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Cochrane Database of Systematic Reviews

Maternal positions and mobility during first stage labour

Information

DOI:
https://doi.org/10.1002/14651858.CD003934.pub4Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 09 October 2013see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Annemarie Lawrence

    Correspondence to: Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Australia

    [email protected]

    [email protected]

  • Lucy Lewis

    School of Nursing and Midwifery, Curtin University, Department of Nursing and Midwifery Education Research, King Edward Memorial Hospital, Perth, Australia

  • G Justus Hofmeyr

    Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, East London, South Africa

  • Cathy Styles

    Women's and Family Service Group, Sunshine Coast Health Service District, Nambour, Australia

Contributions of authors

The review update has been conducted by Lucy Lewis and Annemarie Lawrence.

Data extraction and data entry for the review were carried out by Lucy Lewis and Annemarie Lawrence. The text of the review was drafted by Lucy Lewis and Annemarie Lawrence. Justus Hofmeyr and Cathy Styles commented on drafts.

Sources of support

Internal sources

  • Griffith University, School of Nursing, Queensland, Australia.

  • Centre for Clinical Studies ‐ Women's and Children's Health, Mater Hospital, Queensland, Australia.

  • The University of Liverpool, UK.

  • University of Adelaide, Australian Research Centre for Health of Women and Babies, South Australia, Australia.

  • James Cook University, School of Midwifery and Nutrition, Queensland, Australia.

  • University of Queensland, School of Nursing and Midwifery, Royal Brisbane and Women's Hospital, Queensland, Australia.

  • Institute of Women's and Children's Health, The Townsville Hospital, Queensland, Australia.

  • Tropical Health Research Unit for Nursing and Midwifery Practice (THRU), Queensland, Australia.

External sources

  • Department of Health and Ageing, Commonwealth Government, Australia.

  • National institute for Health Research, UK.

  • Monash Institute of Helath Services Research, Australia.

  • Australasian Cochrane Centre, Australia.

  • Tropical Health Research Unit for Nursing and Midwifery Practice (THRU), Queensland, Australia.

Declarations of interest

None known.

Acknowledgements

We would like to acknowledge the technical and statistical advice provided by Philippa Middleton, Miranda Cumpston and Damien Jolley.

We would also like to thank Caroline Crowther, Lea Budden, Joan Webster and Therese Dowswell for their advice on early versions of this review.

As part of the pre‐publication editorial process, this review has been commented on by two peers (an editor and referee who is external to the editorial team), a member of the Pregnancy and Childbirth Group's international panel of consumers and the Group's Statistical Adviser.

The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pregnancy and Childbirth Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2013 Oct 09

Maternal positions and mobility during first stage labour

Review

Annemarie Lawrence, Lucy Lewis, G Justus Hofmeyr, Cathy Styles

https://doi.org/10.1002/14651858.CD003934.pub4

2013 Aug 20

Maternal positions and mobility during first stage labour

Review

Annemarie Lawrence, Lucy Lewis, G Justus Hofmeyr, Cathy Styles

https://doi.org/10.1002/14651858.CD003934.pub3

2009 Apr 15

Maternal positions and mobility during first stage labour

Review

Annemarie Lawrence, Lucy Lewis, G Justus Hofmeyr, Therese Dowswell, Cathy Styles

https://doi.org/10.1002/14651858.CD003934.pub2

2002 Oct 21

Maternal positions and mobility during first stage labour

Protocol

Lucy Lewis, Joan Webster, Amanda Carter, Carol CM McVeigh, Paul PDM Devenish‐Meares

https://doi.org/10.1002/14651858.CD003934

Differences between protocol and review

The methods section has been updated to reflect changes in methods and software. Perinatal death was not an outcome prespecified in the protocol. Subgroup and sensitivity analyses have been performed according to the updated methods.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
Figures and Tables -
Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.1 Duration of first stage labour (hours).
Figures and Tables -
Figure 3

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.1 Duration of first stage labour (hours).

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.8 Mode of birth: spontaneous vaginal.
Figures and Tables -
Figure 4

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.8 Mode of birth: spontaneous vaginal.

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.15 Mode of birth: operative vaginal: all women.
Figures and Tables -
Figure 5

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.15 Mode of birth: operative vaginal: all women.

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.22 Mode of birth: caesarean birth.
Figures and Tables -
Figure 6

Funnel plot of comparison: 1 Upright and ambulant positions versus recumbent positions and bed care, outcome: 1.22 Mode of birth: caesarean birth.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 1 Duration of first stage labour (hours).
Figures and Tables -
Analysis 1.1

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 1 Duration of first stage labour (hours).

