- Gentle assisted pushing (GAP) and upright position does not speed the second stage of labor.
Why this matters
- The use of fundal pressure during the second stage of labor to assist vaginal birth is strongly discouraged in the United States but routinely used elsewhere.
- Little scientific evidence supports or refutes this practice.
- Women should be encouraged to use the most comfortable labor positions.
- There was no difference in time to delivery between labor positions.
- Open-label, hospital-based, randomized trial conducted between 2015 and 2017.
- Women with healthy, nulliparous, cephalic pregnancies were invited to participate.
- Participants were randomly assigned to 1 of 3 groups after 15 minutes of pushing without delivery: GAP (n=388), upright position (n=386), or routine labor positions (n=384).
- Primary outcome was defined as the mean time from randomization to birth.
- Funding: United Nations Development Programme/United Nations Population Fund/United Nations Children's Fund/WHO/World Bank Special Programme of Research; Development and Research Training in Human Reproduction at WHO.
- Continuous electronic fetal monitoring was not used routinely; this is performed in the United States and can be difficult to perform in certain positions.
- Study could not be blinded, as allocation of group could not be concealed.