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Study backs lying down during labour after low-dose epidural

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First time mothers with an epidural who lie down in the later stages of labour are more likely to have a normal birth than those who remain upright, according to UK researchers.

Adopting a lying down position led to a higher chance of having a spontaneous vaginal birth, without forceps or suction, said the study authors from the Epidural and Position Trial Collaborative Group.

“The intervention appears to be easy and cost-free to adopt”

Study authors

They noted that 30% of women choose to have an epidural because it was the most effective form of pain relief in labour, but highlighted that it led to a higher risk of an instrumental vaginal birth.

They also acknowledged that the National Institute for Health and Care Excellence currently said women with an epidural should be encouraged to adopt an upright position that they found “comfortable”.

But they said the position a woman was in during the second stage of labour – after the cervix was fully dilated – had been suggested to have an effect on the risk of instrumental vaginal birth.

Epidural cannula

Epidural cannula

As a result, they investigated whether adopting a lying down or an upright position increased the rate of spontaneous vaginal birth in nulliparous mothers who had received a low dose epidural.

They carried out a randomised controlled trial, funded by the National Institute of Health Research, involving 3,093 women in 41 hospital labour wards between October 2010 and January 2014.

The women were aged 16 or over, and in the second stage of labour, according to the researchers, who were led by Professor Peter Brocklehurst from Birmingham University.

They said 35.2% of women in the upright group had a spontaneous birth, compared with 41.1% in the lying down group.

This represents a 5.9% absolute increase in the chance of spontaneous vaginal birth in the lying down group, according to the study authors.

“Evidence from this randomised controlled trial indicates that a policy of adopting a lying down position in the second stage of labour in women having their first baby with epidural analgesia increases the chances of a spontaneous vaginal birth,” they stated.

“No disadvantages were apparent in relation to short or longer term outcomes for mother or baby,” they added.

University of Birmingham

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Peter Brocklehurst

The researchers also calculated that the number of women who needed to be treated in line with their approach in order to achieve one additional spontaneous vaginal birth was 17.

“The intervention appears to be easy and cost-free to adopt,” they stated in the British Medical Journal.

“This evidence will allow pregnant women, in consultation with their healthcare providers, to make informed choices about their position in the second stage of labour,” they said.

However, they added that it was unclear what their findings mean for women without an epidural or for those who had given birth before.

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