The birthing chair in the second stage of labour. A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor. Randomised trial comparing the upright and supine positions for the second stage of labour. [Delivery in lateral position. Randomized clinical trial comparing the maternal positions in lateral position and dorsal position for the second stage of labour]. An experiment of squatting birth. The effects of sitting position on the second stage of labor. Alternative positions in the second stage of labour: a randomized controlled trial. Maternal half-sitting position in the second stage of labor. Influence of the position of the mother at delivery over some maternal and neonatal outcomes. A randomized study of the sitting position for delivery using a newly designed obstetric chair. [Labor in the squatting position. [A randomized trial comparing the squatting position with the classical position for the expulsion phase]. Child birth in squatting position. Why deliver in the supine position?
A prospective study of 56 primigravidas was performed to assess the advantages, disadvantages and acceptability of the upright posture during the second stage of labour. Twenty-seven patients laboured in the second stage in a birthing chair, in an upright position. Twenty-one patients laboured in bed in the recumbent position and acted as controls. No difference could be found in the length of second stage, ease or type of delivery between the 2 groups. No differences were detected in the condition of the neonates between the 2 groups. This birthing chair was found to be an acceptable mode of delivery to most of those patients using it. Two hundred ninety-four women were randomly allocated to a group in which the use of a birthing stool (experimental group) or a conventional semirecumbent position (control group) was encouraged. The birthing stool was 32 cm high and allowed the parturient to sit upright and to squat. The husband could sit close behind his wife and support her back. No differences were observed between the two groups regarding mode of delivery, length of the second stage of labor, oxytocin augmentation, perineal trauma, labial lacerations, or vulvar edema. Infant outcome measured by Apgar scores at 1 and 5 minutes postpartum and numbers of neonatal intensive care unit transfers was the same in both groups. Mean estimated blood loss and the number of mothers with a postpartum hemorrhage 600 ml or more were greater in the experimental group than in the control group. Women in the experimental group reported less pain during the second stage of labor, and they and their spouses were more satisfied with the birth position than were parents in the control group. Midwives were less satisfied with their working posture in the experimental group. To assess the maternal and neonatal effects of upright compared with recumbent positions during delivery, in terms of defined outcome variables.
                A randomised controlled trial.
                St Monica's Nursing Home, a midwife based maternity unit in Cape Town, South Africa.
                Five hundred and seventeen women of low obstetrical risk assigned to deliver at the nursing home.
                The trial showed that women who adopted the upright posture for delivery experienced less pain. perineal trauma and fewer episiotomies than those who delivered in the supine position.
                The data suggest that in women of low obstetrical risk, choice of posture during delivery may be encouraged. To evaluate the influence of a maternal position for childbearing, that of lateral decubitus compared with the dorsal decubitus in second phase of parturition, by studying various parameters such as: rate of intact perineum, electronic foetal heart rate monitoring during expulsion, mode of delivery, quantity of maternal blood losses, and neonatal status.
                The type of study was as follows: prospective, comparative and randomized according to Zelen's design, monocentric, in pragmatic mode and intention to treat. After a review of the literature and a retrospective analysis of the activity of a service (Romans-sur-Isère/France), an assumption of improvement of 15% of the rates of intact perineum in lateral position is put forth. An amount of 562 patients was included and randomized in 2 groups in which the childbirth was carried out in dorsal or lateral decubitus. The data were analysed by software SPSS version 13, by using the tests t of Student, Chi(2) of Pearson or the exact test of Fisher. The analysis relates to 487 patients after exclusion of the distortions to the protocol.
                We observed a significant increase in the rate of intact perineum, as well as a significant increase in the maternal blood loss, without exceeding the physiological limits, during expulsion in lateral position. The rate of directed delivery was less but more frequent were the haemorrhages in decubitus side. The rate of artificial delivery and/or uterine revision doubled without however reaching the threshold of significativity. Finally, the other parameters did not differ between the two groups.
