Left Lateral Position vs Supine Position to Reduce Active Labor Duration

Official title

Left Lateral Position Versus Supine Position in Reducing the Duration of the Active Phase of Labor: A Randomized, Single-Blind Clinical Trial

Overview

This randomized clinical trial aims to compare the effect of the left lateral decubitus position versus the supine position on the duration of the active phase of labor in nulliparous women. A total of 188 participants will be randomly assigned to one of two groups. The intervention group will be placed in the left lateral decubitus position, while the control group will remain in the supine position. Both positions will be maintained for 30-minute intervals with 5-minute rest periods, continuing until delivery. The primary outcome is the duration of the active phase of labor. Secondary outcomes include rates of cesarean section, use of oxytocin and analgesics, and maternal and neonatal complications.

Detailed description

Globally, maternal positioning during labor is a key component of humanized childbirth. While the World Health Organization recommends allowing women to adopt comfortable positions, the supine position remains prevalent in many clinical settings for practitioner convenience. This study in Honduras seeks to generate local evidence on the impact of maternal position on labor progression. Nulliparous women at term (≥37 weeks) with a singleton pregnancy in cephalic presentation and in the active phase of labor (≥6 cm dilation) will be recruited from the labor and delivery unit of the Hospital Materno Infantil. After providing informed consent, participants will be randomized. The primary efficacy endpoint is the time from the onset of the active phase (or intervention start, if later) until delivery. The study hypothesizes that the left lateral position will significantly reduce active labor duration compared to the supine position, potentially reducing unnecessary surgical interventions and improving the childbirth experience.

Interventions

• Other Left Lateral Decubitus Group
  Participants will be placed in the left lateral decubitus position for periods of 30 minutes, interspersed with 5-minute rest periods. This cycle will continue throughout the active phase of labor until delivery.
• Other Supine Position Group
  Participants will remain in the supine position for periods of 30 minutes, interspersed with 5-minute rest periods. This cycle will continue throughout the active phase of labor until delivery.

Primary outcome measures

• Duration of the active phase of labor. [Time frame: Time (in minutes) from the diagnosis of the active phase of labor (cervical dilation ≥6 cm) to delivery of the newborn. Within the first 24 hours after diagnosis of active phase.]

Secondary outcome measures (4)

• Incidence of Cesarean Delivery [Time frame: From randomization until delivery (anticipated within 48 hours per participant).]
• Use of Oxytocin for labor augmentation/conduction. [Time frame: From randomization until delivery.]
• Incidence of maternal complications (e.g., perineal tears, hemorrhage, hypotension). [Time frame: From randomization until hospital discharge (approximately 24-48 hours postpartum).]
• Neonatal status as measured by Apgar score. [Time frame: At 1 minute and 5 minutes after birth.]

Eligibility criteria

Inclusion criteria

• Signed and dated informed consent form.
• Nulliparous woman.
• Singleton pregnancy at ≥37 weeks of gestation.
• Intact amniotic membranes.
• Cephalic presentation.
• In the active phase of labor (cervical dilation ≥6 cm).
• Age ≥18 years.
• No contraindication for vaginal delivery.
• Possession of a mobile phone (for potential follow-up contact).

Exclusion criteria

• Previous uterine surgery.
• Maternal condition preventing vaginal delivery.
• Fetal anomaly.
• Premature rupture of membranes.
• Multiple pregnancy.
• Fetal demise.
• Uterine myomas.
• Maternal comorbidities (e.g., chronic hypertension, diabetes mellitus type -1/2/gestational, hypothyroidism).
• Anemia.
• Age <18 years.
• Preterm gestation (<37 weeks).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Honduras · 1 center

• Hospital Escuela — Tegucigalpa

Publications

• Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012 May 16;(5):CD002006. doi: 10.1002/14651858.CD002006.pub3. PMID 22592681

Identifiers

NCT: NCT07411352 · PGO-UNAH-49-1-2026

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