The effect of positioning optimisation compared with usual care on spontaneous birth in women in labour with an epidural regardless of labour onset.

Status

Not yet recruiting

Phases

Unknown

Study type

Interventional

Source

ANZCTR

Registry ID

ACTRN12626001168347

Acronym

POSE (Positioning optimisation for spontaneous birth with epidural)

Enrollment

800

Registered

2026-09-18

Start date

2026-11-02

Completion date

2028-10-31

Last updated

2026-09-18

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Epidural analgesia is a common choice for women in labour. There is no evidence about how to best manage the positioning of a woman once an epidural has been placed. When no epidural is used, evidence supports upright positioning in labour, but this is not the case for women with an epidural where the opposite is true. We aim to fill an important gap in the literature about the management of a woman’s position when using an epidural to maximise safe and spontaneous vaginal birth. We are proposing a randomised controlled trial comparing usual care with structured position changes from side to side every hour and assessing the effect on spontaneous vaginal birth, as well as other important maternal and neonatal outcomes, and maternal experiences in labour.

Interventions

Position change initiated by the midwife providing labour care Every hour (or earlier if clinically indicated) women will be moved into one of the following positions by their midwife with support whilst remaining on a bed throughout. Positions will be held for the entire hour unless the woman requests a change or a change is clinically indicated. - Right lateral (more than 45 degrees rotated towards the right side) - Left lateral (more than 45 degrees rotated towards the left side) - Supported hands and knees position with the bed angle at around 45 degrees (if leg movement allows) The midwife will record the position at each check of observations throughout the labour care and record any interval position changes as routine in the labour and birth flowsheet.

Study design

Allocation

Randomised controlled trial

Intervention model

Parallel

Primary purpose

Treatment

Masking

Open (masking not used)

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

All women with a singleton, cephalic, term (=/> 37 weeks) pregnancy using epidural analgesia in the first stage of labour (regardless of labour onset – spontaneous or induced).

Exclusion criteria

Women where the epidural block was inserted in second stage of labour Intrauterine fetal demise. Age <18 years Inability to provide informed consent Multiple pregnancy Preterm gestation at labour. <37 completed weeks of gestation

Outcome results