Abstract
BackgroundAn evidence-based practice suggests that the birth position adopted by women during labour has a significant impact on the maternal and neonatal birth outcomes. The birth positions are endorsed by guidelines of maternity care in South Africa, which documented that women in labour should be allowed to select the birth position of their choice, preferably alternative birth positions (including upright, kneeling, squatting and lateral positions) during labour. Thus, the lithotomy birth position should be avoided. However, despite available literature, midwives routinely position women in the lithotomy position during normal vertex births, which causes several adverse maternal outcomes (namely prolonged labour, postpartum haemorrhage) and adverse neonatal outcomes (such as foetal asphyxia and respiratory compromise).AimThe aim was to explore and describe factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital.SettingA public hospital in the Tshwane district, Pretoria were used in the study.MethodsThis study used the qualitative, exploratory and descriptive research design. This design gathered quality information on factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital.ResultsThe study revealed the following themes: (1) midwives’ perceptions on alternative use of birth positions and (2) barriers to utilisation of alternative birth positions. The themes were discussed and validated through the use of a literature review.ConclusionThe lack of skills and training during the midwifery undergraduate and postgraduate programme contributes to the midwives being incompetent to utilise alternative birth positions during clinical practice.
Highlights
Before colonisation in Africa, it is evident that women were giving birth in various alternative birth positions, such as sitting, upright position, squatting, kneeling, using hands and knees and the left lateral birth positions
Barriers to the utilisation of alternative birth positions in this study indicate the numerous barriers identified during clinical practice, which hinder midwives’ utilisation of alternative birth positions
Evidence is provided in this study that midwifery practice in the hospital still follows a workplace culture that routinely positions all women in the lithotomy position during labour
Summary
Before colonisation in Africa, it is evident that women were giving birth in various alternative birth positions, such as sitting, upright position, squatting, kneeling, using hands and knees and the left lateral birth positions These positions were common birth practices that usually occurred in a home setting.[1] The current literature supports an evidence-based birth position that is beneficial to women.[2] The World Health Organization[3] endorses the use of alternative birth positions which are associated with favourable maternal and childbirth outcomes. Despite available literature, midwives routinely position women in the lithotomy position during normal vertex births, which causes several adverse maternal outcomes (namely prolonged labour, postpartum haemorrhage) and adverse neonatal outcomes (such as foetal asphyxia and respiratory compromise)
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