episiotomies for multiparous women who adopted upright positions, the committee agreed to recommend upright positions and mobilisation for women without an epidural in situ. Furthermore, the committee noted that mobilisation could help prevent complications such as deep vein thrombosis.
The committee discussed the evidence of benefits in terms of women’s experience of labour and birth associated with upright positions. They agreed that as there was no difference for some of the measures of women’s experience, and improved satisfaction for the upright position for some other measures this strengthened the rationale for a recommendation for women to have a choice in adopting a position they found most comfortable during labour, including upright positions.
As with the recommendations for women with an epidural in situ, the committee included advice for women that lying flat on their back, may lead to aortocaval compression and effects on blood pressure. The committee noted that the risks of lying flat without an epidural are less than for women with an epidural in situ.
The committee noted the evidence of a benefit of upright positions in terms of abnormal fetal heart rate needing intervention and agreed this further supported their recommendation on encouraging upright positions during the second stage of labour for women without an epidural in situ.
Cost effectiveness and resource use
A published UK study (Bick 2017), an economic evaluation, alongside the BUMPES study, found no difference in intervention related maternal and infant costs at 12 months from labour in nulliparous women with low-dose epidural in the 2nd stage of labour, giving birth in an upright position, compared to women giving birth in a lying down position (difference −£42; 95% CI −£254 to £169). The study reported that an upright position resulted in a significantly lower number of spontaneous vaginal births (difference −0.059; standard error 0.02). The results showed that women in the lying down position incurred significantly less resources during their original hospital stay due to the higher rate of spontaneous vaginal births, but there was no significant difference in costs at 12-months follow-up as higher, albeit nonsignificant, costs observed for babies in the lying down group during follow-up offset the lower maternal costs from trial entry to hospital discharge.
The authors reported that the incremental cost effectiveness ratio (ICER) of a lying down birth position relative to an upright position was £722 per additional spontaneous vaginal birth (95% confidence interval −£2,986 to £6,358) but there is no cost-effectiveness threshold for this ICER on which to assess whether this might be considered good value for the NHS. Furthermore, there is considerable uncertainty around the ICER, particularly relating to costs, with the ICER confidence intervals suggesting that a null hypothesis of cost neutrality cannot be rejected. As the committee were not persuaded that there was any evidence of clinical benefits or harms (see Benefits and harms) from an upright birth position, they concluded that the evidence on cost effectiveness was inconclusive and therefore they considered that birth position should be a matter for the woman’s personal preference.
Recommendations supported by this evidence review
This evidence review supports recommendations 1.6.30, 1.9.5 and 1.9.6.
References – included studies
Included studies for review question: What is the most effective position for birth in women with an epidural in situ?
BUMPES 2017
BUMPES (2017) Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. BMJ (Clinical research ed.) 359: j4471 [PMC free article: PMC5646262] [PubMed: 29046273]Golara 2002
Golara, M.; Plaat, F.; Shennan, A. H. (2002) Upright versus recumbent position in the second stage of labour in women with combined spinal-epidural analgesia. International journal of obstetric anesthesia 11(1): 19–22 [PubMed: 15321573]Included studies for review question: What is the most effective position for birth in women without an epidural in situ?
Crowley 1991
Crowley, P., Elbourne, D., Ashurst, H. et al (1991) Delivery in an obstetric birth chair: A randomized controlled trial. British Journal of Obstetrics and Gynaecology 98(7): 667–674 [PubMed: 1883790]Gardosi 1989a
Gardosi, J.; Hutson, N.; B-Lynch, C. (1989) Randomised, controlled trial of squatting in the second stage of labour. Lancet (London, England) 2(8654): 74–7 [PubMed: 2567873]Gardosi 1989b
Gardosi, J.; Sylvester, S.; B-Lynch, C. (1989) Alternative positions in the second stage of labour: a randomized controlled trial. British journal of obstetrics and gynaecology 96(11): 1290–6 [PubMed: 2692698]Marttila 1983
Marttila, M.; Kajanoja, P.; Ylikorkala, O. (1983) Maternal half-sitting position in the second stage of labor. Journal of perinatal medicine 11(6): 286–9 [PubMed: 6668531]Stewart 1989
Stewart, P. and Spiby, H. (1989) A randomized study of the sitting position for delivery using a newly designed obstetric chair. British journal of obstetrics and gynaecology 96(3): 327–33 [PubMed: 2785402]Turner 1986
Turner, MJ, Romney, Mona L, Webb, JB et al (1986) The birthing chair: an obstetric hazard?. Journal of Obstetrics and Gynaecology 6(4): 232–235Waldenstrom 1991
Waldenstrom, U. and Gottvall, K. (1991) A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor. Birth (Berkeley, Calif.) 18(1): 5–10 [PubMed: 2006963]Economic
Bick 2017
Bick, D.; Briley, A.; Brocklehurst, P. et al A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES). Health Technology Assessment 2017;21(65). [PMC free article: PMC5694898] [PubMed: 29110753]
Effectiveness
Appendix A. Review protocols
Appendix B. Literature search strategies
Appendix C. Effectiveness evidence study selection
Study selection for: What is the most effective position for birth in women with an epidural in situ? (PDF, 178K)
Study selection for: What is the most effective position for birth in women without an epidural in situ? (PDF, 163K)
Appendix D. Evidence tables
Evidence tables for review: What is the most effective position for birth in women with an epidural in situ? (PDF, 267K)
Appendix E. Forest plots
This section includes forest plots only for outcomes that are meta-analysed. Outcomes from single studies are not presented here; the quality assessment for such outcomes is provided in the GRADE profiles in appendix F.
Forest plots for review: What is the most effective position for birth in women with an epidural in situ?
No meta-analysis was conducted for this review question and so there are no forest plots.
Forest plots for review: What is the most effective position for birth in women without an epidural in situ?
Download PDF (257K)
Appendix F. GRADE tables
GRADE tables for review: What is the most effective position for birth in women with an epidural in situ? (PDF, 247K)
GRADE tables for review: What is the most effective position for birth in women without an epidural in situ? (PDF, 259K)
Appendix G. Economic evidence study selection
Study selection for: What is the most effective position for birth in women with an epidural in situ? (PDF, 166K)
Study selection for: What is the most effective position for birth in women without an epidural in situ? (PDF, 134K)
Appendix H. Economic evidence tables
Economic evidence tables for review question: What is the most effective position for birth in women with an epidural in situ?
Download PDF (167K)
Economic evidence tables for review question: What is the most effective position for birth in women without an epidural in situ?
No evidence was identified which was applicable to this review question.
Appendix I. Economic model
Economic model for review question: What is the most effective position for birth in women with an epidural in situ?
No economic analysis was conducted for this review question.
Economic model for review question: What is the most effective position for birth in women without an epidural in situ?
No economic analysis was conducted for this review question.
