Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women With Low Dose Epidural: BUMPES Randomised Controlled Trial

Bick, D., Briley, A., Brocklehurst, P., Hardy, P., Juszczak, E., Lynch, L., MacArthur, C., Moore, P., Nolan, Mary, Rivero-Arias, O., Sanders, J., Shennan, A. and Wilson, M. (2017) Upright Versus Lying Down Position in Second Stage of Labour in Nulliparous Women With Low Dose Epidural: BUMPES Randomised Controlled Trial. British Medical Journal, 359. pp. 1-20. ISSN 0959-8138 Online: 1756-1833

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Abstract

INTERVENTIONS
Women were allocated to an upright or lying down position, using a secure web based randomisation service, stratified by centre, with no masking of participants or clinicians to the trial interventions.
MAIN OUTCOME MEASURES
The primary outcome was spontaneous vaginal birth. Women were analysed in the groups into which they were randomly allocated, regardless of position recorded at any time during the second stage of labour (excluding women with no valid consent, who withdrew, or who did not reach second stage before delivery). Secondary outcomes included mode of birth, perineal trauma, infant Apgar, delivery (adjusted risk ratio 1.08, 99% confidence interval 0.99 to 1.18), obstetric anal sphincter injury (1.27, 0.88 to 1.84), infant Apgar score <4 at five minutes (0.66, 0.06 to 6.88), and maternal faecal incontinence at one year (1.18, 0.61 to 2.28).
CONCLUSIONS
Evidence shows that lying down in the second stage of labour results in more spontaneous vaginal births in nulliparous women with epidural analgesia, with no apparent disadvantages in relation to short or longer term outcomes for mother or baby.

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