What do systematic reviews say?

Any upright vs supine

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  no estimate extracted
  19 studies · 5811 participants
  Very low

Any upright vs supine

Any upright probably leads to lower mode of birth: assisted birth compared with supine position (moderate certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 0.75 [0.66, 0.86]
  21 studies · 6481 participants
  Moderate

Any upright vs supine

Any upright showed no clear difference in mode of birth: caesarean section compared with supine position (low certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 1.22 [0.81, 1.81]
  16 studies · 5439 participants
  Low

Any upright vs supine

Any upright showed no clear difference in trauma to the birth canal that required suturing: second degree… compared with supine position (low certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 1.2 [1, 1.44]
  18 studies · 6715 participants
  Low

Any upright vs supine

It is very uncertain whether any upright changes trauma to the birth canal that required suturing: third/fourth… compared with supine position (very low certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 0.72 [0.32, 1.65]
  6 studies · 1840 participants
  Very low

Any upright vs supine

Any upright probably leads to higher blood loss > 500 mL compared with supine position (moderate certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 1.48 [1.1, 1.98]
  15 studies · 5615 participants
  Moderate

Any upright vs supine

Any upright showed no clear difference in admission to neonatal intensive care unit compared with supine position (low certainty).

• Position in the second stage of labour for women without epidural anaesthesia 2017 · Cochrane Headline outcomes only
  RR 0.79 [0.51, 1.21]
  4 studies · 2565 participants
  Low

Remifentanil (PCA) vs epidural/CSE

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  no estimate extracted
  7 studies · 2135 participants
  Very low

Remifentanil (PCA) vs epidural/CSE

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 235 participants
  Low

Remifentanil (PCA) vs epidural/CSE

Remifentanil (PCA) probably leads to higher additional analgesia required compared with epidural/CSE (moderate certainty).

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  RR 9.27 [3.73, 23.03]
  6 studies · 1037 participants
  Moderate

Remifentanil (PCA) vs epidural/CSE

Remifentanil (PCA) showed no clear difference in rate of caesarean delivery compared with epidural/CSE (moderate certainty).

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  RR 1 [0.82, 1.22]
  9 studies · 1578 participants
  Moderate

Remifentanil (PCA) vs epidural/CSE

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 38 participants
  Very low

Remifentanil (PCA) vs epidural/CSE

Remifentanil (PCA) showed no clear difference in maternal respiratory depression (< 9, < 8 breaths/min) compared with epidural/CSE (low certainty).

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  RR 0.91 [0.51, 1.62]
  3 studies · 687 participants
  Low

Remifentanil (PCA) vs epidural/CSE

Remifentanil (PCA) showed no clear difference in apgar score ≤ 7 (< 7) at 5 min compared with epidural/CSE (low certainty).

• Patient‐controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour 2017 · Cochrane Headline outcomes only
  RR 1.26 [0.62, 2.57]
  5 studies · 1322 participants
  Low