Abstract
Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.
Highlights
IntroductionPositions during labour could be freely changed or modified according to parturient desires.in developed countries the hospital admission of labouring women leads obstetrical practice to restrain spontaneous and instinctive attitude and to focus strictly on intrapartum fetal wellbeing and maternal comorbidities [1, 2].This way, the parturient receives fewer opportunities to labour and deliver in a preferred position, assuming the recumbent one as standard because of its easier monitoring of fetal wellbeing, administration of intravenous therapy, loco-regional anaesthesia, and performance of medical procedures, perineal support, and birth assistance [2, 3].The effects of different maternal positions during labour on maternal-fetal and neonatal outcomes are rarely in agreement and available evidences in this field are often controversial and fragmentary [1, 4, 5].The vertical positions may benefit from “gravity effect” potentially able to reduce aortocaval compression, to make uterine contractions effective and to favour a better fetus alignment in the birth canal and to increase pelvic outlet diameters, reducing intrapartum maternal and neonatal complications [6,7,8,9].Anyway counterparts evidences reported an increased haemorrhagic risk associated with upright positions [1, 10,11,12] due to more perineal damage than uterine atony (often requiring medical and surgical procedures and potentially impairing future pregnancy planning and chances) [13,14,15]
The aim of our study was to compare patients spending in a recumbent position more than 50% of labour to those assuming a preferred alternative position in terms of intrapartum, maternal/fetal, and neonatal outcomes
Data about maternal general characteristics, labour process (length of first and second stages of labour, fetal occiput position at the labour onset and at birth, mean value of Numeric Rating Scale (NRS) score detected during labour and before analgesia administration when required, and analgesia request rate), mode of delivery (spontaneous, operative vaginal delivery or emergent caesarean section (CS), need of episiotomy, and rate of perineal tears in cases of vaginal deliveries), and neonatal wellbeing at birth (Apgar score at 5th, and fetal pH value at birth) were recorded
Summary
Positions during labour could be freely changed or modified according to parturient desires.in developed countries the hospital admission of labouring women leads obstetrical practice to restrain spontaneous and instinctive attitude and to focus strictly on intrapartum fetal wellbeing and maternal comorbidities [1, 2].This way, the parturient receives fewer opportunities to labour and deliver in a preferred position, assuming the recumbent one as standard because of its easier monitoring of fetal wellbeing, administration of intravenous therapy, loco-regional anaesthesia, and performance of medical procedures, perineal support, and birth assistance [2, 3].The effects of different maternal positions during labour on maternal-fetal and neonatal outcomes are rarely in agreement and available evidences in this field are often controversial and fragmentary [1, 4, 5].The vertical positions may benefit from “gravity effect” potentially able to reduce aortocaval compression, to make uterine contractions effective and to favour a better fetus alignment in the birth canal and to increase pelvic outlet diameters, reducing intrapartum maternal and neonatal complications [6,7,8,9].Anyway counterparts evidences reported an increased haemorrhagic risk associated with upright positions [1, 10,11,12] due to more perineal damage than uterine atony (often requiring medical and surgical procedures and potentially impairing future pregnancy planning and chances) [13,14,15]. In developed countries the hospital admission of labouring women leads obstetrical practice to restrain spontaneous and instinctive attitude and to focus strictly on intrapartum fetal wellbeing and maternal comorbidities [1, 2] This way, the parturient receives fewer opportunities to labour and deliver in a preferred position, assuming the recumbent one as standard because of its easier monitoring of fetal wellbeing, administration of intravenous therapy, loco-regional anaesthesia, and performance of medical procedures, perineal support, and birth assistance [2, 3]. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Women should be encouraged to move and deliver in the most comfortable position
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