Appendix J. Excluded studies
Excluded studies for review question: What is the most effective position for birth in women with an epidural in situ?
Excluded effectiveness studies
Excluded economic studies
Table 13Excluded studies and reasons for their exclusion
| Study | Reason |
|---|---|
| (2018) Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women with Low Dose Epidural: BUMPES Randomised Controlled Trial. Obstetrical & gynecological survey 73(3): 133–134 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| (2018) Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women with Low Dose Epidural: BUMPES Randomised Controlled Trial. Obstetrical and Gynecological Survey 73(3): 133–134 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| (2018) Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. MIDIRS midwifery digest 28(1): 68–68 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| Aguilar, Omar Calvo; Romero, Ana Luisa Flores; Garcia, Victor Edilberto Morales (2013) Comparison of obstetric and perinatal outcomes in childbirth upright posture vs. supine. Ginecologia y Obstetricia de Mexico 81(1): 1–10 [PubMed: 23513398] | - Non-English language study |
| Amini, L., Jamshidi, R., Kashanian, M. et al (2011) The effect of sitting position during labour on 3rd stage duration and postpartum haemorrhage. Journal of Obstetrics and Gynaecology 31(suppl1): 33–34 | - Conference abstract |
| Amiri Farahani, L.; Shirazi, V.; Rajabalipoor, F. (2012) The effects of different positioning on the duration of the second stage of labor in primiparous women. Journal of zanjan university of medical sciences and health services 20(80): 11 | - Non-English language study |
| Anonymous (1999) Hands/knees posture in late pregnancy or labour for malposition (lateral or posterior) of the presenting part. The practising midwife 2(4): 10–1 [PubMed: 10427281] | - Outcome not in PICO Systematic review reporting the outcome of fetal position from one trial comparing hands and knees position to sitting |
| Bahmaei, K., Iravani, M., Moosavi, P. et al (2018) Effect of maternal positioning with occipito-posterior fetal position during labor on pain intensity and satisfaction of mothers. Iranian journal of obstetrics, gynecology and infertility 21(5): 66–73 | - Non-English language study |
| Berta, Marta, Lindgren, Helena, Christensson, Kyllike et al (2019) Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis. BMC Pregnancy and Childbirth 19(1): 466 [PMC free article: PMC6894325] [PubMed: 31801479] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; induction of labour not reported; individual studies checked for eligibility |
| Bhardwaj, N. (1994) Randomised controlled trial on modified squatting position of birthing. International journal of gynaecology and obstetrics 46: 118 | - Unable to retrieve |
| Bhardwaj, N., Kukade, J. A., Patil, S. et al (1995) Randomised controlled trial on modified squatting position of delivery. Indian journal of maternal and child health 6(2): 33–39 [PubMed: 12319813] | - Unable to retrieve |
| Bick, D., Briley, A., Brocklehurst, P. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG 123: 61 [PMC free article: PMC5694898] [PubMed: 29110753] | - Conference abstract |
| Bick, D., Briley, A., Brocklehurst, P. et al (2017) A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES). Health technology assessment (Winchester, England) 21(65): 1–176 [PMC free article: PMC5694898] [PubMed: 29110753] | - Duplicate |
| Bick, D., Shennan, A., Briley, A. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG: An International Journal of Obstetrics and Gynaecology 123(supplement2): 61 | - Duplicate |
| Bomfim-Hyppolito, S. (1998) Influence of the position of the mother at delivery over some maternal and neonatal outcomes. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 63suppl1: S67–73 [PubMed: 10075214] | - Study conducted in a low or middle income country Study conducted in Brazil |
| Bonoan, M. J.; Otayza, M. L.; Garcia, G. (1997) Acceptability of an indiginous birthing position using a filipino-improvised birthing chair - a third world tertiary care center prospective trial. Acta obstetricia ET gynecologica scandinavica 76(167): 45 | - Study conducted in a low or middle income country Study conducted in the Philippines |
| Brocklehurst, P., Rivero-Arias, O., Eddama, O. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG: An International Journal of Obstetrics and Gynaecology 123(suppl1): 11 | - Conference abstract |
| Brément, S., Mossan, S., Belery, A. et al (2007) Delivery in lateral position. Randomized clinical trial comparing the maternal positions in lateral position and dorsal position for the second stage of labour. Gynecologie, obstetrique & fertilite 35(78): 637–644 [PubMed: 17574897] | - Non-English language study |
| Bueno-Lopez, Vanessa, Falgueras-Serrano, Ana Maria, Crespo-Berros, Silvia et al (2018) Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial. Birth (Berkeley, Calif.) 45(4): 385–392 [PubMed: 29537658] | - Comparator not in PICO Study compares a modified lateral position with any other position (control group not clearly defined) |
| Calvo Aguilar, O.; Flores Romero, A. L.; Morales García, V. E. (2013) Comparison of obstetric and perinatal results of childbirth vertical position vs. childbirth supine position. Ginecologia y obstetricia de Mexico 81(1): 1–10 [PubMed: 23513398] | - Non-English language study |
| Cameron, Carolyn A., Torvaldsen, Siranda, Algert, Charles S. et al (2005) A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta Obstetricia et Gynecologica Scandinavica 84(8): 794–798 [PubMed: 16026407] | - Intervention not in PICO Systematic review includes studies in which position was only maintained in the 1st stage of labour |
| Carbonne, B., Benachi, A., Leveque, M. L. et al (1996) Maternal position during labor: effects on fetal oxygen saturation measured by pulse oximetry. Obstetrics and gynecology 88(5): 797-800 [PubMed: 8885916] | - Comparator not in PICO Study compares different recumbent positions |
| Chang, Su-Chuan, Lin, Lie-Chu, Chou, Min-Min et al (2011) Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery 27(6): 825–831 [PubMed: 20952110] | - Study design Study is not a parallel RCT (data for experimental and control groups collected at different times) |
| Christensson, Kyllike, Thies-Lagergren, Li, Kvist, Linda J. et al (2011) No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: Results of a Swedish randomized controlled trial. BMC Pregnancy and Childbirth 11: 22 [PMC free article: PMC3071335] [PubMed: 21435238] | - Comparator not in PICO Comparator not in PICO as women who gave birth in sitting position compared to women who gave birth in ‘any other position’ (control group not clearly defined). |
| Christensson, Kyllike, Thies-Lagergren, Li, Kvist, Linda J. et al (2012) Striving for scientific stringency: A re-analysis of a randomised controlled trial considering first-time mothers' obstetric outcomes in relation to birth position. BMC Pregnancy and Childbirth 12: 135 [PMC free article: PMC3542096] [PubMed: 23173988] | - Comparator not in PICO Comparator not in PICO as women who gave birth in sitting position compared to women who gave birth in ‘any other position’ (control group not clearly defined) |
| Cuerva Carvajal, A. and Marquez Calderon, S. (2006) [Expulsion stage of delivery: comparison of upright versus lying down positions for childbirth, through maternal and foetal outcomes]. | - Non-English language study |
| Danilenko-Dixon, D. R., Tefft, L., Cohen, R. A. et al (1996) Positional effects on maternal cardiac output during labor with epidural analgesia. American journal of obstetrics and gynecology 175(4pt1): 867–72 [PubMed: 8885738] | - Comparator not in PICO Study compares two recumbent positions |
