best position in 1st stage of labor

RCOG statement

15/04/2009 - 00:01

A recent Cochrane review found that women who assume upright positions during the first stage of labour - such as walking, sitting, standing or kneeling as opposed to lying down - experience a shorter first stage of labour. The review also found that women who laboured in upright positions were less likely to seek pain relief through epidural analgesia.

The Royal College of Obstetricians and Gynaecologists (RCOG) encourages women to mobilise and remain upright as much as possible during the first stage of labour. It is likely that being upright helps that baby's head to descend and turn into the right position. The pressure of the baby’s head on the cervix may also help to strengthen contractions.

In the past, traditional epidural methods meant that it was impossible for women to walk around. However, most hospitals now offer a mobile epidural, which allows women to walk around and remain upright. A mobile epidural contains a different mixture of medication, providing pain relief while limiting loss of sensation in the legs. It is consequently possible for most women to choose pain relief and to remain mobile during the first stage of labour.

Fetal monitoring need not interfere with mobility. Intermittent monitoring of the baby is recommended for low-risk women, while high-risk women may require continuous monitoring. Fetal monitoring equipment can be attached by a lead that allows for freedom of movement. All women having a vaginal birth are encouraged to ambulate during the first stage of labour, provided that they feel capable of doing so. The RCOG recommends that women be encouraged to assume whatever position is most comfortable to them.

Reference

Lawrence A, et al. Maternal positions and mobility during first stage of labor. Cochrane Database of Systematic Reviews. Issue 2, 2009.