Epidural Analgesia and Labour Position: A Study Overview

Impact of Epidural Analgesia on Labour Duration

Epidural analgesia is widely recognized as the most effective method for pain relief during labour, with 30% of women in the United Kingdom opting for this approach each year. While it provides significant relief, the use of an epidural is associated with an extended second stage of labour, defined as the period from complete cervical dilation to birth. This prolongation can lead to an increased likelihood of requiring instruments for vaginal delivery.

Mobility and Positioning with Low Dose Epidural

Low dose epidural analgesia facilitates greater mobility, allowing women to adopt upright positions during labour. This flexibility can influence the birthing process and outcomes.

The BUMPES Study: Research on Labour Position

Study Design and Participants

A recent investigation published in the British Medical Journal explored how a woman’s position during the second stage of labour impacts the rate of spontaneous vaginal deliveries among those receiving epidural analgesia. The Birth in the Upright Maternal Position with Epidural in Second stage (BUMPES) study included 3,093 first-time pregnant women in the second stage of labour who had received effective epidural pain relief during the first stage. Participants were required to be at least 16 years old and at least 37 weeks pregnant.

Randomization of Positions

Participants were randomly assigned to either an upright or a lying down position during the second stage of labour. An upright position encompassed any posture that maintained the pelvis in a vertical orientation, such as walking, standing, sitting out of bed, or supported kneeling. Conversely, a lying down position was defined as any posture that kept the pelvis horizontal, including left or right lateral positions.

Results and Findings

Primary Outcome Measurement

The primary outcome assessed in the BUMPES trial was the incidence of spontaneous vaginal delivery. Shortly after their delivery, participants completed a one-page questionnaire evaluating their satisfaction with the birth experience.

Comparison of Delivery Rates

Results indicated a significant difference in spontaneous vaginal deliveries between the two groups. The upright group achieved a rate of 35.2%, while the lying down group had a rate of 41.4%, reflecting an absolute increase of 5.9%. This evidence suggests that assuming a lying down position during the second stage of labour may enhance the likelihood of spontaneous vaginal delivery for first-time mothers receiving epidural analgesia.

Limitations and Recommendations

Study Limitations

The study acknowledged certain limitations, including the potential influence of women’s perceptions regarding their ability to achieve a spontaneous vaginal birth based on their chosen positions. Existing guidelines from the National Institute for Health and Care Excellence suggest that women receiving low-dose epidural analgesia should adopt any upright position they find comfortable, which may dilute the observed treatment effect.

Conclusion and Future Research

In conclusion, the findings indicate that lying down during the second stage of labour is associated with higher rates of spontaneous vaginal delivery among women administered epidural analgesia compared to those who remain upright. However, the results may not be applicable to women with previous childbirth experiences involving epidurals. Further research is warranted to explore labour outcomes for women who do not receive epidural analgesia.

Written by Kimberly Spencer B.Sc. (Hons)

Reference: Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial. (2017). BMJ, j4471.