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 2 Duration of first stage labour (hours): subgroup analysis: parity.
Figures and Tables -
Analysis 1.2

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 2 Duration of first stage labour (hours): subgroup analysis: parity.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 3 Duration of first stage labour (hours): subgroup analysis: onset of labour.
Figures and Tables -
Analysis 1.3

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 3 Duration of first stage labour (hours): subgroup analysis: onset of labour.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 4 Duration of first stage labour (hours): subgroup analysis: position types.
Figures and Tables -
Analysis 1.4

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 4 Duration of first stage labour (hours): subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 5 Duration of first stage labour (hours): subgroup analysis: position types.
Figures and Tables -
Analysis 1.5

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 5 Duration of first stage labour (hours): subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 6 Duration of first stage labour (hours): subgroup analysis: position types.
Figures and Tables -
Analysis 1.6

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 6 Duration of first stage labour (hours): subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 7 Duration of first stage labour (hours): sensitivity analysis ‐ positions.
Figures and Tables -
Analysis 1.7

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 7 Duration of first stage labour (hours): sensitivity analysis ‐ positions.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 8 Mode of birth: spontaneous vaginal.
Figures and Tables -
Analysis 1.8

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 8 Mode of birth: spontaneous vaginal.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 9 Mode of birth: spontaneous vaginal: subgroup analysis: parity.
Figures and Tables -
Analysis 1.9

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 9 Mode of birth: spontaneous vaginal: subgroup analysis: parity.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 10 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 1.10

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 10 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 11 Mode of birth: spontaneous vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 1.11

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 11 Mode of birth: spontaneous vaginal: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 12 Mode of birth: spontaneous vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 1.12

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 12 Mode of birth: spontaneous vaginal: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 14 Mode of birth: spontaneous vaginal: sensitivity analysis ‐ positions.
Figures and Tables -
Analysis 1.14

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 14 Mode of birth: spontaneous vaginal: sensitivity analysis ‐ positions.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 15 Mode of birth: operative vaginal: all women.
Figures and Tables -
Analysis 1.15

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 15 Mode of birth: operative vaginal: all women.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 16 Mode of birth: operative vaginal: subgroup analysis: parity.
Figures and Tables -
Analysis 1.16

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 16 Mode of birth: operative vaginal: subgroup analysis: parity.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 17 Mode of birth: operative vaginal: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 1.17

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 17 Mode of birth: operative vaginal: subgroup analysis: onset of labour.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 18 Mode of birth: operative vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 1.18

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 18 Mode of birth: operative vaginal: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 19 Mode of birth: operative vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 1.19

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 19 Mode of birth: operative vaginal: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 21 Mode of birth: operative vaginal: sensitivity analysis ‐ positions.
Figures and Tables -
Analysis 1.21

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 21 Mode of birth: operative vaginal: sensitivity analysis ‐ positions.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 22 Mode of birth: caesarean birth.
Figures and Tables -
Analysis 1.22

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 22 Mode of birth: caesarean birth.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 23 Mode of birth: caesarean birth: subgroup analysis: parity.
Figures and Tables -
Analysis 1.23

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 23 Mode of birth: caesarean birth: subgroup analysis: parity.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 24 Mode of birth: caesarean birth: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 1.24

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 24 Mode of birth: caesarean birth: subgroup analysis: onset of labour.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 25 Mode of birth: caesarean birth: subgroup analysis: position types.
Figures and Tables -
Analysis 1.25

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 25 Mode of birth: caesarean birth: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 26 Mode of birth: caesarean birth: subgroup analysis: position types.
Figures and Tables -
Analysis 1.26

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 26 Mode of birth: caesarean birth: subgroup analysis: position types.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 28 Mode of birth: caesarean birth: sensitivity analysis ‐ positions.
Figures and Tables -
Analysis 1.28

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 28 Mode of birth: caesarean birth: sensitivity analysis ‐ positions.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 29 Analgesia type.
Figures and Tables -
Analysis 1.29

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 29 Analgesia type.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 30 Maternal satisfaction.
Figures and Tables -
Analysis 1.30

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 30 Maternal satisfaction.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 31 Maternal comfort.
Figures and Tables -
Analysis 1.31

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 31 Maternal comfort.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 32 Maternal pain.
Figures and Tables -
Analysis 1.32

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 32 Maternal pain.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 33 Maternal pain.
Figures and Tables -
Analysis 1.33

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 33 Maternal pain.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 34 Maternal pain.
Figures and Tables -
Analysis 1.34

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 34 Maternal pain.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 35 Maternal anxiety.
Figures and Tables -
Analysis 1.35

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 35 Maternal anxiety.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 36 Analgesia amount.
Figures and Tables -
Analysis 1.36

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 36 Analgesia amount.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 37 Duration of second stage of labour (minutes).
Figures and Tables -
Analysis 1.37

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 37 Duration of second stage of labour (minutes).

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 38 Augmentation of labour using oxytocin.
Figures and Tables -
Analysis 1.38

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 38 Augmentation of labour using oxytocin.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 39 Artificial rupture of membranes.
Figures and Tables -
Analysis 1.39

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 39 Artificial rupture of membranes.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 41 Estimated blood loss > 500 mL.
Figures and Tables -
Analysis 1.41

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 41 Estimated blood loss > 500 mL.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 42 Perineal trauma.
Figures and Tables -
Analysis 1.42

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 42 Perineal trauma.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 43 Fetal distress (requiring immediate delivery).
Figures and Tables -
Analysis 1.43

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 43 Fetal distress (requiring immediate delivery).

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 44 Use of neonatal mechanical ventilation.
Figures and Tables -
Analysis 1.44

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 44 Use of neonatal mechanical ventilation.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 45 Apgar scores.
Figures and Tables -
Analysis 1.45

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 45 Apgar scores.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 46 Admission to NICU.
Figures and Tables -
Analysis 1.46

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 46 Admission to NICU.

