Epidural analgesia often prolongs the second stage of labour. Researchers recently investigated whether the woman’s position after an epidural during the second stage of labour affects the chances of a spontaneous vaginal delivery.
Epidural analgesia is considered the most effective pain relief for women during labour and is chosen by 30% of women who give birth in the United Kingdom each year. Although effective, the use of an epidural increases the time from complete cervical dilation until birth, also known as the second stage of labour, resulting in an increased risk of the use of instruments during vaginal delivery. Low dose epidural analgesia allows for greater mobility throughout labour and enables women to assume upright positions.
In a study recently published in the British Medical Journal researchers investigated whether a woman’s position during labour affected spontaneous vaginal delivery in those given an epidural. The Birth in the Upright Maternal Position with Epidural in Second stage (BUMPES) study included 3,093 first time pregnant women who were in the second stage of labour and given epidural analgesia during the first stage of labour that provided effective pain relief.
Eligible participants were at least 16 years of age, were 37 weeks or more pregnant, and were randomly allocated into the upright or laying down position during the second stage of labour. An upright position included any posture that would keep the pelvis in the vertical plane for as much of the labour as possible, such as walking, standing, sitting out of bed, or supported kneeling. A laying down position was described as any posture that would maintain the pelvis in the horizontal plane for as much of the labour as possible and included the left or right lateral position.
The primary outcome measured in the BUMPES trial was spontaneous vaginal delivery and the participants were asked to complete a one-page questionnaire about their satisfaction with their birth experience as soon as possible after delivery. The results showed a significant difference in spontaneous vaginal delivery between the upright group (35.2%) and the lying down group (41.4%) amounting to an absolute increase of 5.9%. The evidence from this study suggests that lying down during the second stage of labour in women having their first baby and given epidural analgesia increases the chances of having a spontaneous vaginal delivery.
This study included some limitations. The results may have been affected by the women’s perception of the different positions in their ability to achieve a spontaneous vaginal birth. Existing guidance for the National Institute for Health and Care Excellence recommends that women who are given low-dose epidural analgesia should assume whatever upright position they find comfortable, and this may present a possible dilution of treatment effect.
In conclusion, lying down during the second stage of labour results in more spontaneous vaginal birth delivery in women who were given epidural analgesia than in women who remain upright during the same stage. The results are not generalizable to women who have had children in the past with epidural, and further research is required on the labour outcomes in women without the use of epidural.
Written by Kimberly Spencer B.Sc. (Hons)
Reference: Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. (2017). BMJ, j4471.