Effects of flexible sacrum positions during the second stage of labour on maternal and neonatal outcomes: A systematic review and meta‐analysis

Abstract

Aims and objectives To assess the effects of flexible sacrum positions on mode of delivery, duration of the second stage of labour, perineal trauma, postpartum haemorrhage, maternal pain, abnormal foetal heart rate patterns and Apgar scores based on published literature. Background Maternal positions served as a nonmedical intervention may facilitate optimal maternal and neonatal outcomes during labour. Flexible sacrum positions are conducive to expanding pelvic outlet. Whether flexible sacrum positions have positive effects on maternal and neonatal well‐being is a controversial issue under heated discussion. Design We performed a systematic review and meta‐analysis based on PRISMA guidelines. Methods Randomised controlled trials (RCTs) comparing any flexible sacrum position with non‐flexible sacrum position in the second stage of labour were included. PubMed, EMBASE, Cochrane Library, CINAHL, CNKI (China National Knowledge Infrastructure), SinoMed and Wanfang databases were searched from inception to 11 March 2019 for published RCTs. Risk of bias was assessed by the Cochrane criteria, and random‐effects meta‐analyses were conducted by RevMan 5.3. Results Sixteen studies (3,397 women) published in English were included. Flexible sacrum positions in the second stage of labour could reduce the incidence of operative delivery, instrumental vaginal delivery, caesarean section, episiotomy, severe perineal trauma, severe pain and shorten the duration of active pushing phase in the second stage of labour. However, flexible sacrum positions may increase the incidence of mild perineal trauma. There was no significant difference in the duration of the second stage of labour, maternal satisfaction and other outcomes. Conclusions Flexible sacrum positions are superior in promoting maternal well‐being during childbirth. However, several results require careful interpretation. More rigorous original studies are needed to further explore their effects. Relevance to clinical practice The results support the use of flexible sacrum positions. Flexible sacrum positions are recommended to apply flexibly or tailor to individual woman's labour progress.

Maternal positions during labour: midwives’ knowledge and educational needs in Northern Italy

“…Moreover, the knowledge of these general benefits was evaluated: promoting fetal progression and fetal positioning, containing maternal pain, reducing the risk of abnormal FHR, reducing labor's length, preventing perineal trauma, making uterine contractions more regular and effective, encouraging partner involvement and the empathic relationship between the couple and the midwife. The references for general benefits were taken from the principal studies and reviews about the topic [6][7][8][9][10][11][12][13][14] .…”

“…Several studies have been published evaluating the link between maternal positions and some childbirth outcomes, underlining their role in: promoting the physiological progression of labor 8 , facilitating the correct fetal positioning 9 , promoting fetal well-being 10 , making pain more bearable and increasing maternal satisfaction 11 , reducing perineal trauma 10 , 12 , influencing blood loss 10 , reducing the use of operative vaginal birth 8 , 13 , supporting partner involvement, and strengthening the empathic relationship between the couple and the midwife 11 , 14 .…”

Effect of Flexible Sacrum Position on Maternal and Neonatal Outcomes in Public Health Facilities, Amhara Regional State, Ethiopia: A Quasi-Experimental Study

“…Furthermore, studies showed that FSP reduces the incidence of operative vaginal delivery, instrumental delivery, caesarean section, episiotomy, severe perineal trauma and vaginal tear, severe pain, and shortens the duration of the first stage of labor and active pushing phase in the second stage of labor. However, other studies showed that FSP increase the incidence of first- and second-degree perineal trauma and estimated blood loss greater than 500 mL [ 14 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], and no difference in prevalence of Neonatal Intensive Care Unit(NICU) admissions [ 28 , 29 , 31 ]. Perineal laceration(s) can result in serious maternal morbidity and even mortality in low and middle-income countries, including Ethiopia.…”

Pelvic capacity in pregnant women, identified using magnetic resonance imaging

“…2,3 Maternal birthing position may influence pelvic capacity because upright positions may optimize capacity due to free movements of the pelvic joints. 9,10 Upright positions and mobility during labor are associated with reductions in labor duration, assisted vaginal birth and epidural analgesia. 11,12 The first magnetic resonance imaging (MRI) study comparing the supine and kneeling squat positions in pregnant women was published in 2014.…”

“…Maternal birthing position may influence pelvic capacity because upright positions may optimize capacity due to free movements of the pelvic joints 9,10 . Upright positions and mobility during labor are associated with reductions in labor duration, assisted vaginal birth and epidural analgesia 11,12 .…”