                The test makes it possible to show the improvement of the perineal status during dorsal childbirth in decubitus side compared with the position in decubitus. The data collected prove to be in conformity with those of the literature, which is not very prolix on the subject! The secondary criteria are not improved, and professionals must carry out a reflexion concerning delivery, to adapt the recommendations for the introduction of such practice into a service, must carry out a reflexion. This study provides the scientific basis (NP1), which makes it possible to justify the diffusion of this position of expulsion if one is keen on the improvement of the perineal status. Women throughout the ages have preferred to be delivered with their trunks vertical and most delivery positions illustrated in historical texts show birth in an upright posture with abducted thighs. A consumer attitude study in our hospital showed that patients have considerable interest in alternative birth positions. Squatting has been advocated to prevent caval compression, increase the diameter of the pelvic outlet and, perhaps with least justification, to enlist the force of gravity and thereby facilitate maternal expulsive effort. Despite the extensive literature advocating squatting birth, the suggested advantages of this method have not been examined in any formal, let alone unbiased study. We therefore conducted a randomised trial to examine the effect of squatting on the duration of second stage of labour, the duration of pushing, and several other variables. nan A controlled clinical trial involving 151 primigravidae and 18 midwives assessed the acceptability and outcome of second-stage labour in upright positions. Women who had no specific antenatal preparation and preferences regarding labour positions were managed either conventionally (semi-recumbent and lateral), or encouraged to adopt upright positions (squatting, kneeling, sitting or standing) according to individual preference. Of the women allocated to the upright position 74% completed the second stage upright, with kneeling being the most favoured position, but squatting was, despite all assistance, too difficult to maintain. Adoption of upright positions resulted in a higher rate of intact perineums. There was a clinically apparent reduction of forceps deliveries in the upright group which influenced midwives' attitudes. Moving the parturient from recumbent to upright positions was often perceived to be beneficial when there was slow progress. Estimated blood loss was similar in the two groups, as was the condition of the newborn (Apgar score and umbilical artery pH). Alternative positions in the second stage of labour, in particular kneeling, are achievable even without specific birth aids and antenatal preparation. They appear safe, acceptable to most parturients and their midwives, and are easily integrated into modern labour ward practice; they may have clinical advantages which need further investigation. The maternal half-sitting and supine position during the second stage of fullterm labor was compared in 100 women who, after identical opening phases in supine position, randomly delivered in half-sitting (50 degrees, n = 50) or supine position (n = 50). The whole duration of the second stage of labor or the time spent in active pushing did not differ between the groups. Vacuum extraction was needed twice (4%) in the group delivering in half-sitting and six times (12%) in the group delivering in supine position. Vaginal tear occurred in one mother in both groups. Early decelerations in fetal cardiotocography were seen 22 times in half-sitting and 14 times in supine group (p less than 0.05). However, late decelerations were seen in only one mother with half-sitting, as compared to five mothers with supine position. Four infants of mothers giving birth in supine position had 1 minute APGAR scores 7 or less, whereas all infants of mothers delivering in half-sitting position had APGAR scores higher than 7. Subjectively the mothers liked more the half-sitting position. We conclude that a women can deliver in half-sitting position without maternal or fetal risks. Evaluate possible advantages or disadvantages of the sitting over the horizontal position during the second stage of labor.
                Clinical trial randomly selecting 127 volunteers for the sitting position and 121 for the horizontal position during the second stage of labor. Duration of the second stage and of expulsion of the placenta, vulvo vaginal and perineal lacerations, blood lost and Apgar score were evaluated.
                There was a non-significant decrease of 3.4 min in the duration of the second period in the vertical position in comparison with the horizontal position. There was a similar difference in the duration of delivery of the placenta, but also non-significant. Blood loss was slightly greater among women delivering in vertical position, but the difference did not reach significance. Breastfeeding did not show any influence on blood loss and on the time for delivering the placenta. The incidence of perineal trauma was 44.1% for vertical position and 47% for horizontal position in the whole group and of 47.8% and 71.2% in the group with history of episiotomy. This last difference was statistically significant. The results of this study are in the line of other studies that suggest some advantages and possible disadvantages of the vertical position.
