BUMPES trial

A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural - the BUMPES trial

Bumpes trial logo

The BUMPES trial aimed to find out what the best position is to give birth in for first time mothers who choose to have an epidural. Women adopt many positions in labour including sitting, kneeling, standing, leaning, and lying on an angled bed. The trial aimed to find out whether giving birth in an “upright position” or a “lying down” position results in more first time mothers with an epidural being able to have a straightforward birth.

Click here for a plain English summary of the BUMPES trial and its results.

Click here to go to the BUMPES trial results paper published in BMJ.

Trial details

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.

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