LYING DOWN POSITION RESULTS MORE IN SPONTANEOUS VAGINAL DELIVERY IN NULLIPAROUS ON EPIDURAL ANAESTHESIA

LYING DOWN POSITION RESULTS MORE IN SPONTANEOUS VAGINAL DELIVERY IN NULLIPAROUS ON EPIDURAL ANAESTHESIA

Prof Dr,DRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, +917838059592

As the most effective form of pain relief in labour, epidural analgesia is chosen by approximately 30% of women in the UK each year, and this proportion has remained relatively stable over the past decade. Epidural analgesia leads to prolongation of the second stage of labour (from full dilation of the cervix until birth) and an increased risk of instrumental vaginal delivery. However, this evidence comes mostly from trials that used epidural techniques which cause dense neuraxial blockade which limit mobility during labor so more maternal & baby complications.

             Epidurals that use low dose local anaesthetic in combination with opioids result in a lower risk of instrumental vaginal delivery, but the rate of such delivery is still higher than among women with no epidural.Maternal position during the second stage of labour has been suggested to affect the risk of instrumental vaginal delivery.It was revealed in other studies that Maternal position in the second stage of labour (after the cervix is fully dilated) may affect the incidence of spontaneous vaginal birth, and till now Upright position was considered best for it but the existing evidence from randomised controlled trials were unclear.

          Recently a study published in British medical Journal provides evidence that adopting a lying down position in the second stage of labour results in more spontaneous vaginal births in nulliparous women with epidural analgesia, with no apparent disadvantages for short or longer term outcomes for mother or baby.So to curtail pain of labor ,Mother should be given only low dose epidural anaesthesia and should lie down either left or right lateral as it results in more spontaneous vaginal delivery.There were no adverse consequences of this approach for mother or baby in the short term, or at 12 months post birth

                      But It is unclear what the findings mean for multiparous women in labour with an epidural. However, women should be offered the choice of adopting a lying down position in the second stage until proven otherwise. We also do not know what these results mean for women of all parities without an epidural. Given the variable quality of existing randomised trials of position in the second stage of labour in women without an epidural,6 the results of the BUMPES trial strongly support the development of a similar large pragmatic trial with clear operational descriptions of position in women in labour without epidural analgesia.

          Till now NICE guidlines for position during active labor was to move actively and not to lie down supine or semisupine during active contractions but may adopt any other position wit or witout epidural but this study establish advantage of adopting lying down lateral positions at least in nulliparous with low epidural anaesthesia in second stage of labor.