Raoul Desbriere a , Julie Blanc b, Renaud Le Dû b c d, Jean-Paul Renner f, Xavier Carcopino b c, Anderson Loundou e, Claude d'Ercole b c
Desbriere R, Blanc J, Le Dû R, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol 2013;208:60.e1-8.
Read more: Is posture efficient? Desbriere 2013
These are some of the studies on what women can do in labor to effect labor progress and outcome. More are needed. Please send the names and links of studies which you find important. Together we can make this a better article.
Maternal position during the first stage of labor: a systematic review
From João P Souza and his research team in Brazil.
This review and randomization analysis found walking and being upright to be safe. Two of the studies looked at really long labors and perhaps that is why, overall, the report doesn't show moving around shortened labor compared with laying around. Interventions in labor were common, so this isn't a study to show anything about natural labor per se.
Mobility and maternal position during childbirth in Tanzania: an exploratory study at four government hospitals
2nd Stage or Pushing Stage
MidwifeInfo.com website has this to say about a study on vertical positions in the 2nd Stage:
Fewer abnormal fetal heart rate patterns 1 trial - OR 0.31, 95% CI 0.11 - 0.91).
(Citation: Gupta JK , Nikodem VC. Woman's position during second stage. Cochrane Library)
Nancy from MidwifeInfo says, "I find this evidence too compelling to be ignored by those of us involved in the care of laboring women. There have been varied hypotheses about the reasons for the advantages of non-recumbent positions, such as stronger and more effective uterine contractions (Caldeyro-Barcia 1960), and improved alignment of the fetus for passage through the pelvis (Gold 1950); and also lessened risk of aorto-caval compression and improved acid-base outcomes in the newborn (Ang 1969, Humphrey 1974, Scott 1963). Until recently in the history of childbearing, women would try to avoid the dorsal position and would change position during labor when and as she wished (Engelmann 1882). Different upright positions were achieved using posts, hammocks, furniture, ropes or knotted pieces of cloth, kneeling, crouching or squatting using bricks, stones, a pile of sand, or a birth stool (Englemann 1881). Today, most women deliver in a dorsal, semi-recumbent or lithotomy position. We all know that it is easier for the midwife to monitor the baby and see what is happening if the woman is in a dorsal or semi-recumbent position (yes, the ubiquitous semi-Fowler's position), and we know that this is the position modern Western women expect to assume to birth their babies (or, all too often, to be delivered of them). After all, the TV screen in the labor room is positioned so that the view is best from the semi-recumbent position in the bed, so women just naturally get into bed and slide down into that position. Then they stay there.
Nancy continues, "I would like to propose that we, as midwives, using the best available evidence, make a non-recumbent position the default position for second stage of labor, and use a recumbent position only for specific situations. Why don't we do this now? I would hazard that the reasons have more to do with habit, hospital protocols, fatigue or overwork (I am frequently too tired or too busy to try something different, even if it occurs to me that it might help) than with a conviction that the semi-Fowler's position is better. Even with an epidural, most women can sit in a chair, on a commode, or on a birthing ball next to the bed; or they can stand next to the bed and lean over it, with support from another person. Remembering the significant advantages of an upright position, I would like to challenge all of us to use this evidence to encourage our patients to sit, squat, kneel, or stand to push their babies out."
Thank you, Nancy. I'm sure the readers of SpinningBabies.com agree! Visit MidwifeInfo.com
Researcher Gupta also had this report published:
Woman's position during second stage of labour.
Gupta JK, Nikodem VC.
Which is better, being upright or lying down to push out a baby? This review of the Cochrane articles "suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies."
I wonder about increased blood loss. I think we should look at how much comes with the placental gush and then how much over the postpartum period before we decide. Sometimes when women lose more at birth they lose less in the days and weeks following birth. Watching blood loss within the next hour or two and making a comparison of blood loss would show us if this initial increased blood loss is significant.