Lying Down in Second Stage of Labor After Low-Dose Epidural Tied to Higher Odds of Spontaneous Delivery

Having women lie down during the second stage of labor after an epidural is associated with increased rates of spontaneous vaginal birth without an increase in complications, according to a randomized trial in The BMJ.

Roughly 3200 nulliparous U.K. women who received low-dose epidurals were assigned to undergo the second stage of labor (after the cervix is fully dilated) either lying down or upright (e.g., sitting, kneeling, standing).

The rate of spontaneous vaginal birth was higher in the recumbent group (41% vs. 35% in upright group). The authors estimate that 17 women would need to lie down during the second stage to achieve one additional spontaneous vaginal birth. There were no differences in other maternal or neonatal outcomes.

The authors speculate that sitting could limit pelvic outlet because of pressure on the coccyx. They conclude that women in labor with an epidural “should be offered the choice of adopting a lying down position in the second stage until proven otherwise.”