Juggling Instinct and Fear: An Ethnographic Study of Facilitators and Inhibitors of Physiological Birth Positioning in Two Different Birth Settings

Abstract

BACKGROUND: Although there is evidence to support the benefits for women of using a variety of birth positions, particularly upright birth positions, there is limited research into practices that facilitate or inhibit physiological birth positioning.AIM: To explore how physiological birth positioning is facilitated by midwives and experienced by women in two main settings in New South Wales (NSW), Australia (birth center and delivery ward).METHOD: An ethnographic approach guided data collection and analysis in this study. Data was collected using observation of women in the second stage of labor, focus groups with midwives, and interviews with women.RESULTS: Women were more likely to assume upright birth positions in the birth center setting (81.84%) than in the delivery ward setting (24.47%). They also instinctively wanted to lean forward during labor and birth. Midwives and women constantly “juggle instinct and fear” as they work to adapt to the birth environment, and this impacts physiological birth positioning.CONCLUSION: Women are more likely to adopt physiological birth positions during the first and second stage of labor in a birth center setting compared to a delivery ward setting. The birth center setting acts as a facilitator for physiological birth positions by providing a buffer from medicalized care.CLINICAL IMPLICATIONS: An in-depth exploration into facilitators and inhibitors of physiological birth positioning in two different birth settings provided new insights. Findings from this study have the potential to inform clinical practice through the design of birth environments and models of care that are available to women.