Abstract
There exist very few studies comparing different postures or postural changes during labor in parturients with epidural analgesia. Aim: To disclose whether the intervention of a multidisciplinary nursing team including a physiotherapist during the second stage of labor improves the obstetric outcome in parturients with epidural analgesia. Design: Prospective randomized trial. Setting: University-affiliated hospital. Population: Women undergoing labor with epidural analgesia after a normal gestation. Methods: 150 women were randomized either to actively perform predefined postural changes during the passive phase of the second stage of labor under the guidance of the attending physiotherapist (study group), or to carry out the whole second stage of labor lying in the traditional supine position (control group). Results: There were significantly more eutocic deliveries (p = 0.005) and, conversely, significantly less instrumental deliveries (p < 0.05) and cesarean sections (p < 0.05) in the study group. The total duration of the second stage of labor was significantly shorter (p < 0.01) in the study group. This was at the expense of the passive phase of the second stage of labor (p < 0.01). Significantly less episiotomies were performed in the study group (31.2% vs 17.8%, p < 0.05). Conclusion: The intervention of a physiotherapist during the second stage of labor significantly improved the obstetric outcome.
Highlights
Since the advent and generalized use of epidural analgesia in the obstetric wards of developed countries, pain management during labor is no longer an issue
Bodner-Adler et al [8], in a case control study involving 307 women, found that an upright, squatting position during the second stage of labor was significantly associated with less use of analgesia and oxytocin, and a lower incidence of episiotomies, if compared to the traditional supine position
Downe et al [9], following a randomized prospective trial on the effect of position in the passive second stage of labor under epidural analgesia, reported that women randomized to a lateral position had a better chance of spontaneous vaginal delivery
Summary
Since the advent and generalized use of epidural analgesia in the obstetric wards of developed countries, pain management during labor is no longer an issue. Effective epidural analgesia carries with it an increased risk of changes in fetal position [1], prolonged labor [2] excessive use of oxytocin [3] and a higher rate of instrumental deliveries [4]. Despite recent improvements in schedules and timing of its administration, epidural analgesia is still often associated with a relative increase in the rate of cesarean sections [5] and of third- and fourth-degree perineal tears [6]. A recent Cochrane Review [7] showed that upright and ambulant positions during the first stage of labor were associated with a shorter duration thereof, as well as with a significantly reduced rate of cesarean sections.
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