A Two-Delivery Model Examining Upright Positioning During Labor: A Cost-Effectiveness Analysis [34C]

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Studies have demonstrated the benefits of an upright and mobile position during labor, including lower risk for cesarean delivery and shortened time in labor. We sought to examine the cost-effectiveness and outcomes associated with laboring upright during the first delivery and the resultant effects on the second delivery, such that the risks, benefits, and costs are framed within the public health perspective of the average US childbearing woman’s entire reproductive course.


A cost-effectiveness model using TreeAge software was designed using a theoretical cohort of 1.8 million women, the approximate number of nulliparous term births in the US annually, including uncomplicated deliveries with a trial of labor and with all women having a second delivery, reflecting the average number of births per woman in the US. Outcomes included mode of delivery, maternal death, uterine rupture and hysterectomy, in addition to cost and quality-adjusted life years (QALY) for both pregnancies. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000/QALY.


We found that allowing women to be upright and mobile during her first labor resulted in fewer cesarean deliveries, reduced costs and improved QALYs for both the first and subsequent delivery. In our theoretical cohort, laboring upright led to 64,890 fewer cesarean deliveries, 15 fewer maternal deaths, 113 fewer uterine ruptures, and 30 fewer hysterectomies, saving $785 million with 7,227 increased QALYs.


Laboring upright is a no-cost intervention that leads to improved outcomes, decreased costs, and increased QALYs during a woman’s first and second delivery.

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