BUMPES

Upright maternal position in second stage labour in women with epidural analgesia; a randomised controlled trial.

Trial started: 2010  Trial ended: 2013 

NPEU role: Randomisation service, statistical analysis and economic evaluation. Trial website: https://www.birmingham.ac.uk/research/bctu/trials/womens/bumpes/bumpes-trial.aspx

Summary

Objectives

In nulliparous women with epidural analgesia, does a policy of adopting an 'upright position' throughout second-stage labour increase the incidence of spontaneous vaginal birth (SVB) compared with a policy of adopting a 'lying-down' position?

Methods

A two-arm randomised controlled trial conducted in maternity units in England and Wales. Nulliparous women aged ? 16 years, at ? 37 weeks' gestation with singleton cephalic presentation and intending spontaneous vaginal birth were randomised during second-stage labour with an epidural providing effective pain relief to either an upright or a lying-down position.

Outcome measures

Primary outcome: Incidence of spontaneous vaginal birth (SVB). Secondary outcomes: Augmentation, interventions to maintain blood pressure, duration of labour, episiotomy, genital tract trauma, post-partum haemorrhage, maternal satisfaction, neonatal metabolic acidosis, 5-minute Apgar score of <4, resuscitation at birth and admission to a neonatal unit. At 1 year, outcomes for women included urinary or faecal incontinence, dyspareunia and health-related quality of life; infant outcomes included major morbidity. A cost-consequences analysis with a 1-year time horizon from an NHS perspective.

Results

Between October 2010 and January 2014, 3236 women were randomised from 41 centres in England and Wales. There was a statistically significant difference in the incidence of SVB between groups, with 35.2% of women achieving a SVB in the upright group, compared with 41.1% in the lying-down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). There was no evidence of differences in most of the secondary maternal or neonatal outcomes, or in long-term outcomes at the 12-month follow-up. No significant overall cost differences were observed between upright and lying-down positions for mothers or their babies.

Conclusions

There is clear evidence of the benefit of adopting a lying-down position in second-stage labour in nulliparous women with epidural analgesia, with no apparent disadvantages in either short- or long-term outcomes for mother or baby, and this is cost neutral for the NHS.

Adapted from: Bick D, Briley A, Brocklehurst P, et al. A multicentre, randomised controlled trial of position during the late stages of labour in nulliparous women with an epidural: clinical effectiveness and an economic evaluation (BUMPES). Health Technology Assessment. 2017;21(65). https://doi.org/10.3310/hta21650. © Queen's Printer and Controller of HMSO 2017. Adapted for presentation on this website