Evaluation of the effect of four maternal positions on the duration of the second stage in nulliparous women

ABSTRACT

For centuries, there has been controversy around whether being.upright [standing, sitting, birthing stools, chairs, squatting] or lying down [supine, left lateral, lithotomy] have advantages for women delivering their babies To assess the benefits and risks of the use of different positions during the second stage of labor. The primary outcome was the duration of the second stage. Secondary outcomes were incidence of operative delivery, incidence of perineal and vaginal tears, estimated blood loss during the third stage and Apgar score This prospective randomized study was carried out at the Department of Obstetrics and Gynecology of the Shatby Maternity University Teaching Hospital in Alexandria, Egypt between 1998 and 2002. The study was carried out on 2080 nulliparous women who reached the second stage of labor with alive, full term, singleton fetus presenting with cephalic vertex presentation and with estimated average fetal weight. Women with medical or obstetric risk factors were excluded. Five hundred and twenty cases were randomly allocated into one of 4 groups. Group I cases used squatting position and group II cases used sitting position. Standing and lithotomy positions were the positions taken by cases in groups III and IV respectively There was no significant difference between groups concerning gestational age, estimated fetal weight by ultrasonography, head station and uterine activity. The shortest mean duration of the second stage was observed among cases in group I [30 [6 minutes] while the longest duration was observed among cases in group IV [100 [25 minutes]. In group II the second stage lasted 60 [15 minutes while in group III the second stage lasted 40 [12 minutes. A statistically significant decrease for the use of medical analgesia [p=0.0001] and oxytocin [p=0.0001] [was observed in women using the upright birth position. A significantly lower rate of operative delivery was detected in women who delivered in an upright position [groups I, II, III] compared with women delivering in lithotomy position [group 1V] [p=0.0001]. The frequency of perineal tears, and vaginal and labial trauma did not differ between the four groups [p>0.05]. When analyzing maternal blood loss in the third stage, no significant differences between all groups were found [p>0.05]. No differences in APGAR score <7 at 1 and 5 minutes or cord pH <7.1 were observed [p>0.05] between groups Maternal position during the second stage of labor definitely affects the duration of the second stage. Upright posture [squatting, standing, and sitting] were associated with shorter duration of the second stage in comparison to lying down [lithotomy position]. Also upright posture was associated with lower incidence of operative delivery