| De Jong, P. R., Johanson, R. B., Baxen, P. et al (1997) Randomised trial comparing the upright and supine positions for the second stage of labour. British Journal of Obstetrics and Gynaecology 104(5): 567–571 [PubMed: 9166199] | - Duplicate |
| de Jong, P. R., Johanson, R. B., Baxen, P. et al (1997) Randomised trial comparing the upright and supine positions for the second stage of labour. British journal of obstetrics and gynaecology 104(5): 567–71 [PubMed: 9166199] | - Study conducted in a low or middle income country Study conducted in South Africa |
| de Jong, P. R., Johanson, R., Baxen, P. et al (1995) St Monica's randomized controlled trial of upright vs dorsal position for the second stage of labour. 27th british congress of obstetrics and gynaecology;1995 july 4–7; dublin, ireland: abstractno493 | - Conference abstract |
| De Jonge, A.; Teunissen, T. A. M.; Lagro-Janssen, A. L. M. (2004) Supine position compared to other positions during the second stage of labor: a meta-analytic review. Journal of psychosomatic obstetrics and gynaecology 25(1): 35–45 [PubMed: 15376403] | - Comparator not in PICO Position in control group not defined. Study compares supine position to ‘any other position’ |
| Dokmak, Fatima, Michalek, Irmina Maria, Boulvain, Michel et al (2020) Squatting position in the second stage of labor: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology 254: 147–152 [PubMed: 32966958] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Downe, Soo; Gerrett, David; Renfrew, Mary J. (2004) A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia. Midwifery 20(2): 157–68 [PubMed: 15177859] | Intervention is not applicable to the review question. Women received bolus doses of epidural (not low dose infusion epidurals which are the current standard of care). |
| Eason, E. (1999) Randomised trial comparing the upright and supine positions for the second stage of labour. British journal of obstetrics and gynaecology 106(3): 291–2 [PubMed: 10426659] | - Letter to editor |
| Ekstrom, Asa, Olsson, Sven-Eric, Ragnar, Inga et al (2007) Anal sphincter lacerations and upright delivery postures - A risk analysis from a randomized controlled trial. International Urogynecology Journal 18(2): 141–146 [PubMed: 16636770] | - Comparator not in PICO Study compares two upright positions |
| Farahani, L. A.; Ali Pour, F. R.; Shirazi, V. (2012) Effect of different birthing positions during the second stage of labor on mother's experiences regarding birth, pain, anxiety and fatigue. Journal of mazandaran university of medical sciences 22(95): 75–83 | - Non-English language study |
| Frenea, Stephane, Chirossel, Christine, Rodriguez, Raphael et al (2004) The effects of prolonged ambulation on labor with epidural analgesia. Anesthesia and analgesia 98(1): 224–229 [PubMed: 14693624] | - Intervention not in PICO Intervention compares ambulation and recumbent position during the first stage of labour |
| Gupta, J. K. and Hofmeyr, G. J. (2004) Position for women during second stage of labour. Cochrane database of systematic reviews (Online): cd002006 [PubMed: 14973980] | - Duplicate |
| Gupta, J. K. and Nikodem, V. C. (2000) Woman's position during second stage of labour. Cochrane database of systematic reviews (Online): cd002006 [PubMed: 10796279] | - Duplicate |
| Gupta, Janesh K., Sood, Akanksha, Hofmeyr, G. Justus et al (2017) Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2017(5): cd002006 [PMC free article: PMC6484432] [PubMed: 28539008] | - Population not in PICO Systematic review includes studies conducted in low or middle income countries |
| Hodnett, Ellen D., Weston, Julie, Stremler, Robyn et al (2013) Repeated hands-and-knees positioning during labour: A randomized pilot study. PeerJ 2013(1): e25 [PMC free article: PMC3629039] [PubMed: 23638360] | - Comparator not in PICO Position in control group was woman’s choice |
| Hofmeyr, G. Justus, Vogel, Joshua P., Singata, Mandisa et al (2018) Does gentle assisted pushing or giving birth in the upright position reduce the duration of the second stage of labour? A three-arm, open-label, randomised controlled trial in South Africa. BMJ global health 3(3): e000906 [PMC free article: PMC6035507] [PubMed: 29989055] | - Study conducted in a low or middle income country Study conducted in South Africa |
| Jahdi, Freshteh, Shahnazari, Maryam, Kashanian, Maryam et al (2011) A randomized controlled trial comparing the physiological and directed pushing on the duration of the second stage of labor, the mode of delivery and apgar score. International Journal of Collaborative Research on Internal Medicine and Public Health 3(2): 159–165 | - Study conducted in a low or middle income country Study conducted in Iran |
| Kafka, M., Riss, P., von Trotsenburg, M. et al (1994) The birthing stool--an obstetrical risk?. Geburtshilfe und Frauenheilkunde 54(9): 529–531 [PubMed: 7988858] | - Non-English language study |
| Karraz, MA (2003) Ambulatory epidural anesthesia and the duration of labor. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 80(2): 117–122 [PubMed: 12566183] | - Intervention not in PICO Intervention is during 1st stage of labour only |
| Kemp, Emily, Kingswood, Claire J., Kibuka, Marion et al (2013) Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews 2013(1): cd008070 [PubMed: 23440824] | - Duplicate Earlier version of Cochrane review |
| Kibuka, Marion and Thornton, Jim G. (2017) Position in the second stage of labour for women with epidural anaesthesia. The Cochrane database of systematic reviews 2: cd008070 [PMC free article: PMC6464234] [PubMed: 28231607] | - Duplicate Earlier version of Walker 2018 |
| Leila, Amini, Shayesteh, Jahanfar, Maryam, Kashanian et al (2010) Sitting position: A right way to reduce labour pain with shortening duration of labor. Journal of Psychosomatic Obstetrics and Gynecology 31(suppl1): 104 | - Conference abstract |
| Levy, Ariel T., Weingarten, Sarah, Ali, Ayesha et al (2021) Hands-and-knees posturing and fetal occiput anterior position: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology MFM 3(4): 100346 [PubMed: 33705998] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Levy, Ariel, Ali, Ayesha, Quist-Nelson, Johanna et al (2021) 512 Hands-and-knees position and incidence of occiput anterior position at birth: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 224(2supplement): 323 [PubMed: 33705998] | - Conference abstract |
| Moraloglu, Ozlem, Kansu-Celik, Hatice, Tasci, Yasemin et al (2017) The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 30(2): 245–249 [PubMed: 27028537] | - Study conducted in a low or middle income country Study conducted in Turkey |
| Nasir, Ayesha; Korejo, Razia; Noorani, K. J. (2007) Child birth in squatting position. JPMA. The Journal of the Pakistan Medical Association 57(1): 19–22 [PubMed: 17319414] | - Study conducted in a low or middle income country Study conducted in Pakistan |
| Pizzagalli, F. (2020) Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Maternal postures during the second stage of labour, delivery techniques and perineal protection. Gynecologie Obstetrique Fertilite et Senologie 48(12): 931–943 [PubMed: 33011376] | - Non-English language study |
| Plaat, F.; Golara, M.; Shennan, A. (1996) Upright vs recumbent position with mobile extradurals in the early second stage of labour. British journal of anaesthesia 76: 102 | - Conference abstract |
| Plaat, F.; Golara, M.; Shennan, A. (1996) Upright versus recumbent position with mobile extradurals in the early second stage of labour. Br-j-anaesth 76suppl2: 102 | - Conference abstract |
