No good arguments for the routine choice of the supine position during the second stage of labour; a meta-analysis

Abstract

Objective. To investigate the scientific basis for the routine choice of the supine position during the second stage of labour. Design. Meta-analysis. Method. A search of the literature from 1966 onwards was done in various databases. Randomised clinical trials (RCT's) and cohort or case control studies in the Dutch, English, French or German languages were included. Studies in which the care providers seemed inexperienced in conducting a delivery in all positions occurring in the study were excluded. The data were pooled using the random effects model. Results. Nine RCT's and one cohort study were included. In the supine position there were more instrumental deliveries (odds ratio (OR): 1.37; 95% CI: 1.03-1.84) and episiotomies (OR: 1.73; 1.20-2.50). The estimated blood loss was less (weighted average difference: -58.98 ml; -88.55-29.41) and there was a lower incidence of blood loss of more than 500 ml (OR: 0.52; 0.36-0.75), but it was not clear whether this difference was real or observed. Women in the supine position experienced severe pain more often and had more difficulty in bearing down. Conclusion. There are no good arguments for the routine use of the supine position during the second stage of labour.