Dans quelle position les femmes accouchent-elles en 2015 ? Résultats d’une étude prospective régionale multicentrique

Objective

To assess the frequency of labor and birth positions in 2015, and identify factors associated with choosing and changing position during labor.

Methods

Multicenter prospective study during five weeks in 2015. We collected the distribution of the observed positions during the first and second stage of labor. Then we considered the main birth position as the one used for the longest duration. Factors associated to the main birth position as well as to the changes of position during labor were studied using univariate analysis and the role of each factor was analyzed using multilevel logistic regression.

Results

Among women who delivered, 86.1% did so in gynecological position. There was a center effect for the position during the expulsive phase, which was not related to legal status or level of perinatal care. After adjustment, a labor duration shorter than 2 hours was associated to dorsal decubitus during labor (OR = 2.1 95%CI [1.01–4.3]). Prematurity and labor duration less than 2 hours decreased the occurrence of changes in position during labor: OR = 0.05 95%CI [0.01–0.2] and OR = 0.2 95%CI [0.1–0.3]. Epidural analgesia was associated to change in birth position during labor: (OR = 2.1 95%CI [1.2–3.8]). During the expulsive phase, primiparity and labor duration less than 2 hours were associated to dorsal decubitus position (OR = 3.6 95%CI [1.2–10.8]).

Conclusion

Women still mostly deliver in gynecological position in 2015. A systematic collection of birth positions on the partograph, with an acute definition of these positions, could allow an evaluation of the benefits/disadvantages of the different positions currently available.