| Priddis, Holly; Dahlen, Hannah; Schmied, Virginia (2012) What are the facilitators, inhibitors, and implications of birth positioning? A review of the literature. Women and birth: journal of the Australian College of Midwives 25(3): 100–6 [PubMed: 21664208] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Racinet, C., Eymery, P., Philibert, L. et al (1999) Delivery in the squatting position. A randomized trial comparing the squatting position and the lithotomy position for the expulsion phrase. Journal de gynecologie, obstetrique ET biologie de la reproduction 28(3): 263–270 [PubMed: 10456309] | - Non-English language study |
| Racinet, C., Eymery, P., Philibert, L. et al (1999) [Labor in the squatting position. Journal de gynecologie, obstetrique et biologie de la reproduction 28(3): 263–270 [PubMed: 10456309] | - Non-English language study |
| Ragnar, I., Altman, D., Tyden, T. et al (2006) Comparison of the maternal experience and duration of labour in two upright delivery positions--a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 113(2): 165–70 [PubMed: 16411993] | - Comparator not in PICO Study compares two upright positions |
| Raulli, A. (2001) The use of birth stools during second stage labour and the risk of perineal trauma. | - Conference abstract |
| Rocha, Bruna Dedavid da, Zamberlan, Claudia, Pivetta, Hedioneia Maria Foletto et al (2020) Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and meta-analysis. Posicoes verticalizadas no parto e a prevencao de laceracoes perineais: revisao sistematica e metanalise. 54: e03610 [PubMed: 32935765] | - Comparator not in PICO Systematic review of studies comparing upright positions |
| Roth, Cheryl, Dent, Sarah A., Parfitt, Sheryl E. et al (2016) Randomized Controlled Trial of Use of the Peanut Ball During Labor. MCN. The American journal of maternal child nursing 41(3): 140–6 [PubMed: 26859467] | - Intervention not in PICO Study does not compare upright to recumbent positions |
| Schirmer, J.; Fustinoni, S. M.; Basile, Aldo (2011) Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study. Acta paulista de enfermagem 24(6): 745–750 | - Study conducted in a low or middle income country Study conducted in Brazil |
| Shedmake, Priyanka Vijay and Wakode, S. R. (2021) A Hospital-Based Randomized Controlled Trial-Comparing the Outcome of Normal Delivery Between Squatting and Lying Down Positions During Labour. Journal of obstetrics and gynaecology of India 71(4): 393–398 [PMC free article: PMC8418581] [PubMed: 34566298] | - Study conducted in a low or middle income country Study conducted in India |
| Simarro, M., Salinas, C., Martinez, A. et al (2011) Effects of postural changes during the second stage of labor among women with epidural analgesia. International Urogynecology Journal and Pelvic Floor Dysfunction 22(suppl1): S13–S14 | - Intervention not in PICO Study compares different postural changes (both upright and recumbent positions) to recumbent position |
| Stremler, R. L. (2003) The labour position trial: a randomized, controlled trial of hands and knees positioning for women labouring with a fetus in occipitoposterior position. Dissertation/ thesis: 163p | - Thesis paper |
| Theron, A., Baraz, R., Thorp-Jones, D. et al (2011) Does position in the passive second stage of labour affect birth outcome in nulliparous women using epidural analgesia. International Journal of Obstetric Anesthesia 20(suppl1): 12 | - Conference abstract |
| Thies-Lagergren, L., Christensson, K., Kvist, L. J. et al (2011) Maternal outcomes in nulliparous women who gave vaginal birth on a birth seat or in any other position: Results of a randomised controlled trial in Sweden. Journal of Paediatrics and Child Health 47(suppl1): 36–37 | - Conference abstract |
| Thies-Lagergren, L., Kvist, L. J., Sandin-Bojo, A. K. et al (2012) Augmentation of labour and fetal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births. Journal of Paediatrics and Child Health 48(suppl1): 101–102 | - Conference abstract |
| Thies-Lagergren, L., Kvist, Linda J., Sandin-Bojo, Ann-Kristin et al (2013) Labour augmentation and fetal outcomes in relation to birth positions: a secondary analysis of an RCT evaluating birth seat births. Midwifery 29(4): 344–350 [PubMed: 23084490] | - Comparator not in PICO Position for birth in control group not sufficiently defined |
| Valiani, Mahboubeh; Rezaie, Mehri; Shahshahan, Zahra (2016) Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iranian journal of nursing and midwifery research 21(4): 372–8 [PMC free article: PMC4979260] [PubMed: 27563320] | - Study conducted in a low or middle income country Study conducted in Iran |
| Vaziri, Farideh, Moshfeghy, Zeinab, Arzhe, Amene et al (2016) Spontaneous pushing in lateral position versus Valsalva maneuver during second stage of labor on maternal and fetal outcomes: A randomized clinical trial. Iranian Red Crescent Medical Journal 18(10): e29279 [PMC free article: PMC5286842] [PubMed: 28180019] | - Comparator not in PICO Study compares different pushing techniques in two recumbent positions (lateral and supine) |
| Waldenström, U. and Gottval, K. (1994) Randomized trial of birthing stool or conventional semi-recumbent position for second-stage labor. Jordemodern 107(78): 261–265 [PubMed: 7928535] | - Population not in PICO Included in review for position of birth in women without epidural analgesia |
| Walker, C., Rodriguez, T., Herranz, A. et al (2011) Second stage of labor with postural change and lateral position in women with epidural analgesia: A randomized controlled trial. International Urogynecology Journal and Pelvic Floor Dysfunction 22(suppl1): S11–S12 | - Comparator not in PICO Study compares two recumbent positions (lateral vs lithotomy position) |
| Walker, Kate F., Thornton, Jim G., Jones, Nia W. et al (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews 2018(11): cd008070 [PMC free article: PMC6517130] [PubMed: 30411804] | - Intervention not in PICO Review does not exclude studies in which the position was not maintained into second stage or studies which compare a postural changes intervention; individual studies checked for eligibility |
| Zang, Yu, Lu, Hong, Zhang, Huixin et al (2021) Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews. International journal of nursing studies 114: 103812 [PubMed: 33217662] | - Study design Overview of systematic reviews; included systematic reviews checked for eligibility |
| Zang, Yu, Lu, Hong, Zhao, Yang et al (2020) Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta-analysis. Journal of clinical nursing 29(1718): 3154–3169 [PubMed: 32531856] | - Intervention not in PICO Intervention is flexible sacrum positions which include both upright positions and lateral positions compared to recumbent positions |
| Zhang, H., Huang, S., Guo, X. et al (2017) A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery 50: 117–124 [PubMed: 28414983] | - Study conducted in a low or middle income country Study conducted in China |
| Zhang, Hong-Yu, Shu, Rong, Cai, Wen-Zhi et al (2016) Comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position. International Journal of Nursing Sciences 3(2): 178–184 | - Study conducted in a low or middle income country Study conducted in China |
Excluded economic studies
Table 14Excluded studies and reasons for exclusion
| Study | Code [Reason] |
|---|---|
| Packer, Claire, Hersh, Alyssa R., Greiner, Karen S. et al (2019) Recumbent Versus Upright Positioning during Labor with an Epidural: A Cost-Effectiveness Analysis. Obstetrics and Gynecology 133(suppl1) | - Conference abstract |
Excluded studies for review question: What is the most effective position for birth in women without an epidural in situ?