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 47 Perinatal mortality.
Figures and Tables -
Analysis 1.47

Comparison 1 Upright and ambulant positions versus recumbent positions and bed care, Outcome 47 Perinatal mortality.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 2 Mode of birth: spontaneous vaginal.
Figures and Tables -
Analysis 2.2

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 2 Mode of birth: spontaneous vaginal.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 3 Mode of birth: spontaneous vaginal: subgroup analysis: parity.
Figures and Tables -
Analysis 2.3

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 3 Mode of birth: spontaneous vaginal: subgroup analysis: parity.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 4 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 2.4

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 4 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 5 Mode of birth: spontaneous vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 2.5

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 5 Mode of birth: spontaneous vaginal: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 6 Mode of birth: spontaneous vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 2.6

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 6 Mode of birth: spontaneous vaginal: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 7 Mode of birth: spontaneous vaginal: sensitivity analysis.
Figures and Tables -
Analysis 2.7

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 7 Mode of birth: spontaneous vaginal: sensitivity analysis.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 8 Mode of birth: operative vaginal.
Figures and Tables -
Analysis 2.8

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 8 Mode of birth: operative vaginal.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 9 Mode of birth: operative vaginal: subgroup analysis: parity.
Figures and Tables -
Analysis 2.9

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 9 Mode of birth: operative vaginal: subgroup analysis: parity.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 10 Mode of birth: operative vaginal: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 2.10

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 10 Mode of birth: operative vaginal: subgroup analysis: onset of labour.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 11 Mode of birth: operative vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 2.11

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 11 Mode of birth: operative vaginal: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 12 Mode of birth: operative vaginal: subgroup analysis: position types.
Figures and Tables -
Analysis 2.12

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 12 Mode of birth: operative vaginal: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 13 Mode of birth: operative vaginal: sensitivity analysis.
Figures and Tables -
Analysis 2.13

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 13 Mode of birth: operative vaginal: sensitivity analysis.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 14 Mode of birth: caesarean birth.
Figures and Tables -
Analysis 2.14

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 14 Mode of birth: caesarean birth.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 15 Mode of birth: caesarean birth: subgroup analysis: parity.
Figures and Tables -
Analysis 2.15

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 15 Mode of birth: caesarean birth: subgroup analysis: parity.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 16 Mode of birth: caesarean birth: subgroup analysis: onset of labour.
Figures and Tables -
Analysis 2.16

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 16 Mode of birth: caesarean birth: subgroup analysis: onset of labour.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 17 Mode of birth: caesarean birth: subgroup analysis: position types.
Figures and Tables -
Analysis 2.17

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 17 Mode of birth: caesarean birth: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 18 Mode of birth: caesarean birth: subgroup analysis: position types.
Figures and Tables -
Analysis 2.18

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 18 Mode of birth: caesarean birth: subgroup analysis: position types.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 19 Mode of birth: caesarean birth: sensitivity analysis.
Figures and Tables -
Analysis 2.19

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 19 Mode of birth: caesarean birth: sensitivity analysis.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 21 Maternal pain.
Figures and Tables -
Analysis 2.21

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 21 Maternal pain.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 22 Analgesia amount.
Figures and Tables -
Analysis 2.22

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 22 Analgesia amount.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 23 Duration of second stage of labour (minutes).
Figures and Tables -
Analysis 2.23

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 23 Duration of second stage of labour (minutes).

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 24 Augmentation of labour using oxytocin.
Figures and Tables -
Analysis 2.24

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 24 Augmentation of labour using oxytocin.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 26 Hypotension requiring intervention.
Figures and Tables -
Analysis 2.26

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 26 Hypotension requiring intervention.

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 31 Apgar scores.
Figures and Tables -
Analysis 2.31

Comparison 2 Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women), Outcome 31 Apgar scores.

Summary of findings for the main comparison. Summary of Outcomes

Comparison 1: Upright and ambulant positions versus recumbent positions and bed care

Outcomes showing significance

 

Primary Outcomes

Secondary Outcomes

Maternal

1. Shorter duration of labour if upright. 

Subgroup analysis demonstrated this when:

  • women were nulliparous compared with multiparous

  • women had spontaneous labour compared with induction

  • women were sitting compared with recumbent/supine/lateral

  • women were walking compared with recumbent/supine/lateral

  • women were sitting, standing, squatting, kneeling or walking compared with recumbent/supine/lateral

  • women were siting, standing, squatting, kneeling or walking compared with a supine only position

Sensitivity analysis, which excluded lower quality trials, comparing sitting, standing, squatting, kneeling or walking with recumbent/supine/lateral did confirm this result.

 

2. More likely to have a vaginal birth if upright.

Subgroup analysis demonstrated this when:

  • women were walking compared with recumbent/supine/lateral

  • women were sitting, standing, squatting, kneeling or walking compared with recumbent/supine/lateral

Sensitivity analysis, which excluded lower quality trials, comparing sitting, standing, squatting, kneeling or walking with recumbent/supine/lateral did confirm this result.

3. Less likely to have operative birth if upright.

Subgroup analysis demonstrated this when:

  • women were sitting compared with recumbent/supine/lateral

  • women were walking compared with recumbent/supine/lateral

  • women were sitting, standing, squatting, kneeling or walking compared with recumbent/supine/lateral

Sensitivity analysis, which excluded lower quality trials, did confirm this result.

