Use of the lithotomy position for low-risk women in Perth, Australia

Abstract

In the first half of 2010, it was noted that an increasing number of low-risk women who gave birth spontaneously at term in one Western Australian maternity unit did so in the lithotomy position, which is known to carry a number of associated risks for women. A snapshot review of case notes was undertaken to try and determine the causes, consequences and decision-making surrounding this intervention. The review revealed that in 39% of cases (n = 12), no evident need to move the woman into lithotomy was documented. In 20% (n = 6) of cases, being moved into the lithotomy position was associated with the woman sustaining a perineal tear involving the anal sphincter. Discussion with the woman about moving into lithotomy was not recorded in any case. Anecdotally, it seems that some midwives may move women into the lithotomy position in a well-meaning attempt to optimize their chances of achieving a normal birth within the time limits available to them. Further investigation is needed to determine midwives’ views, practices and rationale for the use of lithotomy in low-risk women.