Excluded effectiveness studies
Table 15Excluded studies and reasons for their exclusion
| Study | Reason |
|---|---|
| (2018) Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women with Low Dose Epidural: BUMPES Randomised Controlled Trial. Obstetrical & gynecological survey 73(3): 133–134 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| (2018) Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women with Low Dose Epidural: BUMPES Randomised Controlled Trial. Obstetrical and Gynecological Survey 73(3): 133–134 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| (2018) Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. MIDIRS midwifery digest 28(1): 68–68 [PMC free article: PMC5646262] [PubMed: 29046273] | - Duplicate |
| Aguilar, Omar Calvo; Ana Luisa Flores, Romero; Victor Edilberto Morales, Garcia (2013) Comparison of obstetric and perinatal outcomes in childbirth upright posture vs. supine. Ginecologia y Obstetricia de Mexico 81(1): 1–10 [PubMed: 23513398] | - Non-English language study |
| Amini, L., Jamshidi, R., Kashanian, M. et al (2011) The effect of sitting position during labour on 3rd stage duration and postpartum haemorrhage. Journal of Obstetrics and Gynaecology 31(suppl1): 33–34 | - Conference abstract |
| Amiri Farahani, L.; Shirazi, V.; Rajabalipoor, F. (2012) The effects of different positioning on the duration of the second stage of labor in primiparous women. Journal of zanjan university of medical sciences and health services 20(80): 11 | - Non-English language study |
| Anonymous (1999) Hands/knees posture in late pregnancy or labour for malposition (lateral or posterior) of the presenting part. The practising midwife 2(4): 10–1 [PubMed: 10427281] | - Outcome not in PICO Systematic review reporting the outcome of fetal position from one trial comparing hands and knees position to sitting |
| Bahmaei, K., Iravani, M., Moosavi, P. et al (2018) Effect of maternal positioning with occipito-posterior fetal position during labor on pain intensity and satisfaction of mothers. Iranian journal of obstetrics, gynecology and infertility 21(5): 66–73 | - Non-English language study |
| Berta, Marta, Lindgren, Helena, Christensson, Kyllike et al (2019) Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis. BMC Pregnancy and Childbirth 19(1): 466 [PMC free article: PMC6894325] [PubMed: 31801479] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; induction of labour not reported; individual studies checked for eligibility |
| Bhardwaj, N. (1994) Randomised controlled trial on modified squatting position of birthing. International journal of gynaecology and obstetrics 46: 118 | - Unable to retrieve |
| Bhardwaj, N., Kukade, J. A., Patil, S. et al (1995) Randomised controlled trial on modified squatting position of delivery. Indian journal of maternal and child health 6(2): 33–39 [PubMed: 12319813] | - Unable to retrieve |
| Bick, D., Briley, A., Brocklehurst, P. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG 123: 61 [PMC free article: PMC5694898] [PubMed: 29110753] | - Conference abstract |
| Bick, D., Briley, A., Brocklehurst, P. et al (2017) A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES). Health technology assessment (Winchester, England) 21(65): 1–176 [PMC free article: PMC5694898] [PubMed: 29110753] | - Duplicate |
| Bick, D., Shennan, A., Briley, A. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG: An International Journal of Obstetrics and Gynaecology 123(supplement2): 61 | - Duplicate |
| Bomfim-Hyppolito, S. (1998) Influence of the position of the mother at delivery over some maternal and neonatal outcomes. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 63suppl1: S67–73 [PubMed: 10075214] | - Study conducted in a low or middle income country Study conducted in Brazil |
| Bonoan, M. J.; Otayza, M. L.; Garcia, G. (1997) Acceptability of an indiginous birthing position using a filipino-improvised birthing chair - a third world tertiary care center prospective trial. Acta obstetricia ET gynecologica scandinavica 76(167): 45 | - Study conducted in a low or middle income country Study conducted in the Philippines |
| Brocklehurst, P., Rivero-Arias, O., Eddama, O. et al (2016) A multicentre, randomised controlled trial of position during the late stages of labour in women with an epidural-(BUMPES). BJOG: An International Journal of Obstetrics and Gynaecology 123(suppl1): 11 | - Conference abstract |
| Brément, S., Mossan, S., Belery, A. et al (2007) Delivery in lateral position. Randomized clinical trial comparing the maternal positions in lateral position and dorsal position for the second stage of labour. Gynecologie, obstetrique & fertilite 35(78): 637–644 [PubMed: 17574897] | - Non-English language study |
| Bueno-Lopez, Vanessa, Falgueras-Serrano, Ana Maria, Crespo-Berros, Silvia et al (2018) Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial. Birth (Berkeley, Calif.) 45(4): 385–392 [PubMed: 29537658] | - Comparator not in PICO Study compares a modified lateral position with any other position (control group not clearly defined) |
| Calvo Aguilar, O.; Flores Romero, A. L.; Morales García, V. E. (2013) Comparison of obstetric and perinatal results of childbirth vertical position vs. childbirth supine position. Ginecologia y obstetricia de Mexico 81(1): 1–10 [PubMed: 23513398] | - Non-English language study |
| Cameron, Carolyn A., Torvaldsen, Siranda, Algert, Charles S. et al (2005) A meta-analysis of upright positions in the second stage to reduce instrumental deliveries in women with epidural analgesia. Acta Obstetricia et Gynecologica Scandinavica 84(8): 794–798 [PubMed: 16026407] | - Intervention not in PICO Systematic review includes studies in which position was only maintained in the 1st stage of labour |
| Carbonne, B., Benachi, A., Leveque, M. L. et al (1996) Maternal position during labor: effects on fetal oxygen saturation measured by pulse oximetry. Obstetrics and gynecology 88(5): 797–800 [PubMed: 8885916] | - Comparator not in PICO Study compares different recumbent positions |
| Chang, Su-Chuan, Lin, Lie-Chu, Chou, Min-Min et al (2011) Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour. Midwifery 27(6): 825–831 [PubMed: 20952110] | - Study design Study is not a parallel RCT (data for experimental and control groups collected at different times) |
| Christensson, Kyllike, Thies-Lagergren, Li, Kvist, Linda J. et al (2011) No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: Results of a Swedish randomized controlled trial. BMC Pregnancy and Childbirth 11: 22 [PMC free article: PMC3071335] [PubMed: 21435238] | - Comparator not in PICO Comparator not in PICO as women who gave birth in sitting position compared to women who gave birth in ‘any other position‘ (control group not clearly defined). |