 

3. Less likely to have caesarean birth if upright.

Subgroup analysis demonstrated this when:

  • women were walking compared with recumbent/supine/lateral

Sensitivity analysis, which excluded lower quality trials, comparing sitting, standing, squatting, kneeling or walking with recumbent/supine/lateral did confirm this result.

1. Less likely to have an epidural if upright.

2. Lower pain scores if upright.

3. BUT More anxiety for nulliparous women if upright.

However this outcome is only from 1 study of 206 women.

 

 

Note: there were no data for: spontaneous rupture of membranes or hypotension requiring intervention.

Fetal / Neonatal

 

1. Less likely to have admission to NICU if mother is upright.

 

Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (all women: epidural)

Outcomes showing significance

 

Primary Outcomes

Secondary Outcomes

Maternal

1. More likely to have operative vaginal birth if multiparous and upright (subgroup analysis: parity only).

Note: there were no data for: duration of first stage labour; maternal satisfaction.

 

Note: there was no data for: artificial rupture of membranes; spontaneous rupture of membranes; estimated blood loss > 500 mL; perineal trauma.

Fetal / Neonatal

Note: there were no data for: fetal distress requiring immediate birth or use of neonatal mechanical ventilation.

Note: there were no data for: admission to the NICU.

NICU: neonatal intensive care unit

Figures and Tables -
Summary of findings for the main comparison. Summary of Outcomes
Table 1. Trial and participant numbers

Trial and participant numbers, grouped by comparison and sorted alphabetically

Comparison 1: Upright and ambulant positions versus recumbent positions and bed care

Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women)

No. of studies

Author

Year

No.

No. of studies

Author

Year

No.

1

Andrews

1990

40

1

Boyle

2002

409

2

Ben Regaya

2010

200

2

Collis

1999

229

3

Bloom

1998

1067

3

Fernando

1994

40

4

Bundsen

1982

60

4

Frenea

2004

61

5

Calvert

1982

200

5

Karraz

2003

221

6

Chan

1963

200

6

Nageotte

1997

761

7

Chen

1987

185

7

Vallejo

2001

160

8

Flynn

1978

68

9

Gau

2011

188

10

Haukkama

1982

60

11

MacLennan

1994

196

12

Mathew

2012

60

13

McManus

1978

40

14

Miquelutti

2007

107

15

Mitre

1974

100

16

Phumduong

2007

204

17

Taavoni

2011

62

18

Williams

1980

300

18

3337

7

1881

Total number of studies for comparisons 1&2: 

25

Total number of participants for comparisons 1&2: 

5218

Figures and Tables -
Table 1. Trial and participant numbers
Table 2. Method of birth outcomes

Method of birth outcomes, grouped by comparison

 

Comparison 1: Upright and ambulant positions versus recumbent positions and bed care

Comparison 2: Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women)

 

Upright

Recumbent

Comp. 1

Upright

Recumbent 

Comp. 2

 

n

total

%

n

total

%

Total

n

total

%

n

total

%

Total

Vaginal Birth

1105

1306

85%

1084

1320

82%

83%

475

808

59%

447

758

59%

59%

Operative Vaginal Birth

125

1252

10%

135

1267

11%

10%

206

808

25%

195

758

26%

26%

Caesarean Birth

72

1329

5%

106

1353

8%

7%

127

808

16%

116

758

15%

16%

Figures and Tables -
Table 2. Method of birth outcomes
Table 3. Characteristics of all studies

Characteristics of all studies, sorted by year of publication

Author

Year

Upright

Recumbent

Country

Parity

No.

All women: epidural

All women: other

1

Chan

1963

sit or walk

supine or lateral

Hong Kong

nulliparous

200

2

Mitre

1974

sit

supine

U.S.A.

nulliparous

100

3

Flynn

1978

walk

lateral

U.K.

mixed

68

External monitoring

4

McManus

1978

walk or sit

lateral

U.K.

mixed

40

Induction; Amniotomy

5

Williams

1980

walk

bed care

U.K.

mixed

300

6

Bundsen

1982

walking

bed care

Sweden

mixed

60

Induction; Amniotomy; Internal Monitoring

7

Calvert

1982

walk or sit

bed care

U.K.

mixed

200

External monitoring

8

Haukkama

1982

sit or walk

bed care

Finland

mixed

60

External monitoring

9

Chen

1987

sit

dorsal or lateral

Japan

mixed

185

Amniotomy

10

Andrews

1990

standing, walking, sitting, squatting, kneeling

supine, lateral, prone

U.S.A.

nulliparous

40

11

Fernando

1994

walking, standing, sitting

bed care

U.K.

nulliparous

40

Epidural

12

MacLennan

1994

walk

bed care

Australia

mixed

196

External monitoring

13

Nageotte

1997

walk

bed care

U.S.A.

nulliparous

761

Epidural

14

Bloom

1998

walking as desired

bed care

U.S.A.

mixed

1067

15

Collis

1999

walking, standing,  sitting

bed care

U.K.

nulliparous

229

Epidural

External Monitoring

16

Vallejo

2001

walk or sit

lateral

U.S.A.

nulliparous

160

Epidural

Induction; External Monitoring

17

Boyle

2002

walk

bed care

U.K.

