nonsignificant trend toward shorter second-stage labor in up rigth positions s Another Cochrane review of upright versus recumbent birth positions of women with epidural analgesia involving 5 trials and 879 women found no statistically significant outcomes and many methodological inconsistencies Difficulties with some of the RCT's of second stage positions include nonblinding of both providers and participants women not remaining in assigned positions, and subjectivity of estimated blood loss estimates. 8,9 None of the published studies attempted to differentiate the effects of pushing positions versus positions for birth, which may have different consequences.