Second stage of labor

Use of any upright or lateral position, compared with supine or lithotomy positions, is associated, in women without epidural analgesia, with a small (4 minutes) reduction in duration of second stage of labor, a 20% reduction in assisted deliveries, a 17% reduction in episiotomies, a 23% increase in second-degree perineal tears, a 63% increase in estimated blood loss >500 mL, a 23% reduction in reporting of severe pain during second stage of labor, and a 69% reduction in abnormal fetal heart rate patterns [3]. Use of the birth stool showed no effect and results with the birth chair were variable. Estimation of blood loss in the upright group may be in™uenced by the fact that blood loss in the birth chair is collected in a receptacle. Physiological advantages for upright labor may include lessened risk of aortocaval compression, improved acid-base outcomes in the neonates, stronger and more efcient uterine contractions, improved alignment of the fetus for passage through the pelvis (“drive angle”) and larger anteroposterior and transverse pelvic outlet diameters, resulting in an increase in the total outlet area in the squatting and kneeling positions [3].