mixed

409

Epidural

18

Karraz

2003

walk

supine, semi supine or lateral

France

mixed

221

Epidural

Induction

19

Frenea

2004

ambulation

dorsal or lateral

France

mixed

61

Epidural

External Monitoring

20

Miquelutti

2007

stand, walk, sit, crouch, kneel

bed care

Brazil

nulliparous

107

21

Phumduong

2007

kneeling

supine

Thailand

nulliparous

204

22

Ben Regaya

2010

ambulation

dorsal or lateral

Tunisia, North Africa

nulliparous

200

23

Gau

2011

sitting, standing, kneeling, squatting

bed care

Taiwan

mixed

188

External Monitoring

24

Taavoni

2011

sitting

bed care

Iran

nulliparous

62

25

Mathew

2012

walk or sit

dorsal or lateral

India

nulliparous

60

Figures and Tables -
Table 3. Characteristics of all studies
Comparison 1. Upright and ambulant positions versus recumbent positions and bed care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Duration of first stage labour (hours) Show forest plot

15

2503

Mean Difference (IV, Random, 95% CI)

‐1.36 [‐2.22, ‐0.51]

2 Duration of first stage labour (hours): subgroup analysis: parity Show forest plot

12

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Nulliparous women

12

1486

Mean Difference (IV, Random, 95% CI)

‐1.21 [‐2.35, ‐0.07]

2.2 Multiparous women

4

662

Mean Difference (IV, Random, 95% CI)

‐0.56 [‐1.19, 0.06]

3 Duration of first stage labour (hours): subgroup analysis: onset of labour Show forest plot

11

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 Spontaneous labour: all women

11

2114

Mean Difference (IV, Random, 95% CI)

‐1.43 [‐2.35, ‐0.50]

3.2 Induction of labour: all women

0

0

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Duration of first stage labour (hours): subgroup analysis: position types Show forest plot

15

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 Sitting vs Recumbent / supine / lateral

3

252

Mean Difference (IV, Random, 95% CI)

‐2.39 [‐4.06, ‐0.72]

4.2 Walking vs Recumbent / supine / lateral

3

302

Mean Difference (IV, Random, 95% CI)

‐3.96 [‐5.36, ‐2.57]

4.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

3

311

Mean Difference (IV, Random, 95% CI)

‐1.02 [‐3.36, 1.33]

4.4 Sitting vs Bed care

1

60

Mean Difference (IV, Random, 95% CI)

0.11 [‐0.29, 0.51]

4.5 Walking vs Bed care

2

1170

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.44, 0.38]

4.6 Sitting, standing, squatting, kneeling or walking vs Bed care

4

424

Mean Difference (IV, Random, 95% CI)

‐0.52 [‐1.49, 0.45]

5 Duration of first stage labour (hours): subgroup analysis: position types Show forest plot

15

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

8

849

Mean Difference (IV, Random, 95% CI)

‐2.19 [‐3.49, ‐0.89]

5.2 Sitting, standing, squatting, kneeling or walking vs Bed care

7

1654

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.30, 0.25]

6 Duration of first stage labour (hours): subgroup analysis: position types Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

6.1 Sitting, standing, squatting, kneeling or walking vs supine only

2

183

Mean Difference (IV, Random, 95% CI)

‐2.24 [‐3.23, ‐1.26]

7 Duration of first stage labour (hours): sensitivity analysis ‐ positions Show forest plot

3

364

Mean Difference (IV, Fixed, 95% CI)

‐3.86 [‐4.73, ‐2.99]

7.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

200

Mean Difference (IV, Fixed, 95% CI)

‐3.00 [‐6.05, ‐3.95]

7.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

164

Mean Difference (IV, Fixed, 95% CI)

‐1.33 [‐2.89, 0.23]

8 Mode of birth: spontaneous vaginal Show forest plot

14

2626

Risk Ratio (M‐H, Random, 95% CI)

1.05 [0.99, 1.11]

9 Mode of birth: spontaneous vaginal: subgroup analysis: parity Show forest plot

8

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 Nulliparous women

8

1282

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.96, 1.17]

9.2 Multiparous women

4

675

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.99, 1.05]

10 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

10.1 Spontaneous labour: all women

8

2124

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.97, 1.12]

10.2 Induction of labour: all women

2

100

Risk Ratio (M‐H, Random, 95% CI)

1.24 [0.98, 1.57]

11 Mode of birth: spontaneous vaginal: subgroup analysis: position types Show forest plot

14

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

11.1 Sitting vs Recumbent / supine / lateral

2

225

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.88, 1.64]

11.2 Walking vs Recumbent / supine / lateral

3

306

Risk Ratio (M‐H, Random, 95% CI)

1.26 [1.11, 1.42]

11.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

2

235

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.85, 1.17]

11.4 Sitting vs Bed care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.5 Walking vs Bed care

4

1426

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.93, 1.11]

11.6 Sitting, standing, squatting, kneeling or walking vs Bed care

4

454

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.92, 1.08]

12 Mode of birth: spontaneous vaginal: subgroup analysis: position types Show forest plot

14

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

12.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

6

746

Risk Ratio (M‐H, Random, 95% CI)

1.14 [1.03, 1.26]

12.2 Sitting, standing, squatting, kneeling or walking vs Bed care

8

1880

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.97, 1.04]

13 Mode of birth: spontaneous vaginal: subgroup analysis: position types

0

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

13.1 Sitting, standing, squatting, kneeling or walking vs supine only

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

14 Mode of birth: spontaneous vaginal: sensitivity analysis ‐ positions Show forest plot

5

630

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.94, 1.13]

