Lawrence Annemarie, Lewis Lucy, Hofmeyr G Justus, Dowswell Therese, Styles Cathy
Institute of Women's and Children's Health (15), Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland, Australia, 4810.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD003934. doi: 10.1002/14651858.CD003934.pub2.
It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour.
The purpose of the review is to assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008).
Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour.
We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. A minimum of two review authors independently assessed each study.
The review includes 21 studies with a total of 3706 women. Overall, the first stage of labour was approximately one hour shorter for women randomised to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomised to upright positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).There were no differences between groups for other outcomes including length of the second stage of labour, mode of delivery, or other outcomes related to the wellbeing of mothers and babies. For women who had epidural analgesia there were no differences between those randomised to upright versus recumbent positions for any of the outcomes examined in the review. Little information on maternal satisfaction was collected, and none of the studies compared different upright or recumbent positions.
AUTHORS' CONCLUSIONS: There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.
在发达国家以及在卫生机构分娩的低收入国家的女性中，在产床上分娩更为常见。没有证据表明这对女性或婴儿有任何益处，尽管这对医护人员可能更方便。观察性研究表明，如果女性在分娩时仰卧，这可能会对子宫收缩产生不利影响并阻碍产程进展。
本综述的目的是评估鼓励处于第一产程的女性采用不同直立姿势（包括行走、坐、站立和跪）与卧位姿势（仰卧、半卧位和侧卧位）相比，对产程长度、分娩方式以及对母亲和婴儿的其他重要结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2008年11月）。
比较在第一产程中随机分配至直立姿势与卧位姿势的女性的随机试验和半随机试验。
我们采用《Cochrane干预措施系统评价手册》中描述的方法进行数据收集、评估研究质量和分析结果。至少两名综述作者独立评估每项研究。
本综述纳入了21项研究，共3706名女性。总体而言，随机分配至直立姿势而非卧位姿势的女性，第一产程大约短1小时（平均差-0.99，95%可信区间-1.60至-0.39）。随机分配至直立姿势的女性接受硬膜外镇痛的可能性较小（风险比0.83，95%可信区间0.72至0.96）。在其他结局方面，包括第二产程长度、分娩方式或与母亲和婴儿健康相关的其他结局，两组之间没有差异。对于接受硬膜外镇痛的女性，在本综述中所检查的任何结局方面，随机分配至直立姿势与卧位姿势的女性之间没有差异。收集到的关于产妇满意度的信息很少，且没有研究比较不同的直立或卧位姿势。
有证据表明，第一产程中的行走和直立姿势可缩短产程，且似乎与增加干预或对母亲和婴儿健康产生负面影响无关。应鼓励女性在第一产程中采取她们觉得最舒适的姿势。