| Christensson, Kyllike, Thies-Lagergren, Li, Kvist, Linda J. et al (2012) Striving for scientific stringency: A re-analysis of a randomised controlled trial considering first-time mothers' obstetric outcomes in relation to birth position. BMC Pregnancy and Childbirth 12: 135 [PMC free article: PMC3542096] [PubMed: 23173988] | - Comparator not in PICO Comparator not in PICO as women who gave birth in sitting position compared to women who gave birth in ‘any other position’ (control group not clearly defined). |
|
CTRI/2022/04/041740 (2022) A Clinical Trial to Determine the Effects of Upright Position on Labour Outcomes. https://trialsearch | - Study conducted in a low or middle income country Conducted in India |
|
CTRI/2022/05/042671 (2022) impact of mothers birthing position on mother and child outcome. https://trialsearch | - Study conducted in a low or middle income country Conducted in India |
| Cuerva Carvajal, A. and Marquez Calderon, S. (2006) [Expulsion stage of delivery: comparison of upright versus lying down positions for childbirth, through maternal and foetal outcomes]. | - Non-English language study |
| Danilenko-Dixon, D. R., Tefft, L., Cohen, R. A. et al (1996) Positional effects on maternal cardiac output during labor with epidural analgesia. American journal of obstetrics and gynecology 175(4pt1): 867–72 [PubMed: 8885738] | - Comparator not in PICO Study compares two recumbent positions |
| De Jong, P. R., Johanson, R. B., Baxen, P. et al (1997) Randomised trial comparing the upright and supine positions for the second stage of labour. British Journal of Obstetrics and Gynaecology 104(5): 567–571 [PubMed: 9166199] | - Duplicate |
| de Jong, P. R., Johanson, R. B., Baxen, P. et al (1997) Randomised trial comparing the upright and supine positions for the second stage of labour. British journal of obstetrics and gynaecology 104(5): 567–71 [PubMed: 9166199] | - Study conducted in a low or middle income country Study conducted in South Africa |
| de Jong, P. R., Johanson, R., Baxen, P. et al (1995) St Monica's randomized controlled trial of upright vs dorsal position for the second stage of labour. 27th british congress of obstetrics and gynaecology;1995 july 4–7; dublin, ireland: abstractno493 | - Conference abstract |
| De Jonge, A.; Teunissen, T. A. M.; Lagro-Janssen, A. L. M. (2004) Supine position compared to other positions during the second stage of labor: a meta-analytic review. Journal of psychosomatic obstetrics and gynaecology 25(1): 35–45 [PubMed: 15376403] | - Comparator not in PICO Position in control group not defined. Study compares supine position to ‘any other position’ |
| Dokmak, Fatima, Michalek, Irmina Maria, Boulvain, Michel et al (2020) Squatting position in the second stage of labor: A systematic review and meta-analysis. European journal of obstetrics, gynecology, and reproductive biology 254: 147–152 [PubMed: 32966958] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Downe, Soo; Gerrett, David; Renfrew, Mary J. (2004) A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia. Midwifery 20(2): 157–68 [PubMed: 15177859] | - Population not in PICO Study conducted pre-date cut-off (1993) and women received bolus doses of epidural (not low dose infusion epidurals which are the current standard of care) |
| Eason, E. (1999) Randomised trial comparing the upright and supine positions for the second stage of labour. British journal of obstetrics and gynaecology 106(3): 291–2 [PubMed: 10426659] | - Letter to editor |
| Ekstrom, Asa, Olsson, Sven-Eric, Ragnar, Inga et al (2007) Anal sphincter lacerations and upright delivery postures - A risk analysis from a randomized controlled trial. International Urogynecology Journal 18(2): 141–146 [PubMed: 16636770] | - Comparator not in PICO Study compares two upright positions |
| Farahani, L. A.; Ali Pour, F. R.; Shirazi, V. (2012) Effect of different birthing positions during the second stage of labor on mother's experiences regarding birth, pain, anxiety and fatigue. Journal of mazandaran university of medical sciences 22(95): 75–83 | - Non-English language study |
| Frenea, Stephane, Chirossel, Christine, Rodriguez, Raphael et al (2004) The effects of prolonged ambulation on labor with epidural analgesia. Anesthesia and analgesia 98(1): 224–229 [PubMed: 14693624] | - Intervention not in PICO Intervention compares ambulation and recumbent position during the first stage of labour |
| Gupta, J. K. and Hofmeyr, G. J. (2004) Position for women during second stage of labour. Cochrane database of systematic reviews (Online): cd002006 [PubMed: 14973980] | - Duplicate |
| Gupta, J. K. and Nikodem, V. C. (2000) Woman's position during second stage of labour. Cochrane database of systematic reviews (Online): cd002006 [PubMed: 10796279] | - Duplicate |
| Hodnett, Ellen D., Weston, Julie, Stremler, Robyn et al (2013) Repeated hands-and-knees positioning during labour: A randomized pilot study. PeerJ 2013(1): e25 [PMC free article: PMC3629039] [PubMed: 23638360] | - Comparator not in PICO Position in control group was woman’s choice |
| Hofmeyr, G. Justus, Vogel, Joshua, P., Singata, Mandisa et al (2018) Does gentle assisted pushing or giving birth in the upright position reduce the duration of the second stage of labour? A three-arm, open-label, randomised controlled trial in South Africa. BMJ global health 3(3): e000906 [PMC free article: PMC6035507] [PubMed: 29989055] | - Study conducted in a low or middle income country Study conducted in South Africa |
|
IRCT20091001002531N5 (2021) Comparison of maternal and neonatal outcomes between two delivery positions. https://trialsearch | - Study conducted in a low or middle income country Conducted in Iran |
|
IRCT20220306054201N1 (2022) effectiveness of maternal lunge position on rotation of posterior fetal occipital position and delivery outcome. https://trialsearch | - Study conducted in a low or middle income country Conducted in Iran |
| Jahdi, Freshteh, Shahnazari, Maryam, Kashanian, Maryam et al (2011) A randomized controlled trial comparing the physiological and directed pushing on the duration of the second stage of labor, the mode of delivery and apgar score. International Journal of Collaborative Research on Internal Medicine and Public Health 3(2): 159–165 | - Study conducted in a low or middle income country Study conducted in Iran |
| Kafka, M., Riss, P., von Trotsenburg, M. et al (1994) The birthing stool--an obstetrical risk?. Geburtshilfe und Frauenheilkunde 54(9): 529–531 [PubMed: 7988858] | - Non-English language study |
| Karraz, MA (2003) Ambulatory epidural anesthesia and the duration of labor. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 80(2): 117–122 [PubMed: 12566183] | - Intervention not in PICO Intervention is during 1st stage of labour only |
