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Thilagavathy Ganapathy
Professor, HOD, Dept. OBG Nursing, The Oxford College of Nursing, The Oxford Educational Institution,
6/9, I Cross, Hongasandra, Begur, Bangalore-68
ABSTRACT
Objective: To compare the effects of supported sitting versus the supine- lithotomy maternal birthing
position in healthy primigravidae on the obstetrical , perinatal outcome and maternal birthing
experiences.
Design: Two groups randomized interventional design.
Setting: Municipal Maternity Corporation Hospital, Bangalore, Karnataka.
Methods: Healthy primigravidae [n=200] randomly allocated to supported sitting [n =100] & supinelithotomy[n =100] maternal birthing position during the second stage of labor. Analysis was performed
by SPSS version-15, relevant descriptive and inferential statistics computed for data presentation.
Main outcome measure: Duration of second stage third stage, rate of instrumental delivery, intensity
of intrapartal pain, FHR pattern, APGAR scores of the newborn, amount of blood loss and maternal
birthing experiences.
Results: Supported sitting position during second stage of labor was associated with a shorter
duration of second , third stage of labor, fewer reports of excruciating intrapartal pain, fewer rates
of instrumental delivery, irregular FHR pattern, higher APGAR scores, minimal blood loss and
favorable maternal birthing experiences.
Conclusion: In healthy primigravidae supported sitting position was associated with benecial
obstetrical, perinatal outcome and favorable maternal birthing experiences.
Key words: Supported Sitting, Supine- Lithotomy, Obstetrical and Perinatal Outcome.
INTRODUCTION
The appropriateness of maternal birthing position
in healthy primigravidae during the second stage of
labor has been a controversy and debated while the
evidence on which to have recommendations remain
inconclusive. Most previous studies evaluating the
effects of upright maternal birthing position versus
the supine- lithotomy position during labor suggest
the advantages of upright position in terms of shorter
duration of labor, less intrapartal pain, increased
pelvic diameters, more efcient uterine contractions,
Correspondence Address :
Thilagavathy G,
Professor, HOD, Dept. OBG Nursing,
The Oxford College of Nursing,
The Oxford Educational Institution,
6/9, I Cross, Hongasandra,
Begur, Bangalore-68.
M= 9900795255
Email: thilkg@gmail.com
88
Mean + SD
Supported Sitting
Supine-Lithotomy
21.4 + 2.02
21.3 + 1.94
Gestational Weeks
40 + 1.07
40+1 + 1.14
62 + 4.97
63 + 5.42
Maternal Hb {gm%}
10.7 + 0.43
10.6 + 0.41
Newborn Weight{Kgs}
2.920 + 0.24
2.930 + 0.25
Maternal Weight{Kgs}
Supported
Sitting
Supine
-Lithotomy
t[198] value
Efficient Uterine
contraction
92
92
75
75
21.052**
Drop in Baseline
Blood pressure
17
17
4.989**
Intensity of labor
pain
16
16
58
58
10.390**
{Score >90mm in
VAS}
93
93
87
87
4.320**
Regular
pattern
FHR
100
100
72
72
14.403**
100
100
51
51
23.872**
42
42
4.255**
Assisted Vaginal
Delivery--
74
74
51
51
3.450**
{Forceps/Vacuum/ }
84
84
71
71
3.240**
Apgar Sore 9 at 1
minute.
75
75
74
74
1.649NS;p>0.001
Apgar Sore 10 at 5
minutes.
Estimated Blood
Loss {300-500
Supine- Lithotomy
0.090** NS
0.165**NS
0.335 **NS
Neonatal Weight
3.050**NS
3.470** NS
Use of Oxytocin
0.661** NS
0.548** NS
Use of Analgesics
0.717 ** NS
0.837 ** NS
NS = Not signicant
90
in supine hypotension.
In supported sitting position group there were a
fewer reports of excruciating intrapartal labor pain
as compared to supine lithotomy position group.
There was statistically a signicant reduction in the
labor pain scores by 12mm in VAS-100mm in the
supported sitting position group, which is consistent
with the ndings of Adachi 6 who evaluated the effects
of upright versus supine lithotomy position among
low risk term primigravidae, that the upright posture
during labor resulted in signicant reduction of labor
pain intensity by 13mm in VAS.
The present study revealed a signicant reduction in
the rate of instrumental delivery among the supported
sitting position group participants as compared to
supine lithotomy, which could be presumed to be due
to increased pelvic diameters and spontaneous bearing
down efforts in the upright birthing position. Similar
ndings were reported by Dejonge 3 that the use of
upright maternal position during labor signicantly
reduces the rate of instrumental delivery.
Supported sitting position was associated with a
benecial fetal and neonatal physiological parameters
in terms of fewer irregular FHR pattern and higher
Apgar scores of the newborns as compared to supine
lithotomy position. Similar ndings were reported
by Cito 7 who evaluated the effects of upright versus
supine lithotomy position on the FHR pattern among
low risk term primigravidae, that the supine lithotomy
position during labor was associated with a greater
number of variable deceleration of FHR pattern than
the upright maternal posture.
There were insignicant difference in the estimated
average amount of blood loss between the two groups[
340 Vs 330ml] which is consistent with the ndings of
Terry RR 8{2006} and Bodner A 9 {2003}. This indicates
that the upright supported sitting position is a safe
alternative maternal birthing position in terms of blood
loss during labor.
A supported sitting maternal birthing position was
associated with a more favorable maternal birthing
experiences in terms of fewer reports of excruciating
intrapartal labor pain, greater level of comfort, more
ease in pushing , greater perception of their active
participation during pushing, more perceived feelings
of being safe and greater degree of satisfaction. This
may be explained by the supported sitting position
being more exible when it comes to moving the
lower back, diverting some of the pressure to lower
spine may result in lower level of pain and greater
level of comfort . Consistent ndings were reported by
Mayberry 10 who compared womens preferences for
upright versus supine posture during labor, without
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