Upright Position During the First Stage of Labor: A Randomized Controlled Trial

Abstract

There is marginal evidence that adopting the upright position during labor promotes vaginal delivery, and this measure has been recommended by the World Health Organization. This prospective, randomized, controlled trial compared 54 nulliparous parturients who were encouraged to adopt the upright position (standing, sitting, crouching, kneeling, walking) during the first stage of labor with 53 others who served as a control group. Women in the study group received brief and simple information on the possible benefits of being upright, and were encouraged to do so using models to clarify positional differences. They were asked to be upright following 30 minutes or longer in the supine position. The 2 groups were sociodemographically comparable. The median age was 21 years and the gestational age was 40 weeks. Initial cervical dilation was 4 cm. Between admission to the study and the start of analgesia, women in the upright and control groups remained in the upright position 57% and 28% of the time, respectively. There were no group differences in type of delivery, cervical dilation at the time of analgesia, the need for uterotonic drugs or episiotomy, the duration of the first and second stages of labor, or fetal and neonatal well-being. Similarly, the 2 groups had similar degrees of pain. A majority of participants preferred the upright position because they found it to be more comfortable, but there was no significant group difference in preferences. Four women in the study group and 10 in the control group remained exclusively upright or supine, respectively, throughout the first stage of labor. Women in the first stage of labor may be encouraged to assume the upright position when feasible. Although it did not shorten labor in this trial, it was safe for the fetus and newborn infant, and was well accepted by women taking part in the trial. Further randomized studies will be needed to ensure that this practice does not compromise the laboring woman or her fetus in any way.