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. 2013 Oct 9;2013(10):CD003934. doi: 10.1002/14651858.CD003934.pub4

Comparison 2. Upright and ambulant positions versus recumbent positions and bed care (with epidural: all women).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Duration of first stage labour: (minutes) 0 0 Mean Difference (IV, Fixed, 95% CI) 0.0 [0.0, 0.0]
2 Mode of birth: spontaneous vaginal 6 1566 Risk Ratio (M‐H, Fixed, 95% CI) 0.96 [0.89, 1.05]
3 Mode of birth: spontaneous vaginal: subgroup analysis: parity 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
3.1 Nulliparous women 4 1179 Risk Ratio (M‐H, Fixed, 95% CI) 0.94 [0.84, 1.04]
3.2 Multiparous women 1 111 Risk Ratio (M‐H, Fixed, 95% CI) 1.02 [0.81, 1.27]
4 Mode of birth: spontaneous vaginal: subgroup analysis: onset of labour 1   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
4.1 Spontaneous labour: all women 1 505 Risk Ratio (M‐H, Random, 95% CI) 0.94 [0.81, 1.09]
4.2 Induction of labour: all women 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
5 Mode of birth: spontaneous vaginal: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
5.1 Sitting vs Recumbent / supine / lateral 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
5.2 Walking vs Recumbent / supine / lateral 2 276 Risk Ratio (M‐H, Random, 95% CI) 1.02 [0.81, 1.28]
5.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 151 Risk Ratio (M‐H, Random, 95% CI) 0.92 [0.75, 1.13]
5.4 Sitting vs Bed care 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
5.5 Walking vs Bed care 2 910 Risk Ratio (M‐H, Random, 95% CI) 0.93 [0.83, 1.06]
5.6 Sitting, standing, squatting, kneeling or walking vs Bed care 1 229 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.78, 1.27]
6 Mode of birth: spontaneous vaginal: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
6.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 3 427 Risk Ratio (M‐H, Random, 95% CI) 0.99 [0.86, 1.15]
6.2 Sitting, standing, squatting, kneeling or walking vs Bed care 3 1139 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.85, 1.06]
7 Mode of birth: spontaneous vaginal: sensitivity analysis 3   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
7.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 61 Risk Ratio (M‐H, Fixed, 95% CI) 0.85 [0.61, 1.20]
7.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care 2 634 Risk Ratio (M‐H, Fixed, 95% CI) 0.95 [0.81, 1.11]
8 Mode of birth: operative vaginal 6 1566 Risk Ratio (M‐H, Fixed, 95% CI) 1.06 [0.90, 1.25]
9 Mode of birth: operative vaginal: subgroup analysis: parity 4   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
9.1 Nulliparous women 4 1084 Risk Ratio (M‐H, Random, 95% CI) 1.36 [0.95, 1.94]
9.2 Multiparous women 1 111 Risk Ratio (M‐H, Random, 95% CI) 1.09 [0.49, 2.42]
10 Mode of birth: operative vaginal: subgroup analysis: onset of labour 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
10.1 Spontaneous labour: all women 1 505 Risk Ratio (M‐H, Fixed, 95% CI) 1.18 [0.88, 1.59]
10.2 Induction of labour: all women 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
11 Mode of birth: operative vaginal: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
11.1 Sitting vs Recumbent / supine / lateral 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11.2 Walking vs Recumbent / supine / lateral 2 276 Risk Ratio (M‐H, Random, 95% CI) 1.17 [0.56, 2.44]
11.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 151 Risk Ratio (M‐H, Random, 95% CI) 2.03 [0.73, 5.65]
11.4 Sitting vs Bed care 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11.5 Walking vs Bed care 2 910 Risk Ratio (M‐H, Random, 95% CI) 1.03 [0.81, 1.31]
11.6 Sitting, standing, squatting, kneeling or walking vs Bed care 1 229 Risk Ratio (M‐H, Random, 95% CI) 1.00 [0.69, 1.45]
12 Mode of birth: operative vaginal: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
12.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 3 427 Risk Ratio (M‐H, Random, 95% CI) 1.41 [0.77, 2.56]
12.2 Sitting, standing, squatting, kneeling or walking vs Bed care 3 1139 Risk Ratio (M‐H, Random, 95% CI) 1.02 [0.86, 1.20]
13 Mode of birth: operative vaginal: sensitivity analysis 3   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
13.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 61 Risk Ratio (M‐H, Fixed, 95% CI) 1.55 [0.49, 4.95]
