Effects of Lateral Positions in Second-Stage Labour on Maternal and Neonatal Outcomes: An Observational Study Using Propensity Score Matching Analysis.
Jing Huang, Hong Lu, Jianying Wang and 6 others
PMID 41638641WHAT IT FOUND
Lateral positions during second-stage labour reduced episiotomy rates in first-time mothers but increased blood loss at two hours postpartum.
For mothers who had given birth before, lateral positions showed no significant benefit or harm compared to lithotomy positions.
Key findings
01Among primiparous women, lateral positions significantly reduced episiotomy use (ATE: -21.49%, p=0.003) and the risk of moderate perineal tears (ATT: -14.51%, p=0.022).
02Lateral positions were associated with significantly greater blood loss at 2 hours postpartum in both primiparous (ATE: 73.09 mL) and parous women (ATE: 80.74 mL), though the proportion exceeding 500 mL did not differ.
03Among primiparous women who actually adopted lateral positions, the second stage of labour was significantly longer by 10.39 minutes (p=0.008).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Observational design means causality cannot be established; position choice was not randomised. Propensity score matching only controls for observed covariates, leaving potential bias from unmeasured factors like midwife preference. The study was powered for perineal tears, not rare outcomes like severe tears or low Apgar scores, so safety regarding these cannot be confirmed. No cases of severe perineal tears or Apgar scores <7 were observed, preventing analysis of these critical safety outcomes. Results may not generalise to settings with different staffing levels or cultural attitudes towards birth positions.
Declared interests
The authors declare no conflicts of interest. The study received institutional approval but no specific external funding source is detailed beyond standard institutional support.
The easy way to misread this
Do not interpret the reduced episiotomy rate as proof that lateral positions are universally safe or beneficial for all women. The study found increased blood loss in both primiparous and parous women, and a longer second stage for primiparous women. Additionally, no severe perineal tears or low Apgar scores occurred, so the study cannot confirm safety for these rare but serious outcomes.