Methods	Randomised trial. Randomised in blocks.
Participants	Women recruited from a hospital in Southern Thailand. (2 groups used in this analysis (n = 83)) Inclusion criteria - married, primiparous women aged 18 - 35 years and in latent phase for > 10 hours. Singleton fetus, cephalic presentation, gestation 38 - 42 weeks, fetal weight 2500 - 4000 g Exclusion criteria - had analgesia before recruitment, induced labour, membrane rupture > 20 hours previously, psychiatric problem, infection, asthma or objection to intervention
Interventions	5 separate intervention groups (described below). In this review we have included data from two groups: Intervention group - CAT position alternating half hourly with head high position (CAT position = facing towards bed head at 45 degrees with knees bent, taking weight on knees and elbows; head high position = lying at a 45-degree angle) (n = 40) Comparison group - supine in bed (n = 43).
Outcomes	Duration of first stage. Pain.
Notes	Complicated study design with five study groups: 1. CAT position alternating with head-high position with music (n = 40). 2. CAT position alternating with head-high position (n = 40). 3. CAT position alternating with supine position (n = 40). 4. Head-high position (lying in bed on back at 45 degrees) (n = 41). 5. Supine in bed (n = 43). In this review we have used data for groups 2 and 5 in the analyses (It was not clear what ‘CAT’ signified)
Risk of bias
Item	Authors’ judgement	Description
Adequate sequence generation?	Unclear	No information.
Allocation concealment?	Unclear	Described as ‘random assignments’.
Blinding? Women	No	Not feasible.
Blinding? Clinical staff	No
Blinding? Outcome assessor	No
Incomplete outcome data addressed? All outcomes	Yes	Three women were lost to follow up as they had caesarean sections during the first stage of labour. It was not clear whether this was before randomisation. No other loss to follow up was apparent