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  Stay upright during labour, say experts
Women in first stage labour are better off standing, sitting, kneeling or walking around rather than lying in bed, evidence shows.

A systematic review published online in The Cochrane Library shows women are likely to have a shorter first stage labour and are less likely to have an epidural if they stay upright at the time.

"Women shouldn't be confined to the bed unless there's a very good reason," says research midwife Annemarie Lawrence of The Townsville Hospital, who led the study.

"They should be listening to their bodies and changing to positions that suit them."

Lawrence says being in bed during labour is something we've all come to expect from TV shows, but this is a relatively new phenomenon.

"In pre-westernised culture, women used to hang from ropes and support people and they were all upright," she says.

Lawrence says while confining women to bed may be more convenient for staff, there is no evidence it is advantageous to women or babies.

She and colleagues analysed 21 controlled studies dating back to 1960 involving nearly 4000 women in different countries.

The most statistically significant findings were that being upright reduced first stage labour by between 0.39 and 1.6 hours.

Lawrence says being upright speeds up labour because the baby's head pushes down on the cervix and helps bring on regular contractions and cervical dilation.

She says women who remained upright were 17% less likely to have an epidural.

"If you have a six hour labour instead of a seven hour labour then you're going to have a lot less contractions which means a lot less pain overall," says Lawrence
Control

But, Lawrence says, there are likely to be other reasons for reduced pain.

She says it is very hard for a heavily pregnant woman lying down to move around and easier to say yes to an epidural.

Also, when a woman is lying down the baby's weight on the her back can exacerbate pain, adds Lawrence.

By contrast, she says women who are upright are freer to move around and do things to get more comfortable, and this gives them a greater sense of control over their pain.

"We think there's a physiological and psychological advantage to being upright," says Lawrence.

She says the findings also show being upright during first stage labour makes no difference to the number of interventions, such as caesareans, made during birth.

Lawrence says in some cases it may be useful for women to lie down to slow down labour if it is too fast.

"You wouldn't tell everyone that they have to stay upright and mobile in first stage labour, but there is definitely some benefit and no risk to using those positions," she says.

An earlier Cochrane Collaboration review found when mothers who are upright during the birth process need less help from doctors, and it is less painful for them.

There are also less problems with the baby's heartbeat and fewer cuts to the birth outlet.
Support from obstetricians

Dr Ted Weaver, president of the Royal Australian College of Obstetricians and Gynaecologists agrees women should be encouraged to remain upright during labour.

"We've known for quite a long time that if mothers are upright during labour that it might shorten their labour, that it might reduce their pain relief requirements," he says.

"These are quite simple things that we can do that might actually make labour more easy for women and does not seem to be associated with any particular problems."

Lawrence believes women may think they need to stay in bed during labour if they often attached to monitoring equipment, such as continuous foetal monitoring.

But Weaver says there is no evidence that continuous monitoring increases the safety of births in women who are not at risk.

Even where continuous monitoring is required, it should not prevent women from standing up, he says.
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