                Mothers should be given the choice of the posture to be assumed during parturition. The supine position should not be imposed and episiotomy should not be a routine. A new obstetric chair has been designed to overcome some of the problems of those currently available commercially. The chair has been used to assess the effects of the sitting position in the second stage of labour on the outcome of delivery in 304 women randomly allocated to be delivered either in the chair or in the conventional dorsal position. Delivery in the chair conferred no benefits to mother or baby and resulted in greater mean blood loss and a higher rate of postpartum haemorrhage. To evaluate the influence of a vertical delivery position squatting during expulsion, studying different parameters such as duration of expulsion, neonatal status, delivery mode, frequency of hemorrhagia, perineum status and patient comfort.
                Randomized, unicentric, comparative, open, prospective.
                After a retrospective study determining feasibility, 240 patients were randomized to equal 2 groups in which the delivery was performed in squat position versus in lithotomy position. All the above described parameters were recorded and treated by the Epi-Info software package using Student t test, chi 2 and Kruskall-Wallis test.
                Our study has shown a tendency to shorten the length of the expulsion phase and a reduced use of forceps in the squat position. This is consistent with other studies published in the literature. We would like to emphasize that even if it does not show a medical advantage on the studied parameters, the squat position is not deleterious and can provide a better comfort for the patients who want to use it. To assess the risks and benefits of squatting position during second stage of labour and its comparison with the supine position.
                The study was conducted at the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi from 1st January 1999 to 31st January 2000. A total of two hundred patients of similar ante partum, intrapartum and socio-economic conditions were selected. Only patients of gestation more than 37 weeks, presenting in active labour with cephalic presentation were included. Patients with multiple gestation, malpresentation, previous scar, maternal fever and prenatal diagnosed fetal malformation were excluded from the study. Random selection was done after informed consent and alternately divided into two groups A and B. Both groups were ambulatory during first stage of labour. In second stage, group-A adopted the squatting position, while group-B remained supine in lithotomy position. The third stage of labour in both the groups was conducted in the supine position.
                There was no difference in the application of episiotomies in both groups, however extension of the episiotomy occurred in 7% patients of the non-squatting group (P < 0.05). Para urethral tears occurred in 5% patients in squatting group, but all occurred in patients who were not given an episiotomy. Second degree, and third degree perineal tears occurred in 9% patients in the non-squatting group but none in the squatting group (P < 0.05). Forceps application was also significantly less in group-A 11% and 24% in group-B (P < 0.05).There were two cases of shoulder dystocia in group B but none in the group-A. During the Third stage of labour there were no cases of retained placenta in group A but there were 4% cases of retained placenta and 1% case of postpartum haemorrhage of more than 500 ml due to atony of the uterus in group-B. One patient in the non-squatting position had to have a caesarean section due to persistent occipito posterior position. There was no significant difference in the apgar scores, foetal heart rate patterns or requirement of neonatal resuscitation.
                It appears that squatting position may result in less instrumental deliveries, extension of episiotomies and perineal tears. This study was conducted at the Lokmanya Tilak Municipal General Hospital, Bombay, India during the year 1990. The aim was to compare the routinely used supine position versus ambulation in the first stage and squatting position during the second stage of labour. Our study was comprised of 200 patients both primigravidas and multigravidas; 100 were kept in the supine position throughout labour and 100 were kept ambulatory in the first stage and adopted the squatting position during the second stage. The study showed a shortening of both stages of labour in the squatting group but the incidence of complications was less in the control group. It was concluded that without proper birthing chairs which can give excellent perineal support, the usual supine position is preferable in our setup.
The findings of this review suggest several possible benefits for upright posture in women without epidural, but with the possibility of increased risk of blood loss greater than 500 mL. Until such time as the benefits and risks of various delivery positions are estimated with greater certainty, when methodologically stringent data from trials are available, women should be allowed to make choices about the birth positions in which they might wish to assume for birth of their babies.