Andrews 1990.

Methods	Randomised trial: using a convenience sample over a 3‐month period.
Participants	40 women, Cleveland, U.S.A. 20 study participants: nulliparous 20 control participants nulliparous Inclusion Criteria: Parity: nulliparous, Pluralty: single vertex fetus in an anterior position, Gestation: 38 to 42 weeks Onset of labour: spontaneous Other: medically uncomplicated pregnancies; adequate pelvic measurements; intact amniotic membranes at the beginning of the maximum slope in their labour (4 to 9 cm dilatation).
Interventions	Study group: 20 women ‐ upright: standing, ambulating, sitting, squatting, or kneeling. 15 women chose to lie down after receiving medication for rest: 5 of these women immediately returned to the upright position, stating that the contractions were more painful when they were lying down. The remaining 10 chose the lateral position to rest for up to 1 hour during the study period. Control group: 20 women ‐ recumbent: supine, lateral, or prone ‐ hands and knees. All women: ‐ position assumed when cervical dilatation was from 4 to 9 cm, ‐ were free to choose several variations within each position group. ‐ were free to assume positions from the other group for routines of care or rest, these activities were documented.
Outcomes	Maternal Outcomes: Duration of first stage of labour. Maternal Comfort. Analgesia amount. Neonatal Outcomes: Nil
Notes	1. The length of maximum slope in labour was recorded. This is a subdivision of the first stage of labour, during which rapid cervical dilatation takes place (from 4 to 9 cm). The duration of the first stage was determined by the first recorded time that cervical dilatation was assessed to be 4 cm and on the first recorded time that dilatation was assessed to be 9 cm. 2. The Maternal Comfort Assessment Tool was used. The tool estimates the level of maternal comfort by measuring focus of attention; eye contact during contractions; breathing pattern and vocal behaviour during contractions; muscle tension and activity during contractions; and verbalisations regarding ability to continue with labour. In addition, vital signs; degree of cervical dilatation; duration, frequency, and intensity of contractions; medications; and use of monitoring apparatus were recorded. When the scores for each category of observable behaviour in the tool are added, the highest possible comfort score for each contraction was 14 and the lowest was 0. Comfort scores for a series of 3 contractions were recorded on an hourly basis during the phase of maximum slope, and averaged for mean hourly comfort scores. Hourly comfort scores where then average to obtain an overall mean comfort score for each woman. 3. The amount of narcotic and other analgesia. The randomisation method is unclear. Women in the recumbent position were monitored externally more often (n = 13) than women in the upright position (n = 1), which may have been an additional source of discomfort for women in the recumbent group. Apgar scores were not included as outcome measures because only a mean Apgar at 1 minute for each group was provided.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Described as 'randomly assigned'.
Allocation concealment (selection bias)	Unclear risk	Not stated.
Blinding (performance bias and detection bias) Women	High risk	Not feasible.
Blinding (performance bias and detection bias) Clinical staff	High risk	Not feasible.
Blinding (performance bias and detection bias) Outcome assessor	Unclear risk	Not stated.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No stated losses to follow‐up.
Selective reporting (reporting bias)	Unclear risk	Unclear.