Lying on one’s side in labour with epidural leads to more spontaneous births

Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births.

Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.

This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.

The current guidance recommends an upright position when actively contracting in the later stages of labour. However, this research suggests that for first-time mothers with epidurals, lying on their side could be considered.

Why was this study needed?

Between 2014 and 2015, 16.4% of women who gave birth in England had an epidural during labour.

Epidurals are effective in reducing pain from contractions but may increase the length of the second stage of labour and the likelihood of an assisted birth.

There is low-quality evidence suggesting that giving birth upright could reduce the chances of an assisted birth in women without epidurals. In women with epidurals, very low-quality evidence had pointed to no clear difference between giving birth lying on one’s side and being upright on the chances of having an assisted birth.

This trial aimed to find out whether giving birth upright increased the chances of unassisted spontaneous vaginal birth in first-time mothers with a low-dose epidural, compared with lying on their side.

What did this study do?

This pragmatic randomised controlled trial, BUMPES, involved 3,236 women with a low-dose epidural for labour from 41 UK hospitals.

All were first-time mothers and more than 37 weeks pregnant with a single baby. They were randomly allocated to two groups for the second stage of labour. These were either lying on their side with up to 30 degrees inclination of the bed; or in an upright position (such as walking, sitting out of bed or standing). Midwives encouraged them to stay in their allocated position, but they could change position during labour if they wished.

Participants and midwives knew the birth position allocations, but the main measure, vaginal birth, is objective and unlikely to have been influenced in a major way by previous ideas of benefit. Details of epidural management may have varied between hospitals.

Only first-time mothers with low-dose epidurals took part so the results may not apply to other women including those who have previously given birth.