13.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care 2 634 Risk Ratio (M‐H, Fixed, 95% CI) 0.95 [0.77, 1.16]
14 Mode of birth: caesarean birth 6 1566 Risk Ratio (M‐H, Fixed, 95% CI) 1.05 [0.83, 1.32]
15 Mode of birth: caesarean birth: subgroup analysis: parity 4   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
15.1 Nulliparous women 4 1084 Risk Ratio (M‐H, Random, 95% CI) 1.14 [0.75, 1.73]
15.2 Multiparous women 1 206 Risk Ratio (M‐H, Random, 95% CI) 1.31 [0.55, 3.09]
16 Mode of birth: caesarean birth: subgroup analysis: onset of labour 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
16.1 Spontaneous labour: all women 1 505 Risk Ratio (M‐H, Fixed, 95% CI) 0.95 [0.64, 1.40]
16.2 Induction of labour: all women 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
17 Mode of birth: caesarean birth: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
17.1 Sitting vs Recumbent / supine / lateral 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.2 Walking vs Recumbent / supine / lateral 2 276 Risk Ratio (M‐H, Random, 95% CI) 0.74 [0.35, 1.56]
17.3 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 151 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.49, 1.82]
17.4 Sitting vs Bed care 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.5 Walking vs Bed care 2 910 Risk Ratio (M‐H, Random, 95% CI) 1.20 [0.74, 1.94]
17.6 Sitting, standing, squatting, kneeling or walking vs Bed care 1 229 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.53, 1.95]
18 Mode of birth: caesarean birth: subgroup analysis: position types 6   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
18.1 Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 3 427 Risk Ratio (M‐H, Random, 95% CI) 0.81 [0.52, 1.28]
18.2 Sitting, standing, squatting, kneeling or walking vs Bed care 3 1139 Risk Ratio (M‐H, Random, 95% CI) 1.15 [0.83, 1.59]
19 Mode of birth: caesarean birth: sensitivity analysis 3   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
19.1 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Recumbent / supine / lateral 1 61 Risk Ratio (M‐H, Fixed, 95% CI) 1.29 [0.38, 4.35]
19.2 Trials of better quality ‐ Sitting, standing, squatting, kneeling or walking vs Bed care 2 634 Risk Ratio (M‐H, Fixed, 95% CI) 1.35 [0.93, 1.96]
20 Maternal satisfaction 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
21 Maternal pain 2   Risk Ratio (M‐H, Random, 95% CI) Subtotals only
21.1 Requiring additional Bupivocaine bolus doses 2 720 Risk Ratio (M‐H, Random, 95% CI) 0.57 [0.22, 1.48]
22 Analgesia amount 5   Mean Difference (IV, Random, 95% CI) Subtotals only
22.1 Bupivocaine 3 463 Mean Difference (IV, Random, 95% CI) ‐0.24 [‐2.32, 1.84]
22.2 Ropivacaine 1 151 Mean Difference (IV, Random, 95% CI) 19.70 [0.77, 38.63]
22.3 Fentanyl 1 229 Mean Difference (IV, Random, 95% CI) ‐0.38 [‐1.99, 1.23]
22.4 Bupivocaine & Fentanyl 1 409 Mean Difference (IV, Random, 95% CI) ‐1.37 [‐7.59, 4.85]
23 Duration of second stage of labour (minutes) 2 204 Mean Difference (IV, Fixed, 95% CI) 2.35 [‐15.22, 19.91]
24 Augmentation of labour using oxytocin 5 1161 Risk Ratio (M‐H, Fixed, 95% CI) 0.98 [0.90, 1.07]
25 Artificial rupture of membranes 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
26 Hypotension requiring intervention 3 781 Risk Ratio (M‐H, Fixed, 95% CI) 1.12 [0.52, 2.45]
27 Estimated blood loss > 500 mL 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
28 Perineal trauma 0   Risk Ratio (M‐H, Fixed, 95% CI) Totals not selected
28.1 Episiotomy 0   Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
28.2 Second‐degree tears 0   Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
28.3 Third‐degree tears 0   Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
29 Fetal distress (requiring immediate delivery) 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
30 Use of neonatal mechanical ventilation 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
31 Apgar scores 5   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
31.1 Apgar < 7 at 1 min 2 191 Risk Ratio (M‐H, Fixed, 95% CI) 1.01 [0.37, 2.76]
31.2 Apgar < 7 at 5 mins 4 835 Risk Ratio (M‐H, Fixed, 95% CI) 1.04 [0.21, 5.05]
32 Admission to NICU 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]
33 Perinatal mortality 0 0 Risk Ratio (M‐H, Fixed, 95% CI) 0.0 [0.0, 0.0]