Comparison of the maternal experience and duration of labour in two upright delivery positions—a randomised controlled trial

ABSTRACT

Objective To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience.

Design A randomised controlled trial.

Setting A county hospital delivery ward.

Sample Primiparous subjects (n= 271) were randomly allocated to a kneeling (n= 138) or a sitting (n= 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial.

Methods Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis.

Main outcome measure Duration of the second stage of labour.

Results A comparison of the duration of the second stage of labour (kneeling 48.5 minutes ± 27.6 SD, sitting 41 minutes ± 23.4 SD) revealed no significant difference between the groups. A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P= 0.002), less comfort for giving birth (P= 0.03) and more frequent feelings of vulnerability (P= 0.05) and exposure (P= 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) (Table 3).

 

  Table 3. Qualitative outcome of second stage of labour at a sitting position compared with kneeling

Sitting, n= 133 Kneeling, n= 138 Logistic regression analysis, adjusted odds ratio (95% CI) Did you experience the position comfortable for giving birth?* 1 1 0.5 (0.1–0.9), P= 0.03 Did you feel vulnerable in the position?* 3 2 2.1 (0.9–4.6), P= 0.05 Did you feel exposed in the position?* 2 1 1.7 (1.5–1.9), P= 0.02 Did you feel safe in the position during pushing?* 1 1 0.9 (0.7–1.3), P= 0.7 Did you experience the second stage as long?** 69 37 1.4 (0.8–0.9), P= 0.002 How much did you participate during the pushing?** 5 10 1.2 (0.9–1.2), P= 0.13 How much pain did you experience in the assigned position?** 33 17 1.3 (1.1–1.9), P= 0.01 Do you experience postpartum perineal pain?* 2 1 1.9 (1.3–2.9), P= 0.001 Do you consider your delivery difficult?* 2 1 1.7 (1.4–2.0), P= 0.01 Would you give birth in the same position again?*** 95 (89) 92 (82) 0.89 (0.47–1.4), P= 0.43   *Median score, 0–3: 0 = not at all; 1 = some; 2 = a lot; 3 = very much.   **Visual analogue scale 0–100.   ***Yes, number of subjects (%).

Conclusions Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.