Cover Image
close this bookCare in Normal Birth (WHO, 1996, 60 p.)
View the document(introduction...)
View the documentACKNOWLEDGEMENTS
close this folder1. INTRODUCTION
View the document1.1 Preamble
View the document1.2 Background
View the document1.3 Risk Approach in Maternity Care
View the document1.4 Definition of Normal Birth
View the document1.5 Aim of the Care in Normal Birth, Tasks of the Caregiver
View the document1.6 The Caregiver in Normal Birth
close this folder2. GENERAL ASPECTS OF CARE IN LABOUR
View the document2.1 Assessing the Well-being of the Woman during Labour
View the document2.2 Routine Procedures
View the document2.3 Nutrition
View the document2.4 Place of Birth
View the document2.5 Support in Childbirth
close this folder2.6 Labour Pain
View the document(introduction...)
View the document2.6.1 Non-pharmacological methods of pain relief
View the document2.6.2 Pharmacological pain relief in labour
close this folder2.7 Monitoring the Fetus during Labour
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View the document2.7.1 Assessment of amniotic fluid
View the document2.7.2 Monitoring the fetal heart rate
View the document2.7.3 Fetal scalp blood examination
View the document2.7.4 Comparison of auscultation and electronic fetal monitoring
View the document2.8 Cleanliness
close this folder3. CARE DURING THE FIRST STAGE OF LABOUR
View the document3.1 Assessing the Start of Labour
View the document3.2 Position and Movement during the First Stage of Labour
View the document3.3 Vaginal Examination
View the document3.4 Monitoring the Progress of Labour
close this folder3.5 Prevention of Prolonged Labour
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View the document3.5.1 Early amniotomy
View the document3.5.2 Intravenous infusion of oxytocin
View the document3.5.3 Intramuscular oxytocin administration
close this folder4. CARE DURING THE SECOND STAGE OF LABOUR
View the document4.1 Physiological Background
View the document4.2 The Onset of the Second Stage
View the document4.3 The Onset of Pushing during the Second Stage
View the document4.4 The Procedure of Pushing during the Second Stage
View the document4.5 Duration of the Second Stage
View the document4.6 Maternal Position during the Second Stage
close this folder4.7 Care of the Perineum
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View the document4.7.1 “Guarding the perineum” during delivery
View the document4.7.2 Perineal tear and episiotomy
close this folder5. CARE DURING THE THIRD STAGE OF LABOUR
View the document5.1 Background
View the document5.2 Prophylactic use of Oxytocics
View the document5.3 Controlled Cord Traction
View the document5.4 Active Versus Expectant Management of the Third Stage
View the document5.5 Timing of Cord Clamping
View the document5.6 Immediate Care of the Newborn
View the document5.7 Care of the Mother Immediately after Delivery of the Placenta
close this folder6. CLASSIFICATION OF PRACTICES IN NORMAL BIRTH
View the document(introduction...)
View the document6.1 Practices which are Demonstrably Useful and Should be Encouraged
View the document6.2 Practices which are Clearly Harmful or Ineffective and Should be Eliminated
View the document6.3 Practices for which Insufficient Evidence Exists to Support a Clear Recommendation and which Should be Used with Caution while Further Research Clarifies the Issue
View the document6.4 Practices which are Frequently Used Inappropriately
View the document7. REFERENCES
View the document8. LIST OF PARTICIPANTS
View the documentSAFE MOTHERHOOD RESOURCE LIST
View the documentBACK COVER

3.2 Position and Movement during the First Stage of Labour

Several studies show that, during the first stage of labour, the supine position affects the blood flow in the uterus. The heavy uterus can cause aortocaval compression and the reduced blood flow can compromise the condition of the fetus. The supine position is also found to reduce the intensity of the contractions (Flynn et al 1978, McManus and Calder 1978, Williams et al 1980, Chen et al 1987), and thus interferes with the progress of labour. Standing and lying on the side are associated with greater intensity and greater efficiency of the contractions (their ability to accomplish cervical dilatation).

Despite the continued prevalence of the supine position many options are open to women in labour. However, various constraints frequently limit those options, from the design of the delivery-suite bed to delivery protocols or the presence of routine intravenous lines or monitoring equipment. Where such constraints are kept to a minimum women can stand, walk, sit upright or on hands and knees, take a shower or a bath to relax or adopt each position alternately as they choose. Trials that have compared these positions to the supine have found that, on average, labour was experienced as less painful (there was less need for analgesia) and augmentation was used less frequently in the non-supine positions (Chan 1963, Flynn et al 1978, McManus and Calder 1978, Diaz et al 1980, Williams et al 1980, Hemminki 1983, Melzack 1991). One trial (Flynn et al 1978) found a significantly lower incidence of fetal heart rate abnormalities in the upright position, but other trials detected no significant differences in neonatal outcomes.

In conclusion, there is no evidence to support the encouragement of the supine position during the first stage of labour. The only exception is where the membranes have ruptured in the presence of a non-engaged fetal head. If and when the membranes are ruptured and the birth attendant has established a sufficient engagement of the fetal head, women should be free and encouraged to choose the position they prefer during labour. They will often change positions, as no position is comfortable for a long period of time.