A new method of positioning at delivery compared with the dorsal recumbent position: an exploratory retrospective study of obstetric outcomes.

BACKGROUND

In the last 30 years, several initiatives have aimed to reintroduce a certain freedom in positioning during labour. The objective of this study was to compare an alternative method of positioning at delivery (APOR B method) with the dorsal recumbent (supine) position.

METHODS

We undertook a comparative, retrospective study of 276 singleton deliveries at ≥ 36 weeks. The APOR B method used by two general practitioners (GPs) was compared with the dorsal recumbent position used by two other GPs with similar years of experience. We assessed obstetric outcomes with logistic regression analyses.

RESULTS

The study populations were similar except for more cases of induced labour (40% vs. 27%, P = 0.030) and earlier gestational age at delivery (mean ± SD 39.1 ± 1.4 vs. 39.4 ± 1.0 weeks of amenorrhea, P = 0.032) in the APOR B group (adjustment provided). Mode of delivery and perineal outcomes were similar, with 74% and 72% (P = 0.816) of spontaneous vaginal deliveries and 38% and 44% (P = 0.368) of intact perineums for APOR B and dorsal recumbent positions, respectively. Women in the APOR B group were less likely to have vaginal tears (15% vs. 28%, aOR 0.45, 95% CI 0.23 to 0.89). No differences were observed in the frequency of abnormal fetal heart rate, Apgar score < 7 at five minutes, dystocia, and blood loss. However, umbilical cord arterial pH < 7.20 was more frequent in the APOR B group (32% vs. 20%, aOR 2.0, 95% CI 1.1 to 3.8).

CONCLUSION

The outcomes of the two methods of positioning at delivery were mostly equivalent, except for fewer vaginal tears and lower umbilical cord arterial pH in the APOR B group. These findings will need to be further assessed in randomized controlled trials.