Clinical Edge

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Best Birth Position Without Epidural Anesthesia

Cochrane; ePub 2017 May 25; Gupta, et al

Women who give birth in the upright position without epidural anesthesia may benefit from a reduction in duration of second stage when compared with supine positions, according to a Cochrane review of 30 randomized, quasi-randomized, or cluster-randomized controlled trials involving 9,015 women of any upright position assumed by pregnant women during the second stage of labor compared with supine or lithotomy positions. Reviewers found:

  • In 19 trials (n=5,811) women who gave birth in the upright position had the length of time they were pushing reduced by ~6 minutes when compared to supine positions.
  • In 21 trials, (n=6,481), fewer women had an assisted delivery.
  • In 16 trials (n=5,439), the number of women having a cesarean delivery did not differ.
  • Fewer women had an episiotomy, although there was a tendency for more women to have perineal tears.
  • In 15 trials (n=5,615) women were more likely to have a blood loss of ≥500 mL in the upright position.
  • There was no difference in the number of admissions to the neonatal unit.


Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews. 2017, Issue 5. Art. No.: CD002006. doi:10.1002/14651858.CD002006.pub4.