Many women go through labour in a hospital bed. A new Cochrane review has investigated whether this is better or worse than standing up or walking round. It found that being upright or mobile reduced the length of labour by an average of an hour, without any increase in problems during birth.

The review itself has had a long gestation, but its recent delivery provides collective knowledge from 21 trials in more than 3700 women. They span more than 30 years of research and come from many different parts of the world. The largest single contribution is seven studies done in the UK. The most recent are two trials published a couple of years ago, from Brazil and Thailand.

Women who laboured in recumbent positions were compared with those who were upright. This included sitting, kneeling, standing and walking. Separate analyses were done of the trials in which women were receiving epidural pain relief.

In the absence of an epidural, the average duration of the first stage of labour, until the cervix was fully dilated, was an hour less for women who were upright compared to those who were recumbent. Other outcomes were similar between the groups. For example, about nine in every ten women in both groups had a spontaneous vaginal delivery, and four or five per hundred had a caesarean section. The use of pain relief was similar whether the woman was upright or lying down and, in the few studies that timed it, the second stage of labour lasted about the same amount of time in both groups. Unfortunately, the trials tell us little about whether the different positions led to different levels of satisfaction among the women.

For the nearly 1200 women who took part in the studies while having an epidural, length of labour was similar if they were upright or recumbent. Other outcomes were also similar, regardless of position.

This collecting together of the research evidence allows us to go further than a simple “yes” or “no” to the question of whether being upright speeds up labour, and whether it is beneficial or harmful for the mother and baby. It shows that labour is about an hour shorter and other outcomes are similar. The authors of the new Cochrane review conclude that their work supports the encouragement of women to take up whatever position they find most comfortable during the first stage of labour.

This Cochrane review is available in full at www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003934/frame.html

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April 27 2009