Maternal positions and mobility during first stage labour

 

Abstract

Background

It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour.

Objectives

The purpose of the review is to assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2008).

Selection criteria

Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour.

Data collection and analysis

We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. A minimum of two review authors independently assessed each study.

Main results

The review includes 21 studies with a total of 3706 women. Overall, the first stage of labour was approximately one hour shorter for women randomised to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomised to upright positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).There were no differences between groups for other outcomes including length of the second stage of labour, mode of delivery, or other outcomes related to the wellbeing of mothers and babies. For women who had epidural analgesia there were no differences between those randomised to upright versus recumbent positions for any of the outcomes examined in the review. Little information on maternal satisfaction was collected, and none of the studies compared different upright or recumbent positions.

Authors' conclusions

There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.

 

Plain language summary

Mothers' position during the first stage of labour

Women in the developed world and in health facilities in low-income countries usually lie in bed during the first stage of labour. Elsewhere, women progress through this first stage while upright, either standing, sitting, kneeling or walking around, although they may choose to lie down as their labour progresses. The attitudes and expectations of healthcare staff, women and their partners have shifted with regard to pain, pain relief and appropriate behaviour during labour and childbirth. A woman semi-reclining or lying down on the side or back during the first stage of labour may be more convenient for staff and can make it easier to monitor progression and check the baby. Fetal monitoring, epidurals for pain relief, and use of intravenous infusions also limit movement. Lying on the back (supine) puts the weight of the pregnant uterus on abdominal blood vessels and contractions may be less strong than when upright. Effective contractions help cervical dilatation and the descent of the baby.

The results of the review suggest that the first stage of labour may be approximately an hour shorter for women who are upright or walk around during the first stage of labour. The women’s body position did not affect the rate of interventions. The review authors identified 21 controlled studies from a number of countries that randomly assigned a total of 3706 women to upright or recumbent positions in the first stage of labour. Nine of the studies included only women who were giving birth to their first baby. The length of the second stage of labour and the numbers of women who achieved spontaneous vaginal deliveries or required assisted deliveries and augmentation were similar between groups, where reported. Use of opioid analgesia was no different, although women randomised to upright positions were less likely to have epidural analgesia. In those studies specifically examining position and mobility for women receiving epidural analgesia (five trials, 1176 women), an upright or recumbent position did not change the length of the first stage of labour (time from epidural insertion to complete cervical dilatation) or rates of spontaneous vaginal, assisted and caesarean delivery. Little information was given on maternal satisfaction or outcomes for babies.

 

摘要

背景

第一產程時孕婦姿勢與活動的研究

在已開發國家和低收入國家的醫療機構中，孕婦躺在床上待產已相當普遍。沒有證據顯示，這樣做對母嬰會更好，不過對於照護人員來說更為便利。觀察型研究認為如果孕婦仰臥姿勢待產，對於子宮收縮有不良影響，也會延遲產程

目標

此篇回顧的目的是評估孕婦採用不同的直立姿勢(包括走、坐、站和跪)與平臥姿勢(包括仰臥、半臥位和側臥)生產時，對於第一產程的時間長短、生產方式和其它母嬰重要結果的影響

搜尋策略

我們搜尋 Cochrane Pregnancy and Childbirth Group Trials Register (November 2008)

選擇標準

比較孕婦第一產程隨機分派採用直立姿勢與平臥姿勢生產之隨機對照和半隨機對照試驗

資料收集與分析

我們使用Cochrane Handbook for Systematic Reviews of Interventions 所描述的方法進行資料的收集、評估研究品質和分析結果。至少有2位回顧作者獨立評估每個試驗

主要結論

回顧納入21篇有3706名孕婦參與的試驗。整體而言，隨機分派用直立姿勢待產的孕婦相較於用平臥姿勢的孕婦，其第一產程的時間縮短將近1小時 D −0.99, 95% CI −1.60 to −0.39)，較少需要硬膜外麻醉(R .83 95% CI 0.72 to 0.96)，而第二產程的所需時間、生產方式及其它有關母嬰健康一些結果，在兩組間並無差異。有使用硬膜外麻醉的孕婦，兩組間結果之間也無差異。少有關於母親滿意度的資料，也沒有針對各種直立姿勢之間或各種平臥姿勢之間的比較研究

作者結論

有證據顯示，孕婦第一產程時，行走和直立姿勢會縮短產程的時間，不會增加其它醫療方式的使用，對母親及嬰兒健康亦無負面影響。應鼓勵孕婦在第一產程採用她們感到最舒適的姿勢

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

已開發國家和低收入國家的醫療機構中，生產的孕婦在第一產程時通常平臥在床上，而在別處，第一產程時的孕婦可以採用直立姿勢，如坐、站、跪或走動，也可在產程有進展的時候選擇平臥姿勢。照護人員、孕婦本身和她們伴侶的態度和期待，會影響待產和分娩過程中孕婦對疼痛的關注、疼痛的緩解和行為表現。孕婦在第一產程中採用半臥、側臥或仰臥的姿勢，對照護人員較便利，比較容易監控產程進展和檢查胎兒狀況。待產過程中，使用胎兒監視器、硬膜外麻醉減痛以及靜脈輸液都限制了孕婦的行動。平躺在床上，懷孕子宮的重量會壓迫腹部血管，子宮收縮可能不如直立姿勢的強，而有效的宮縮才能促進子宮頸的擴張和胎頭下降。回顧研究的結果顯示，孕婦採用直立姿勢或走動，使第一產程時間縮短將近1小時，直立或平臥姿勢不會影響醫療方式的使用比率。此篇回顧研究選用了來自多個國家的21篇試驗，3706名孕婦在第一產程時被隨機分派採用直立或平臥姿勢，其中九篇試驗參與者初產婦，研究結果顯示，兩組之間第二產程時間、自然生產數、需要輔助生產和催生的人數皆相當，需要鴉片類止痛藥的狀況也無差別，不過，隨機分派到直立姿勢組的孕婦比較不需要硬膜外麻醉。在特別針對接受硬膜外麻醉孕婦女的姿勢和活動性的試驗(5篇，1176名孕婦)結果顯示，採用直立姿勢或平臥姿勢不會改變第一產程的長短(從施行硬膜外麻醉到子宮頸全開的時間)，自然陰道生產、輔助生產和剖腹生產的比率也沒有受到影響。探討母親的滿意度及嬰兒狀況的資料很少