Up to 30% of women in the UK each year choose an epidural during labour, but this pain relief also raises the risk of forceps, vacuum, or caesarean deliveries. This trial tests whether a simple change—giving birth sitting up rather than lying down—can lower that risk for women who have an epidural. Previous studies showed that upright positions reduce the need for assisted delivery, but those studies excluded women with epidurals. Because an epidural can weaken the urge to push and limit movement, it is unclear whether the same benefit applies. The BUMPES trial will randomly assign half of its participants to give birth upright and half lying down, directly answering that question. If upright positioning proves effective, it could reduce the roughly 40% rate of instrumental delivery seen in large obstetric centres. Fewer forceps or vacuum deliveries would mean less perineal trauma, fewer surgical repairs, and lower rates of long-term problems such as incontinence and pain during intercourse. For the roughly 30% of women who choose an epidural, this is a low-cost, low-risk intervention that could improve both physical and psychological recovery after birth.
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As the most effective form of pain relief in labour, epidural analgesia (an injection into the spine) is chosen by up to 30% of women in the UK each year. Its uptake is greater in women having their first baby, and the rate of uptake is up to 40% in large obstetric centres. Despite high maternal satisfaction with pain relief, epidurals do have unwanted side effects. For example, a systematic review of epidural versus non-epidural or no analgesia in labour found that epidural pain relief was associated with an increased risk of instrumental vaginal delivery (IVD) such as births where forceps or where a vacuum pump is used, or a C-section. If the rate of IVD could be reduced this would have a beneficial effect for both women and their babies. IVD is associated with increased risks of perineal trauma (the area between the vagina and the anus) and the consequent effects of surgical repair. Other problems that are associated with IVD include urinary and faecal incontinence, pain during intercourse and other problems with general physical and psychological health. A review of position in the part of labour where the cervix is fully open (known as the second stage of labour) has shown that women who gave birth in an upright position, such as sitting up in bed or standing, when compared to those who were lying down there was a reduced incidence in IVD in the upright group. However this study was undertaken in women who did not have an epidural in place. This trial aims to study if position has the same effect in reducing the incidence of IVD occurs in women that have an epidural in place. The trial will randomise 50% of participants to give birth in an 'upright' position, and the other 50% to give birth 'lying down'.
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