Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Lai KC, Shiu WY, Chan KY, Leung SK, Wan OM
Affiliation :
Department of Obstetrics & Gynaecology, United Christian Hospital
Introduction :
There is substantial evidence that has several advantages to the upright positions in the first stage of labour, including effects of gravity, increased intensity of uterine contractions, reduced instrumental delivery and caesarean section incidence, and reduced duration of labour, thus enhanced overall labour experience.
Objectives :
To assess the effects of the active first stage of labour in upright and ambulatory positions compared with semi-recumbent positions on various birth outcomes, including duration of first stage of labour, mode of delivery, pain level, and satisfaction of nulliparous women.
Methodology :
A quasi-experimental controlled trial was conducted from December 2022 to September 2023 in the delivery ward of United Christian Hospital. Seventy women were recruited and assigned to either the intervention group (n=35), which involves maintaining an upright posture through the use of standing, sitting, kneeling, squatting, or walking positions; or the control group (n=35), which remained in semi-recumbent position. The intervention group was recommended to maintain the upright posture for 30 minutes, followed by 30 minutes of bed rest every hour till the end of the first stage of labour. Pain intensity was evaluated using a 10-point numerical rating scale prior to intervention, every hour afterward, until the end of the first stage of labour. A 5-point Likert scale is used to evaluate the overall satisfactory level.
Result & Outcome :
The intervention group had a significantly shorter duration of the first stage of labour (P<0.05), with a mean difference of -1.37 hours and a 95% confidence interval range of -2.42 to -0.32, compared to the control group. 80% of women had a vaginal birth in upright and bedridden positions, while only 68.6% of women delivered vaginally in semi-recumbent positions. The rates of instrumental birth and caesarean section were 11.4% and 8.6% in the upright and ambulatory positions, respectively, while those in the semi-recumbent position rose to 17.1% and 14.3%. Women in upright postures had significantly lower pain levels than the control group at all time points, with a significant decrease in pain reports at the 1st and 5th hours (p<0.05 and p<0.01, respectively). Additionally, 77% of women were satisfied with upright posture and mobility, compared to 12% with the semi-recumbent position.
In clinical practice, upright and ambulant positions should be encouraged during the first stage of labour, as they improve labour progression, thereby improving labour outcomes.
