Position in the second stage of labour for women without epidural anaesthesia

Gupta, Janesh; Sood, Akanksha; Hofmeyr, G Justus; Vogel, Joshua P.

doi:10.1002/14651858.cd002006.pub4

Cited by 246 publications

(305 citation statements)

References 64 publications

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“…There was a high bias risk in multiple fields in the studies and the number of women who applied the intervention is considerably low in some studies. It was determined that in the study performed by Gupta et al (2012), the effect of the upright position on the episiotomy rate was similar to that in our study (RR = 0.79, 95% CI = 0.70-0.90, in the random effects model).…”

Section: Effect Of the Upright Position On Perineal Healthsupporting

confidence: 84%

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A meta‐analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia

Demirci

Kukulu

2017

Journal of Advanced Nursing

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The reductions in these ratios improved comfort. Due to methodological shortcomings of the studies, the increased ratio of postpartum haemorrhage should be interpreted with caution. Researchers are recommended to conduct studies rigorously. In addition, healthcare professionals are recommended to decide the appropriate birth position by considering the individual risk factors and preferences of the women.

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Section: Effect Of the Upright Position On Perineal Healthsupporting

confidence: 84%

“…The meta-analysis study performed by Gupta et al (2012) established that the upright position had a similar level of effect on caesarean birth incidence (RR = 0.97, 95% CI = 0.59-1.59). Some of the studies included in the analysis determined that the caesarean birth incidence was lower in the upright position.…”

Section: Postpartum Haemorrhagementioning

confidence: 96%

A meta‐analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia

Demirci

Kukulu

2017

Journal of Advanced Nursing

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“…[20][21][22][23][24][25][26][27] There are several intrapartum interventions that can potentially modify this risk, such as maternal birthing position, choice of instrument for operative vaginal delivery, perineal massage, warm compresses, episiotomy cutting policy, and manual perineal support (MPS). 21,[28][29][30][31] MPS is commonly referred to by clinicians as the 'hands on' technique, with a wide variety of techniques practiced worldwide. Amongst these are the flexion technique and the Ritgen's manoeuvre (or a modification of either).…”

Section: Introductionmentioning

confidence: 99%

Manual perineal support at the time of childbirth: a systematic review and meta‐analysis

Bulchandani

Watts

Sucharitha

et al. 2015

BJOG

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Background Genital tract trauma is common with vaginal births and is associated with significant morbidity, particularly with obstetric anal sphincter injuries (OASIS). Debate continues regarding the effectiveness of perineal support during childbirth in reducing the risk of trauma.Objectives This review aimed to assess the effect of routine 'hands on'/manual perineal support (MPS) during childbirth, versus ad hoc/no perineal support ('hands off/poised'), on the risk and degree of perineal trauma.Search strategy This review is registered on PROSPERO (http:// www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42014007058). We searched the CENTRAL, Embase, Medline, CINAHL, and OVIDs midwifery and infant care databases (from inception to December 2014).Selection criteria Published randomised controlled trials (RCTs) and non-randomised studies (NRSs) evaluating any 'hands on' perineal support technique during childbirth.Data collection and analysis Two reviewers independently assessed trials for inclusion, data extraction, and methodological quality. Discrepancies were resolved by discussion with a third reviewer.Main results We included five RCTs and seven NRSs in the review. Meta-analysis of RCTs did not demonstrate a statistically significant protective effect of MPS on the risk of OASIS (three studies, 6647 women; relative risk, RR 1.03; 95% confidence interval, 95% CI 0.32-3.36; statistical test for heterogeneity I 2 = 71%). Meta-analysis of NRSs showed a significant reduction in the risk of OASIS with MPS (three studies, 74 744 women; RR 0.45; 95% CI 0.40-0.50; I 2 = 32%).Conclusion Current evidence is insufficient to drive change in practice. An adequately powered randomised trial with an efficient design to evaluate the complex interventions adopted as part of MPS policies, ensuring controlled childbirth, is urgently needed.Keywords Obstetric anal sphincter injuries, parturition, perineal support, perineal trauma. IntroductionIt is reported that 85% of women having a vaginal birth sustain some degree of perineal trauma. 1 Perineal tears are defined as first degree when the perineal skin is involved, second degree when the tear involves perineal muscles and skin, third degree when the anal sphincter complex is involved, and fourth degree when the tear involves all of the above structures and the anal epithelium or rectal mucosa. 2,3 Third-and fourth-degree tears are collectively called obstetric anal sphincter injuries (OASIS). The overall rate of OASIS varies in reports (0.6-10.2%), 4-8 and is sometimes attributed to differences in definitions and clinical practices. 9 Perineal trauma is associated with considerable shortand long-term morbidity. The risk and severity of complications is proportional to the extent of the trauma. 10,11 Despite identification and repair, postpartum complications such as perineal pain and faecal incontinence have a higher prevalence following OASIS, [12][13][14][15][16] and are associated with www.bjog.org Systematic review major psychological, physical, and social problems....

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“…21 • Supporting the laboring woman to walk and move about freely and assisting her to assume the positions of her choice, including squatting, sitting, and hands-and-knees, and providing tools supportive of upright positions. 21,22 • Providing all mothers with privacy during labor and birth, as evidenced by privacy walls or curtains, or separate/individual labor and birthing rooms where possible.…”

Section: Step 6: Provide Evidence-based Practicementioning

confidence: 99%

The International Childbirth Initiative: 12 steps to safe and respectful MotherBaby–Family maternity care

Lalonde

Herschderfer²,

Pascali-Bonaro³

et al. 2019

Intl J Gynecology & Obste

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Position in the second stage of labour for women without epidural anaesthesia

Abstract: Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Analysis 2.11. Comparison 2 Birth stool or squat stool versus supine position, Outcome Shoulder dystocia (not prespecified

Cited by 246 publications

References 64 publications

A meta‐analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia

A meta‐analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia

Manual perineal support at the time of childbirth: a systematic review and meta‐analysis

The International Childbirth Initiative: 12 steps to safe and respectful MotherBaby–Family maternity care

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