The Effect of Upright Positions During The First Stage of Labour on Childbirth Types: A Meta-Analysis

Objective: To assess the effect of the upright positions on childbirth types in woman who did not receive routine epidural analgesia during the first stage of labor Methods: In this meta-analysis, articles, master's theses, and PhD theses published between 1970 and 2015 in 10 databases were reviewed for keywords and inclusion criteria. The bias risks of the studies were assessed according to Cochrane Handbook for Systematic Reviews of Interventions, and the overall effect size analysis, heterogeneity tests, and sensitivity analysis were performed with the publication bias, risk ratio effect size, and random effects model. Results: The criteria for the meta-analysis were met by 13 intervention studies (n=2441). According to the random effect model, the overall effect size of vaginal birth was 1.035 (95% CI=0.961-1.115), that of instrumental vaginal birth was 0.871 (95% CI=0.591-1.285), and that of cesarean birth was 0.625 (95% CI=0.416-0.940). After sensitivity analysis, it revealed that the risk ratio for the cesarean delivery rate was statistically insignificant with 0.602 (95% CI=0.319-1.134), but effect size and the heterogeneity of cesarean delivery effect size were wider. Conclusion: In women who did not receive routine epidural analgesia at the first stage of labor, the effect of the upright position on vaginal and instrumental vaginal births was insignificant; however, the rate of cesarean delivery was less in the upright position. This study should be repeated in the clinical setting with an appropriately designed experimental framework. The methodology of the research subject should be conducted in an appropriately designed experimental work. Women should be encouraged to use the upright position while giving birth because the absence of any harm in the upright position is important in reducing the rate of cesarean birth, but the individual factors of the positions should be taken into consideration.