14.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

1.2 [1.05, 1.38]

14.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

3

390

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.83, 1.05]

15 Mode of birth: operative vaginal: all women Show forest plot

13

2519

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.73, 1.14]

16 Mode of birth: operative vaginal: subgroup analysis: parity Show forest plot

7

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

16.1 Nulliparous women

7

1175

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.65, 1.18]

16.2 Multiparous women

4

675

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.24, 3.51]

17 Mode of birth: operative vaginal: subgroup analysis: onset of labour Show forest plot

9

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

17.1 Spontaneous labour: all women

7

2017

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.62, 1.39]

17.2 Induction of labour: all women

2

100

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.23, 1.58]

18 Mode of birth: operative vaginal: subgroup analysis: position types Show forest plot

13

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

18.1 Sitting vs Recumbent / supine / lateral

2

225

Risk Ratio (M‐H, Fixed, 95% CI)

0.18 [0.04, 0.75]

18.2 Walking vs Recumbent / supine / lateral

3

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.28, 0.89]

18.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / later

2

235

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.58, 1.52]

18.4 Sitting vs Bed care

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

18.5 Walking vs Bed care

4

1426

Risk Ratio (M‐H, Fixed, 95% CI)

1.19 [0.84, 1.68]

18.6 Sitting, standing, squatting, kneeling or walking vs Bed care

3

347

Risk Ratio (M‐H, Fixed, 95% CI)

1.15 [0.67, 1.96]

19 Mode of birth: operative vaginal: subgroup analysis: position types Show forest plot

13

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

19.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / later

6

746

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.43, 0.89]

19.2 Sitting, standing, squatting, kneeling or walking vs Bed care

7

1773

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.88, 1.57]

20 Mode of birth: operative vaginal: subgroup analysis: position types

0

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

20.1 Sitting, standing, squatting, kneeling or walking vs supine only

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Mode of birth: operative vaginal: sensitivity analysis ‐ positions Show forest plot

4

523

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.67, 1.45]

21.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.34, 1.31]

21.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

283

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.76, 1.97]

22 Mode of birth: caesarean birth Show forest plot

14

2682

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.54, 0.94]

23 Mode of birth: caesarean birth: subgroup analysis: parity Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

23.1 Nulliparous women

8

1237

Risk Ratio (M‐H, Fixed, 95% CI)

0.79 [0.52, 1.18]

23.2 Multiparous women

4

675

Risk Ratio (M‐H, Fixed, 95% CI)

0.55 [0.22, 1.38]

24 Mode of birth: caesarean birth: subgroup analysis: onset of labour Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

24.1 Spontaneous labour: all women

8

2079

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.49, 1.01]

24.2 Induction of labour: all women

2

100

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.02, 3.86]

25 Mode of birth: caesarean birth: subgroup analysis: position types Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

25.1 Sitting vs Recumbent / supine / lateral

2

225

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.36, 2.84]

25.2 Walking vs Recumbent / supine / lateral

3

306

Risk Ratio (M‐H, Fixed, 95% CI)

0.31 [0.12, 0.79]

25.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

2

235

Risk Ratio (M‐H, Fixed, 95% CI)

1.30 [0.46, 3.63]

25.4 Sitting vs Bed care

1

62

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 70.92]

25.5 Walking vs Bed care

4

1426

Risk Ratio (M‐H, Fixed, 95% CI)

0.70 [0.45, 1.09]

25.6 Sitting, standing, squatting, kneeling or walking vs Bed care

3

448

Risk Ratio (M‐H, Fixed, 95% CI)

0.74 [0.46, 1.21]

26 Mode of birth: caesarean birth: subgroup analysis: position types Show forest plot

14

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

26.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

6

746

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.39, 1.15]

26.2 Sitting, standing, squatting, kneeling or walking vs Bed care

8

1936

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.53, 1.02]

27 Mode of birth: caesarean birth: subgroup analysis: position types

0

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

27.1 Sitting, standing, squatting, kneeling or walking vs supine only

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28 Mode of birth: caesarean birth: sensitivity analysis ‐ positions Show forest plot

4

624

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.48, 1.09]

28.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

0.35 [0.14, 0.86]

28.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

384

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.59, 1.52]

29 Analgesia type Show forest plot

10

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

29.1 Opioid

7

1831

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.85, 1.15]

29.2 Epidural

9

2107

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.66, 0.99]

29.3 Entonox

3

300

Risk Ratio (M‐H, Random, 95% CI)

0.97 [0.72, 1.31]

30 Maternal satisfaction Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

30.1 Satisfaction with position reported at 6 cm

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.31 [0.60, 2.85]

30.2 Preferred upright position

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.97, 1.61]

31 Maternal comfort Show forest plot

1

40

Mean Difference (IV, Fixed, 95% CI)

0.74 [‐0.27, 1.75]

31.1 Comfort score

1

40

Mean Difference (IV, Fixed, 95% CI)

0.74 [‐0.27, 1.75]

32 Maternal pain Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

32.1 Complaints of discomfort/labour more uncomfortable

3

338

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.12, 3.72]

32.2 Requiring analgesia

4

1536

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.84, 1.08]

33 Maternal pain Show forest plot

2

400

Mean Difference (IV, Fixed, 95% CI)

6.36 [‐0.31, 13.03]

