Background: Epidural analgesia leads to increased risk of instrumental vaginal delivery (IVD). There is debate about whether or not posture in second-stage labour influences the incidence of spontaneous vaginal birth (SVB).
Objectives: In nulliparous women with epidural analgesia, does a policy of adopting an ‘upright position’ throughout second-stage labour increase the incidence of SVB compared with a policy of adopting a ‘lying-down’ position?
Design: Two-arm randomised controlled trial.
Setting: Maternity units, England and Wales.
Participants: Nulliparous women aged ≥ 16 years, 37 weeks’ gestation or more, singleton cephalic.
Interventions: (1) Upright position to maintain the pelvis in as vertical a plane as possible; and
(2) lying-down position to maintain the pelvis in as horizontal a plane as possible.
Main outcome measures: The primary outcome measure was incidence of SVB. Secondary outcomes included augmentation, interventions to maintain blood pressure, duration of labour, episiotomy, genital tract trauma, post-partum haemorrhage, maternal satisfaction, neonatal metabolic acidosis, 5-minute Apgar score of ≤ 4, resuscitation at birth and admission to neonatal unit.
At 1 year for (1) women: urinary or faecal incontinence, dyspareunia and health-related quality of life; (2) for infants: major morbidity.
A cost–consequences analysis with a time horizon of 1 year after the birth from a NHS perspective.
Trial registration: Current Controlled Trials ISRCTN35706297.
Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme.
Chief Investigator: Peter Brocklehurst, Professor of Women’s Health, Birmingham Clinical Trials Unit.