www.elsevier.com/locate/midw A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia Soo Downe, BA (Hons), MSc, PhD, RM (Principal Lecturer, Director) a, *, David Gerrett, B Pharm, MSc, PhD, MRPharmS (Senior Research Fellow) b , Mary J. Renfrew, BSc, PhD, RGN SCM (Professor of Midwifery Studies, Director) c a Research in Childbearing and Health (ReaCH) Group, Midwifery Studies Research Unit, University of Central Lancashire, Preston, Lancashire, UK b Department of Health and Community Studies, University of Derby, Derbyshire UK7, UK c Mother and Infant Research Unit, University of Leeds, Yorkshire, UK Received 6 March 2001; received in revised form 10 August 2001; accepted 24 July 2003 Summary Objective: to determine whether the rate of instrumental birth in nulliparous women using epidural analgesia is affected by maternal position in the passive second stage of labour. Design: a pragmatic prospective randomised trial. Setting: consultant maternity unit in the Midlands. Participants: one hundred and seven nulliparous women using epidural analgesia and reaching the second stage of labour with no contraindications to spontaneous birth. Interventions: the lateral versus the supported sitting position during the passive second stage of labour. Measurements: mode of birth, incidence of episiotomy, and perineal suturing. Findings: recruitment was lower than anticipated (107 vs. 220 planned). Lateral position was associated with lower rates of instrumental birth rate (lateral group 33%; sitting group 52%; p ¼ 0.05, RR 0.64, CI for RR: 0.40–1.01; Number-needed-to- treat (NNT) ¼ 5), of episiotomy (45% vs. 64%; p ¼ 0.05, RR 0.66, CI for RR: 0.44–1.00, NNT ¼ 5), and of perineal suturing (78% vs. 86%; p ¼ 0.243, RR 0.75, CI for RR 0.47– 1.17). The odds ratio for instrumental birth in the sitting group was 2.2 (CI 1.00–4.6). Logistic regression of potential confounder variables was undertaken, due to a large variation in maternal weight between the randomised groups. Of the nine possible confounders tested, only position of the baby’s head at full dilation affected the risk of instrumental birth significantly (p ¼ 0.4, OR 2.7 where the fetal head was in the lateral or posterior position). Maternal weight did not appear to have any effect. The ARTICLE IN PRESS *Corresponding author. E-mail address: sdowne@uclan.ac.uk (S. Downe). 0266-6138/$ - see front matter & 2003 Elsevier Ltd. All rights reserved. doi:10.1016/S0266-6138(03)00052-4 Midwifery (2004) 20, 157–168