Upright Versus Recumbent Position in the Second Stage of Labor for Women With Epidural Analgesia: A Randomized Clinical Trial

Ali Shahriari; Masoomeh  Nataj-Majd; Majid Akrami; Maryam Khooshideh; Mahsa Soleimani

doi:10.18502/acta.v61i11.16076

Ali Shahriari Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
Masoomeh Nataj-Majd Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
Majid Akrami Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
Maryam Khooshideh Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mahsa Soleimani Department of Obstetrics and Gynecology, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/acta.v61i11.16076

Keywords: Epidural analgesia; Natural vaginal delivery; Cesarean section; Labor stages; Patient positioning

Abstract

Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.