Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review

Seong-Hi Park; JeongHae Hwang; Yun-Kyoung Choi; Chang-Bum Kang

doi:10.4069/kjwhn.2012.18.3.209

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Park, Hwang, Choi, and Kang: Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review

Original Article

Korean Journal of Women Health Nursing

Korean Journal of Women Health Nursing 2012; 18(3): 209-222.

Published online: 30 September 2012

DOI: https://doi.org/10.4069/kjwhn.2012.18.3.209

Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review

Seong-Hi Park¹, JeongHae Hwang², Yun-Kyoung Choi³, Chang-Bum Kang⁴

¹School of Nursing, Hanzhong University, Donghae, Korea.

²Department of Health Administration, Hanyang Cyber University, Seoul, Korea.

³Department of Nursing, Korea National Open University, Seoul, Korea.

⁴Research Development Team, Korea Health Promotion Foundation, Seoul, Korea.

Corresponding author: Choi, Yun-Kyoung. Department of Nursing, Korea National Open University, 86 Daehak-ro, Jongno-gu, Seoul 110-791, Korea. Tel: +82-2-3668-4745, Fax: +82-2-3673-4274, ykchoi2012@knou.ac.kr

Received 31 July 2012 Revised 10 September 2012 Accepted 15 September 2012

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to determine whether upright position is effective in labor through systematic review in randomized controlled trials.

Methods

We established the PICO (Patient-Intervention-Comparator-Outcome) strategy, and reviewed 282 literatures from national and international electronic databases, and finally selected 9 references based on inclusion and exclusion criteria. We evaluated the quality of references and carried out a meta-analysis.

Results

The maternal outcomes showed that the duration of their second-stage labor was 2.29 minutes shorter than that of the women in the recumbent position, and were less likely to have episiotomy. The other outcomes, including the mode of delivery, blood loss, hemoglobin level, use of oxytocin, use of analgesics, and perineal laceration, did not differ between the groups. The fetal heart rate abnormality occurred less than in the control group. The Apgar scores of the groups did not differ.

Conclusion

There is evidence that an upright position in the second stage of labor reduces the duration of the second stage of labor, the incidence of episiotomy, and an abnormal fetal heart rate.

Keywords: Posture, Meta-analysis, Randomized controlled trial, Labor stage, second

Figures and Tables

Figure 1

Flow chart of study selection.

Figure 2

Maternal outcomes of upright position versus recumbent position in labor.

Figure 3

Fetal & Newborn outcomes of upright position versus recumbent position in labor.

Table 1

Characteristics selected in 9 Studies (N=9)

Int.=intervention group; Cont.=Control group; SL=stage of labor; MD=modee of delivery; BL=Blood loss; HL=Hemoglobin level; Oxy.=Oxytocin; Anal.=analgesics; PL=Perineal laceration; FH=fetal heart; NO=neonatal outcomes; Eiv.=evidence; UPPI=upright position with providing information; HKP=hands and knees position; SSP=supported sitting position; SP=sitting position; RSA=Republic of South Africa; UP=upright position; UAP=upright, ambulatory position; ASP=ambulatory, squatting position.

Summary Statement

▪ What is already known about this topic:

Supine position in labor may have adverse physiological effects on the condition of the woman and her baby and on the progression of labor.

▪ What this paper adds:

There is evidence that an mother's upright position in the second stage of labor reduces incidence of length of the second stage of labor, episiotomy, and an abnormal fetal heart rate.

▪ Implications for practice, education, and policy

These results have important implications for the development of nurse's active role and nursing intervention in normal vaginal delivery.

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