Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women: randomized controlled clinical trial

Abstract

Abstract Objective To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women. Methods This is a randomized controlled clinical trial conducted at the delivery department of Damanhour Educational Institute, El Behira Governorate, Egypt. The study sample involved 150 parturient women equally divided into intervention and control groups using randomization block technique. The researchers used four tools for data collection: Demographic data interview schedule, World Health Organization Partograph, Apgar's score, to evaluate neonatal outcomes, and visual analogue pain intensity scale. For the study group, the parturient women were encouraged to assume one of the upright positions or ambulating around the bed so as to maintain the pelvis in vertical plane as far as possible for 20–25 min for every 1 h. The control group received routine hospital care, which includes lying down in bed. IBM SPSS 23.0 was used to analyze the data. Results Significant differences (P < 0.05) were observed between the study and control groups in relation to cervical dilation, fetal head descent, uterine contractions interval, and frequency. The duration of the first stage of labor significantly reduced (P = 0.018) in the intervention group compared with control group. No significant differences (P > 0.05) were observed between both groups in term of emergency cesarean birth rates, oxytocin use, and neonatal outcomes. Conclusions This study proves that upright and ambulant positions significantly enhance uterine contractility, cervical dilatation, and fetal head descent and reduce the first stage duration.