| Kemp, Emily, Kingswood, Claire J., Kibuka, Marion et al (2013) Position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews 2013(1): cd008070 [PubMed: 23440824] | - Duplicate Earlier version of Cochrane review |
| Kibuka, Marion, Price, Amy, Onakpoya, Igho et al (2021) Evaluating the effects of maternal positions in childbirth: An overview of Cochrane Systematic Reviews. European journal of midwifery 5: 57 [PMC free article: PMC8678923] [PubMed: 35005482] | - Systematic review Studies do not meet inclusion: Does not exclude studies in which the position was not maintained into second stage or studies which compare a postural changes intervention. Intervention during first stage of labour. Women did not have epidural analgesia. Reference list checked for eligible studies |
| Kibuka, Marion and Thornton, Jim G. (2017) Position in the second stage of labour for women with epidural anaesthesia. The Cochrane database of systematic reviews 2: cd008070 [PMC free article: PMC6464234] [PubMed: 28231607] | - Duplicate Earlier version of Walker 2018 |
| Leila, Amini, Shayesteh, Jahanfar, Maryam, Kashanian et al (2010) Sitting position: A right way to reduce labour pain with shortening duration of labor. Journal of Psychosomatic Obstetrics and Gynecology 31(suppl1): 104 | - Conference abstract |
| Levy, Ariel T., Weingarten, Sarah, Ali, Ayesha et al (2021) Hands-and-knees posturing and fetal occiput anterior position: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology MFM 3(4): 100346 [PubMed: 33705998] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Levy, Ariel, Ali, Ayesha, Quist-Nelson, Johanna et al (2021) 512 Hands-and-knees position and incidence of occiput anterior position at birth: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 224(2supplement): 323 [PubMed: 33705998] | - Conference abstract |
| Moraloglu, Ozlem, Kansu-Celik, Hatice, Tasci, Yasemin et al (2017) The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 30(2): 245–249 [PubMed: 27028537] | - Study conducted in a low or middle income country Study conducted in Turkey |
| Nasir, Ayesha; Korejo, Razia; Noorani, K. J. (2007) Child birth in squatting position. JPMA. The Journal of the Pakistan Medical Association 57(1): 19–22 [PubMed: 17319414] | - Study conducted in a low or middle income country Study conducted in Pakistan |
|
NCT05307393 (2022) Maternal Positioning to Correct Fetal Occiput Posterior. https: | - Unable to retrieve Clinical trial - study start date January 2023 |
|
NCT05360823 (2022) The Effect of Using a Birth Ball and Squatting Position During Labor. https: | - Unable to retrieve Clinical trial - no results posted or publication link |
| Pizzagalli, F. (2020) Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Maternal postures during the second stage of labour, delivery techniques and perineal protection. Gynecologie Obstetrique Fertilite et Senologie 48(12): 931–943 [PubMed: 33011376] | - Non-English language study |
| Plaat, F.; Golara, M.; Shennan, A. (1996) Upright vs recumbent position with mobile extradurals in the early second stage of labour. British journal of anaesthesia 76: 102 | - Conference abstract |
| Plaat, F.; Golara, M.; Shennan, A. (1996) Upright versus recumbent position with mobile extradurals in the early second stage of labour. Br-j-anaesth 76suppl2: 102 | - Conference abstract |
| Priddis, Holly; Dahlen, Hannah; Schmied, Virginia (2012) What are the facilitators, inhibitors, and implications of birth positioning? A review of the literature. Women and birth: journal of the Australian College of Midwives 25(3): 100–6 [PubMed: 21664208] | - Population not in PICO Systematic review does not exclude studies in which women did not receive epidural and does not perform subgroup analysis; individual studies checked for eligibility |
| Racinet, C., Eymery, P., Philibert, L. et al (1999) Delivery in the squatting position. A randomized trial comparing the squatting position and the lithotomy position for the expulsion phrase. Journal de gynecologie, obstetrique ET biologie de la reproduction 28(3): 263–270 [PubMed: 10456309] | - Non-English language study |
| Racinet, C., Eymery, P., Philibert, L. et al (1999) [Labor in the squatting position. Journal de gynecologie, obstetrique et biologie de la reproduction 28(3): 263–270 [PubMed: 10456309] | - Non-English language study |
| Ragnar, I., Altman, D., Tyden, T. et al (2006) Comparison of the maternal experience and duration of labour in two upright delivery positions--a randomised controlled trial. BJOG: an international journal of obstetrics and gynaecology 113(2): 165–70 [PubMed: 16411993] | - Comparator not in PICO Study compares two upright positions |
| Raulli, A. (2001) The use of birth stools during second stage labour and the risk of perineal trauma. | - Conference abstract |
| Rocha, Bruna Dedavid da, Zamberlan, Claudia, Pivetta, Hedioneia Maria Foletto et al (2020) Upright positions in childbirth and the prevention of perineal lacerations: a systematic review and metaanalysis. Posicoes verticalizadas no parto e a prevencao de laceracoes perineais: revisao sistematica e metanalise. 54: e03610 [PubMed: 32935765] | - Comparator not in PICO Systematic review of studies comparing upright positions |
| Roth, Cheryl, Dent, Sarah A., Parfitt, Sheryl E. et al (2016) Randomized Controlled Trial of Use of the Peanut Ball During Labor. MCN. The American journal of maternal child nursing 41(3): 140–6 [PubMed: 26859467] | - Intervention not in PICO Study does not compare upright to recumbent positions |
| Schirmer, J.; Fustinoni, S. M.; Basile, Aldo (2011) Perineal outcomes on the left lateral versus vertical semi-sitting birth positions: a randomized study. Acta paulista de enfermagem 24(6): 745–750 | - Study conducted in a low or middle income country Study conducted in Brazil |
| Shedmake, Priyanka Vijay and Wakode, S. R. (2021) A Hospital-Based Randomized Controlled Trial-Comparing the Outcome of Normal Delivery Between Squatting and Lying Down Positions During Labour. Journal of obstetrics and gynaecology of India 71(4): 393–398 [PMC free article: PMC8418581] [PubMed: 34566298] | - Study conducted in a low or middle income country Study conducted in India |
| Simarro, M., Salinas, C., Martinez, A. et al (2011) Effects of postural changes during the second stage of labor among women with epidural analgesia. International Urogynecology Journal and Pelvic Floor Dysfunction 22(suppl1): S13–S14 | - Intervention not in PICO Study compares different postural changes (both upright and recumbent positions) to recumbent position |