34 Maternal pain Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

34.1 Visual Analogue Scale (VAS) Score

1

60

Mean Difference (IV, Fixed, 95% CI)

‐1.74 [‐2.51, ‐0.97]

34.2 Visual Analogue Scale (VAS) Score @ 4 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐2.70, ‐1.30]

34.3 Visual Analogue Scale (VAS) Score @ 8 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐1.70 [‐2.20, ‐1.20]

34.4 Verbal Response Scale (VRS) Score @ 4 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐10.40 [‐13.27, ‐7.53]

34.5 Verbal Response Scale (VRS) Score@ 8 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐5.00 [‐11.33, ‐2.67]

34.6 Present Pain Intensity Scale (PPI) @ 4 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐1.40 [‐3.61, 0.81]

34.7 Present Pain Intensity Scale (PPI) @ 8 cm

1

87

Mean Difference (IV, Fixed, 95% CI)

‐0.80 [‐3.76, 2.16]

35 Maternal anxiety Show forest plot

1

200

Mean Difference (IV, Fixed, 95% CI)

8.0 [‐0.19, 16.19]

36 Analgesia amount Show forest plot

1

40

Mean Difference (IV, Fixed, 95% CI)

‐17.5 [‐36.89, 1.89]

36.1 Narcotics and other analgesia

1

40

Mean Difference (IV, Fixed, 95% CI)

‐17.5 [‐36.89, 1.89]

37 Duration of second stage of labour (minutes) Show forest plot

9

2077

Mean Difference (IV, Random, 95% CI)

‐3.71 [‐9.37, 1.94]

38 Augmentation of labour using oxytocin Show forest plot

8

1826

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.76, 1.05]

39 Artificial rupture of membranes Show forest plot

4

276

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.95, 1.10]

40 Hypotension requiring intervention

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

41 Estimated blood loss > 500 mL Show forest plot

2

240

Risk Ratio (M‐H, Fixed, 95% CI)

0.71 [0.14, 3.55]

42 Perineal trauma Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

42.1 Episiotomy

3

1374

Risk Ratio (M‐H, Fixed, 95% CI)

0.92 [0.82, 1.04]

42.2 Second‐degree tears

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

42.3 Third‐degree tears

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

43 Fetal distress (requiring immediate delivery) Show forest plot

6

1757

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.35, 1.33]

44 Use of neonatal mechanical ventilation Show forest plot

2

1107

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.19, 3.10]

44.1 Intubation in delivery room

2

1107

Risk Ratio (M‐H, Fixed, 95% CI)

0.77 [0.19, 3.10]

45 Apgar scores Show forest plot

8

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

45.1 Apgar < 4 at birth

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.01, 3.92]

45.2 Apgar < 7 at 1 min

6

706

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.54, 1.31]

45.3 Apgar < 7 at 5 mins

4

466

Risk Ratio (M‐H, Fixed, 95% CI)

3.27 [0.34, 31.05]

45.4 Apgar < 3 at 5 mins

1

1067

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

45.5 Apgar < 8 at 5 mins

1

87

Risk Ratio (M‐H, Fixed, 95% CI)

0.12 [0.01, 2.19]

46 Admission to NICU Show forest plot

2

396

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.25, 1.36]

46.1 Admission to NICU

1

200

Risk Ratio (M‐H, Fixed, 95% CI)

0.2 [0.04, 0.89]

46.2 Admission to Level I or II nursery

1

196

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.45, 5.37]

47 Perinatal mortality Show forest plot

5

1564

Risk Ratio (M‐H, Fixed, 95% CI)

0.50 [0.05, 5.37]

Figures and Tables -
Comparison 1. Upright and ambulant positions versus recumbent positions and bed care
Comparison 2. Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Duration of first stage labour: (minutes)

0

0

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Mode of birth: spontaneous vaginal Show forest plot

6

1566

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.89, 1.05]

3 Mode of birth: spontaneous vaginal: subgroup analysis: parity Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Nulliparous women

4

1179

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.84, 1.04]

3.2 Multiparous women

1

111

Risk Ratio (M‐H, Fixed, 95% CI)

1.02 [0.81, 1.27]

4 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

4.1 Spontaneous labour: all women

1

505

Risk Ratio (M‐H, Random, 95% CI)

0.94 [0.81, 1.09]

4.2 Induction of labour: all women

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Mode of birth: spontaneous vaginal: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

5.1 Sitting vs Recumbent / supine / lateral

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Walking vs Recumbent / supine / lateral

2

276

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.81, 1.28]

5.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

151

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.75, 1.13]

5.4 Sitting vs Bed care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.5 Walking vs Bed care

2

910

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.83, 1.06]

5.6 Sitting, standing, squatting, kneeling or walking vs Bed care

1

229

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.78, 1.27]

6 Mode of birth: spontaneous vaginal: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

3

427

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.86, 1.15]

6.2 Sitting, standing, squatting, kneeling or walking vs Bed care

3

1139

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.85, 1.06]

7 Mode of birth: spontaneous vaginal: sensitivity analysis Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.61, 1.20]

7.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

634

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.81, 1.11]

8 Mode of birth: operative vaginal Show forest plot

6

1566

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.90, 1.25]

9 Mode of birth: operative vaginal: subgroup analysis: parity Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

9.1 Nulliparous women

4

1084

Risk Ratio (M‐H, Random, 95% CI)

1.36 [0.95, 1.94]

