Extrait

Background and study aims Epidurals are the most effective method of relieving pain during labour. About 150,000 women have epidurals during childbirth in the UK each year and they consistently report high levels of satisfaction. However, epidurals do have some disadvantages. Studies have shown that they increase the chance of women needing help to delivery their baby using forceps or vacuum suction. During an instrumental delivery a woman may need to have an episiotomy or my find it causes a tear in her birth canal as her baby is born. Instrumental deliveries also increase the risk of subsequently developing loss of bowel control (incontinence), leaking urine and suffering sexual problems after childbirth. There is debate about whether adopting an upright position during the late stage of labour, when the neck of the womb is fully open, gives a greater chance of having a normal vaginal birth. It is thought that an upright position may help by several different mechanisms: gravity may help align the baby more correctly in the birth canal and may increase the blood supply to the womb; it may also result in stronger contractions of the womb and assist a woman to push more effectively at delivery. At present few women who have an epidural are encouraged to be upright in the late stage of labour. Most adopt a position lying down or half-sitting in bed. However, advances in epidural pain relief over the last two decades have resulted in the widespread use of a technique that allows women to move around rather than to be immobile. This approach uses low doses of local anaesthetic, the drug which was responsible for leg weakness in old-style epidurals, together with another painkiller called fentanyl. With these 'mobile' epidurals, most women are able to move around safely whilst in labour, including the late stages of labour, and remain comfortable. Furthermore, the chance of needing an instrumental delivery is much less, although still greater than with no epidural. The aim of this study is to find out whether adopting an upright position throughout the second stage of labour decreases the need for instrumental vaginal delivery, compared with adopting a 'lying-down' position. Who can participate? Women who are in labour for the first time and who have an effective epidural, and for whom no complications are expected What does the study involve? Participating mothers are randomly allocated to one of two groups: one group is encouraged by the midwife to adopt as upright a posture as possible (this would include walking, standing, sitting out of bed or sitting bolt upright in bed) for as much as possible of the late stage of labour, right up to their baby's birth, and the other group are asked to adopt a lying down position in bed. The health of participating mothers and babies are measured up to 1 year after birth with a postal or telephone questionnaire. What are the possible benefits and risks of participating? Not provided at time of registration Where is the study run from? University of Oxford (UK) When is the study starting and how long is it expected to run for? April 2010 to April 2015 Who is funding the study? NIHR Health Technology Assessment Programme - HTA (UK) Who is the main contact? Prof Peter Brocklehurst [email protected]

Critère d'inclusion

• Labour/ birthing position

Liens

• ictrp
• isrctn