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Pregnant woman

The 2018 BMJ research paper of the year award was won by the BUMPES trial conducted by The Epidural and Position Trial Collaborative Group. Professor Peter Brocklehurst, the Chief Investigator, was at the NPEU when the trial was designed and NPEU staff were involved in the design, conduct and statistical and economic analysis.

The trial investigated whether lying down or being upright during the second stage of labour made a difference to the need for a caesarean section or the use of instruments (forceps and ventouse) during vaginal delivery for women having their first baby with a low-dose epidural.

In the UK approximately 30% of women choose epidural analgesia, a procedure which prolongs the second stage of labour and increases the risk of instrumental vaginal delivery. UK clinical guidelines recommend that women with an epidural are encouraged to adopt whatever upright position they find comfortable.

The BUMPES trial involved randomising over 3,000 women in 41 maternity units in the UK. Women who received an epidural were randomly allocated to two groups: either an upright or lying down position in the second stage of labour. Recognising that women in each group might choose to change position, the researchers regularly recorded the position the women were in for the majority of the time. The primary outcome for the trial was spontaneous vaginal birth and a statistically significant and clinically important difference was found between the groups. 35.2% (548/1,556) of women in the upright group gave birth vaginally without the use of instruments compared with 41.1% (632/1,537) in the lying down group.

The results clearly show that for women having their first baby with epidural analgesia, lying down during the second stage of labour increases the chances of a spontaneous vaginal birth. No complications were apparent for mother or baby up to one year after the birth. This evidence will allow pregnant women, in consultation with their healthcare providers, to make informed choices about their position in the second stage of labour.