9.2 Multiparous women

1

111

Risk Ratio (M‐H, Random, 95% CI)

1.09 [0.49, 2.42]

10 Mode of birth: operative vaginal: subgroup analysis: onset of labour Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 Spontaneous labour: all women

1

505

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.88, 1.59]

10.2 Induction of labour: all women

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

11 Mode of birth: operative vaginal: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

11.1 Sitting vs Recumbent / supine / lateral

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.2 Walking vs Recumbent / supine / lateral

2

276

Risk Ratio (M‐H, Random, 95% CI)

1.17 [0.56, 2.44]

11.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

151

Risk Ratio (M‐H, Random, 95% CI)

2.03 [0.73, 5.65]

11.4 Sitting vs Bed care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.5 Walking vs Bed care

2

910

Risk Ratio (M‐H, Random, 95% CI)

1.03 [0.81, 1.31]

11.6 Sitting, standing, squatting, kneeling or walking vs Bed care

1

229

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.69, 1.45]

12 Mode of birth: operative vaginal: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

12.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

3

427

Risk Ratio (M‐H, Random, 95% CI)

1.41 [0.77, 2.56]

12.2 Sitting, standing, squatting, kneeling or walking vs Bed care

3

1139

Risk Ratio (M‐H, Random, 95% CI)

1.02 [0.86, 1.20]

13 Mode of birth: operative vaginal: sensitivity analysis Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.55 [0.49, 4.95]

13.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

634

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.77, 1.16]

14 Mode of birth: caesarean birth Show forest plot

6

1566

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.83, 1.32]

15 Mode of birth: caesarean birth: subgroup analysis: parity Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

15.1 Nulliparous women

4

1084

Risk Ratio (M‐H, Random, 95% CI)

1.14 [0.75, 1.73]

15.2 Multiparous women

1

206

Risk Ratio (M‐H, Random, 95% CI)

1.31 [0.55, 3.09]

16 Mode of birth: caesarean birth: subgroup analysis: onset of labour Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

16.1 Spontaneous labour: all women

1

505

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.64, 1.40]

16.2 Induction of labour: all women

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

17 Mode of birth: caesarean birth: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

17.1 Sitting vs Recumbent / supine / lateral

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.2 Walking vs Recumbent / supine / lateral

2

276

Risk Ratio (M‐H, Random, 95% CI)

0.74 [0.35, 1.56]

17.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

151

Risk Ratio (M‐H, Random, 95% CI)

0.95 [0.49, 1.82]

17.4 Sitting vs Bed care

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.5 Walking vs Bed care

2

910

Risk Ratio (M‐H, Random, 95% CI)

1.20 [0.74, 1.94]

17.6 Sitting, standing, squatting, kneeling or walking vs Bed care

1

229

Risk Ratio (M‐H, Random, 95% CI)

1.01 [0.53, 1.95]

18 Mode of birth: caesarean birth: subgroup analysis: position types Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

18.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

3

427

Risk Ratio (M‐H, Random, 95% CI)

0.81 [0.52, 1.28]

18.2 Sitting, standing, squatting, kneeling or walking vs Bed care

3

1139

Risk Ratio (M‐H, Random, 95% CI)

1.15 [0.83, 1.59]

19 Mode of birth: caesarean birth: sensitivity analysis Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

19.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral

1

61

Risk Ratio (M‐H, Fixed, 95% CI)

1.29 [0.38, 4.35]

19.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care

2

634

Risk Ratio (M‐H, Fixed, 95% CI)

1.35 [0.93, 1.96]

20 Maternal satisfaction

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

21 Maternal pain Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

21.1 Requiring additional Bupivocaine bolus doses

2

720

Risk Ratio (M‐H, Random, 95% CI)

0.57 [0.22, 1.48]

22 Analgesia amount Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

22.1 Bupivocaine

3

463

Mean Difference (IV, Random, 95% CI)

‐0.24 [‐2.32, 1.84]

22.2 Ropivacaine

1

151

Mean Difference (IV, Random, 95% CI)

19.70 [0.77, 38.63]

22.3 Fentanyl

1

229

Mean Difference (IV, Random, 95% CI)

‐0.38 [‐1.99, 1.23]

22.4 Bupivocaine & Fentanyl

1

409

Mean Difference (IV, Random, 95% CI)

‐1.37 [‐7.59, 4.85]

23 Duration of second stage of labour (minutes) Show forest plot

2

204

Mean Difference (IV, Fixed, 95% CI)

2.35 [‐15.22, 19.91]

24 Augmentation of labour using oxytocin Show forest plot

5

1161

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.90, 1.07]

25 Artificial rupture of membranes

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

26 Hypotension requiring intervention Show forest plot

3

781

Risk Ratio (M‐H, Fixed, 95% CI)

1.12 [0.52, 2.45]

27 Estimated blood loss > 500 mL

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28 Perineal trauma

0

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

28.1 Episiotomy

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28.2 Second‐degree tears

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

28.3 Third‐degree tears

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

29 Fetal distress (requiring immediate delivery)

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

30 Use of neonatal mechanical ventilation

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

31 Apgar scores Show forest plot

5

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

31.1 Apgar < 7 at 1 min

2

191

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.37, 2.76]

31.2 Apgar < 7 at 5 mins

4

835

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.21, 5.05]

32 Admission to NICU

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

33 Perinatal mortality

0

0

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women)