Evidence for Three Common Obstetrical Practices: A Systematic Review.

Abstract

<h4>Background</h4>Many obstetrical practices persist despite limited evidence supporting their efficacy. These practices often originate from tradition, theoretical benefit, or fear of adverse outcomes and litigation. However, emerging research calls into question the validity and safety of some common interventions. A critical reevaluation to ensure optimal patient outcomes and efficient healthcare resource utilization is therefore needed.<h4>Methods</h4>This systematic review assessed the evidence for three widely prescribed obstetrical practices: maternal oxygenation during labor for fetal resuscitation, bedrest during pregnancy, and recommendations for side-sleeping during pregnancy. A comprehensive literature search was conducted across major databases, adhering to PRISMA guidelines. Studies were screened based on predefined inclusion and exclusion criteria. Data on outcomes, risk of bias, and clinical efficacy were synthesized descriptively and quantitatively where applicable.<h4>Results</h4>A total of 79 studies met inclusion criteria: 22 on maternal oxygenation, 29 on bedrest, and 28 on sleeping position. Maternal oxygenation during labor showed no significant benefit in neonatal outcomes such as APGAR scores, NICU admissions, or mortality, and raised concerns over potential harms including oxidative stress and fetal acidemia. Bedrest during pregnancy did not reduce adverse outcomes and was associated with psychological, physical, and economic burdens. In contrast, maternal side-sleeping after 28 weeks of gestation was consistently associated with a reduced risk of stillbirth, with no significant difference between sleeping on the left or right side. These findings support public health initiatives recommending side-sleeping in late pregnancy.<h4>Conclusion</h4>This review highlights the need to critically assess longstanding obstetrical practices that lack robust evidence of benefit. Maternal oxygenation during labor and bedrest should not be routinely recommended given the absence of proven efficacy and potential risks. Maternal side-sleeping after 28 weeks of gestation is supported as a safe, effective intervention to reduce stillbirth risk. Evidence-based guidelines must continue evolving to ensure the highest standards of care in obstetrics.