| Stremler, R. L. (2003) The labour position trial: a randomized, controlled trial of hands and knees positioning for women labouring with a fetus in occipitoposterior position. Dissertation/ thesis: 163p | - Thesis paper |
| Theron, A., Baraz, R., Thorp-Jones, D. et al (2011) Does position in the passive second stage of labour affect birth outcome in nulliparous women using epidural analgesia. International Journal of Obstetric Anesthesia 20(suppl1): 12 | - Conference abstract |
| Thies-Lagergren, L., Christensson, K., Kvist, L. J. et al (2011) Maternal outcomes in nulliparous women who gave vaginal birth on a birth seat or in any other position: Results of a randomised controlled trial in Sweden. Journal of Paediatrics and Child Health 47(suppl1): 36–37 | - Conference abstract |
| Thies-Lagergren, L., Kvist, L. J., Sandin-Bojo, A. K. et al (2012) Augmentation of labour and fetal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births. Journal of Paediatrics and Child Health 48(suppl1): 101–102 | - Conference abstract |
| Thies-Lagergren, L., Kvist, Linda J., Sandin-Bojo, Ann-Kristin et al (2013) Labour augmentation and fetal outcomes in relation to birth positions: a secondary analysis of an RCT evaluating birth seat births. Midwifery 29(4): 344–350 [PubMed: 23084490] | - Comparator not in PICO Position for birth in control group not sufficiently defined |
| Valiani, Mahboubeh; Rezaie, Mehri; Shahshahan, Zahra (2016) Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iranian journal of nursing and midwifery research 21(4): 372–8 [PMC free article: PMC4979260] [PubMed: 27563320] | - Study conducted in a low or middle income country Study conducted in Iran |
| Vaziri, Farideh, Moshfeghy, Zeinab, Arzhe, Amene et al (2016) Spontaneous pushing in lateral position versus Valsalva maneuver during second stage of labor on maternal and fetal outcomes: A randomized clinical trial. Iranian Red Crescent Medical Journal 18(10): e29279 [PMC free article: PMC5286842] [PubMed: 28180019] | - Comparator not in PICO Study compares different pushing techniques in two recumbent positions (lateral and supine) |
| Waldenström, U. and Gottval, K. (1994) Randomized trial of birthing stool or conventional semi-recumbent position for second-stage labor. Jordemodern 107(78): 261–265 [PubMed: 7928535] | - Population not in PICO Included in review for position of birth in women without epidural analgesia |
| Walker, C., Rodriguez, T., Herranz, A. et al (2011) Second stage of labor with postural change and lateral position in women with epidural analgesia: A randomized controlled trial. International Urogynecology Journal and Pelvic Floor Dysfunction 22(suppl1): S11–S12 | - Comparator not in PICO Study compares two recumbent positions (lateral vs lithotomy position) |
| Walker, Kate F., Thornton, Jim G., Jones, Nia W. et al (2018) Maternal position in the second stage of labour for women with epidural anaesthesia. Cochrane Database of Systematic Reviews 2018(11): cd008070 [PMC free article: PMC6517130] [PubMed: 30411804] | - Intervention not in PICO Review does not exclude studies in which the position was not maintained into second stage or studies which compare a postural changes intervention; individual studies checked for eligibility |
| Zang, Yu, Lu, Hong, Zhang, Huixin et al (2021) Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews. International journal of nursing studies 114: 103812 [PubMed: 33217662] | - Study design Overview of systematic reviews; included systematic reviews checked for eligibility |
| Zang, Yu, Lu, Hong, Zhao, Yang et al (2020) Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta-analysis. Journal of clinical nursing 29(1718): 3154–3169 [PubMed: 32531856] | - Intervention not in PICO Intervention is flexible sacrum positions which include both upright positions and lateral positions compared to recumbent positions |
| Zhang, H., Huang, S., Guo, X. et al (2017) A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery 50: 117–124 [PubMed: 28414983] | - Study conducted in a low or middle income country Study conducted in China |
| Zhang, Hong-Yu, Shu, Rong, Cai, Wen-Zhi et al (2016) Comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position. International Journal of Nursing Sciences 3(2): 178–184 | - Study conducted in a low or middle income country Study conducted in China |
No economic evidence was identified for this review.
Appendix K. Research recommendations – full details
Research recommendations for review question: What is the most effective position for birth in women with an epidural in situ?
No research recommendations were made for this review question.
Research recommendations for review question: What is the most effective position for birth in women without an epidural in situ?
No research recommendations were made for this review question.
Final version
Evidence reviews underpinning recommendations 1.6.30, 1.9.5 and 1.9.6 in the NICE guideline
These evidence reviews were developed by NICE
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.
- NLM CatalogRelated NLM Catalog Entries
- PMCPubMed Central citations
- PubMedLinks to PubMed
- Maternal position in the second stage of labour for women with epidural anaesthesia.[Cochrane Database Syst Rev. 2018]Maternal position in the second stage of labour for women with epidural anaesthesia.Walker KF, Kibuka M, Thornton JG, Jones NW. Cochrane Database Syst Rev. 2018 Nov 9; 11(11):CD008070. Epub 2018 Nov 9.
- Review Position in the second stage of labour for women without epidural anaesthesia.[Cochrane Database Syst Rev. 2017]Review Position in the second stage of labour for women without epidural anaesthesia.Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Cochrane Database Syst Rev. 2017 May 25; 5(5):CD002006. Epub 2017 May 25.
- Review Maternal positions and mobility during first stage labour.[Cochrane Database Syst Rev. 2013]Review Maternal positions and mobility during first stage labour.Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Cochrane Database Syst Rev. 2013 Aug 20; (8):CD003934. Epub 2013 Aug 20.
- Review Maternal positions and mobility during first stage labour.[Cochrane Database Syst Rev. 2013]Review Maternal positions and mobility during first stage labour.Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Cochrane Database Syst Rev. 2013 Oct 9; (10):CD003934. Epub 2013 Oct 9.
- Review Maternal positions and mobility during first stage labour.[Cochrane Database Syst Rev. 2009]Review Maternal positions and mobility during first stage labour.Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Cochrane Database Syst Rev. 2009 Apr 15; (2):CD003934. Epub 2009 Apr 15.
- Evidence reviews for position for birthEvidence reviews for position for birth
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