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 Researchers examined data on 3,093 women who had babies at 41
hospitals from 2010 to 2014. Women were randomly assigned to labor
either lying down or upright.
Overall, 41 percent of the mothers who labored lying down had what’s
known as a spontaneous vaginal birth, when the baby emerges without
assistance from tools like forceps or a vacuum and a surgical
cesarean delivery isn’t needed. That compares to 35 percent of the
women who labored in an upright position.
“Lying down compared with being upright, increases a woman's chances
of having a spontaneous vaginal birth,” said study author Dr. Peter
Brocklehurst of the University of Birmingham.
“This matters both to women and babies because avoiding instrumental
births, whether with forceps or (vacuum extraction) or a cesarean
section in the late stage of labor, avoids any of the traumas, both
short term and long term, which follow from these interventions,”
Brocklehurst said by email.
Roughly 30 percent of women in the UK choose spinal anesthesia known
as an epidural during labor, and this method of pain relief is
associated with longer labor and higher odds that tools or surgery
will be required, researchers note in The BMJ.
Some previous research also suggests that the position women are in
during the second stage of labor, when the cervix is fully dilated
and it’s time to push, may independently influence their odds of
having a spontaneous vaginal birth.
“We do not clearly understand how the lying down position increases
the chances of a spontaneous vaginal birth,” Brocklehurst said.
It’s possible that when women are upright during the second stage of
labor, swelling of tissues below the baby’s head in the birth canal
might make it harder for women to push babies out, he said. It’s
also possible that when women are lying down, contractions may be
more productive at helping the baby emerge from the birth canal.
In the study, there was an almost 6 percent absolute increase in the
chance of a spontaneous vaginal birth when women were lying down
during labor.
Women were slightly more likely to have deliveries assisted by
forceps or other instruments, a C-section delivery, or tearing or
other injuries during delivery when they were upright, but the
differences were too small to rule out the possibility that they
were due to chance.
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One limitation of the study is that more women stuck with their
assigned labor position in the upright group than the lying down
group, researchers note. This may be due in part to current
guidelines in the UK that encourage women to be upright during
labor, and it may mean the results underestimate the benefits of
lying down.
The study findings are surprising because many clinicians believe
that the added effects of gravity, along with being better able to
tilt one’s pelvis, make delivery easier from an upright position,
said Dr. Philip Hess, a researcher at Harvard Medical School and
director of obstetric anesthesia at Beth Israel Deaconess Medical
Center in Boston.
“This study goes against that belief,” Hess, who wasn’t involved in
the study, said by email.
“This matters for patients because not all patients find squatting
to be easy,” Hess added. “This is especially true if they are
receiving denser epidural pain relief that decreases the strength in
the woman’s legs.”
Based on the results, women should feel free to choose a labor
position that makes the most sense in their individual situation, he
said.
“Patients should be in a comfortable position for them during the
second stage, and patients should not be forced to remain upright if
it is challenging or uncomfortable,” Hess continued. “Being upright
for some time can still be beneficial, but it’s ok to lie down for
the delivery.”
SOURCE: http://bit.ly/2lHbBYO The BMJ, online October 18, 2017.
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