First time mothers with an epidural who lie down in labor are more likely to have a normal birth

Adopting a lying down position rather than being upright in the later stages of labour for women with a low dose epidural leads to a higher chance of having a spontaneous vaginal birth (without the need for forceps or suction), finds a study published by The BMJ today.

30% of women choose to have an epidural as it's the most effective form of pain relief in labour. However, having an epidural leads to an increased risk of an instrumental vaginal birth. The position a woman is in during the second stage of labour (after the cervix is fully dilated) has been suggested to have an effect on the risk of instrumental vaginal birth.

So, Peter Brocklehurst from the University of Birmingham and colleagues investigated whether adopting a lying down or an upright position increased the rate of spontaneous vaginal birth in first time (nulliparous) mothers who had chosen to have a low dose epidural.

They carried out a randomised controlled trial, funded by the National Institute of Health Research, of 3,093 women in 41 UK hospital labour wards between October 2010 and January 2014.

The women were aged 16 or over, and in the second stage of labour, who had opted for an epidural.

Among the 3,093 women, (1556 in the upright group and 1537 in the lying down group), there were fewer spontaneous births in women in the upright group (35.2%), compared with women in the lying down group (41.1%). This represents a 5.9% absolute increase in the chance of spontaneous vaginal birth in the lying down group.

No disadvantages were apparent in relation to short or longer-term outcomes for mother or baby.

However, the researchers outline some limitations in the study. NICE guidelines currently recommend women with an epidural should be encouraged to adopt an upright position in late labour. Adherence was lower in the lying down group, which may be because of the current guidance. If that was the case, lying down may be even more effective at increasing the chance of a normal birth. It's also unclear what the findings mean for women without an epidural or for those who have given birth before (multiparous).

Nevertheless, "The intervention appears to be easy and cost-free to adopt. This evidence will allow pregnant women, in consultation with their healthcare providers, to make informed choices about their position in the second stage of labour" they conclude.