Childbirth usually occurs in three stages: from the onset of true labor until the cervix is completely dilated (stage one), the birth of the baby (stage two), and the delivery of the placenta (stage three). The majority of women in the developed world spend most of stage one, the longest phase of labor, in bed. This Cochrane review sought to determine the effect of an upright position, such as walking, sitting, or standing, compared with a recumbent position on length of labor, type of delivery, and maternal and child outcomes.

The authors reviewed 21 international trials in which a total of 3,706 women were randomized to either an upright or recumbent position during first-stage labor. Both groups used opioids to a similar degree, but the upright group was less likely than the recumbent group to have epidurals. In addition, compared with recumbent women, those in an upright position had a one-hour shorter first-stage labor. There was not enough data to conclude that an upright position during labor had an effect on outcomes for mothers and infants.

The crux of the matter. First-stage labor was approximately one-hour shorter in women who remained upright. Kneeling, walking, or sitting are considered safe early-stage labor positions and are recommended to avoid prolonging labor. Of course, laboring women should be encouraged to take the position they find most comfortable.