Alternative Birth Positions Research Articles

Perception of Women Toward Childbirth Positions Among Women on Postnatal Unit at Jimma Medical Center, South West Ethiopia: A Phenomenological Qualitative Study

Objective: To explore the perceptions of women toward child birthing positions among women on the postnatal unit at Jimma Medical Center, Jimma town, Ethiopia, in 2020. Design: A descriptive phenomenological approach was employed among women from the postnatal unit and maternity care providers from the labor and delivery unit. Setting: Jimma Medical Center, south-west Ethiopia Participants: 40 study participants were selected purposively. 30 postnatal women were recruited for both an in-depth interview and a focus group discussion. From maternity health care providers, 10 health professionals were interviewed. Results: This study involved 30 study participants for in-depth interviews and one focus group discussion with 10 participants. Regarding the variables influencing the use of alternative birth positions in the medical facility, responses were obtained from both women and medical professionals. The women were placed in common supine positions because they were ignorant of other birth positions, because they were passive in allowing themselves to be in the position that they preferred, and because medical professionals lacked the necessary knowledge and expertise to provide alternative birth positions. Conclusion and Recommendations: The women were coerced to take birth positions against their will by healthcare providers. Thus, evidence-based alternative birth positions should be made available and implemented in order to enhance the practice of healthcare providers.

The Vertical Birthing Positions and Their Perinatal Outcomes in Hilly Tribal Home Birth Settings: A Qualitative Observational Study

This study aims to document the cultural significance of vertical birthing positions and knowledge of easing complicated deliveries among the Porja hilly tribal group, Visakhapatnam district, Andhra Pradesh, India. With the purposive sampling method, 31 postpartum mothers were selected on the inclusion criteria of having been given childbirth in the last six months. The socio-demographic profile of the respondents was presented to understand the socio-cultural living conditions. The qualitative data collection involved 31 face-to-face in-depth interviews with postpartum women and two focus group discussions involving six to eight traditional birth attendants (TBAs) on the cultural efficacy of upright positions. Handwritten transcripts of the interviews and conversations were transcribed and coded into themes and categories. Qualitative themes reveal that the pregnant women with anaemia and morbidity conditions had been exposed to maternal distress and foetal distress (breathing problems and loss of consciousness) but had managed by adopting immediate alternative vertical birthing positions with the suggestion of TBAs. The findings suggest that vertical birth positions are age-old childbirth customs which have been adopted as as a priority option by labouring women, especially in socio-economically disadvantaged societies where medical facilities are unavailable.

Alternative Birthing Positions Compared to the Conventional Position in the Second Stage of Labor: A Review.

The position in which the woman delivers has a lot of impact on the ease of delivery.Women's satisfaction with their birthing experience and the care they receive is significantly impacted by the fact that giving birth is frequently a challenging experience. Birthing positions refer to various postures which can be assumed at the time of delivery by a pregnant woman.Currently, the majority of women give birth either while lying flat on their backs or in a semi-sitting position.Upright positions, which include standing, sitting, or squatting along with side-lying and hands-and-knees, are less common birth positions. Doctors, nurses, and midwives are among the most important healthcare professionals, having a significant influence in deciding which position the woman will give birth in and on the physiological and psychological effects of the experience of a woman in labor. There isn't much research to back up the best position for mothers during the second stage of labor. This review article aims to review and compare the advantages and risks of common birthing positions and know about the knowledge of alternative birthing positions among pregnant women.

Maternal and New-Born Outcomes When Using Upright and Supine Birth Positions During Labour and Delivery: A Quasi-Experimental Study

Purpose: The purpose of the study is to assess the effects of upright and supine birth positions on maternal and new-born outcomes including maternal blood losses, duration of labor, perineum tear or intact, and APGAR score of the new-born in the first and fifth minutes in two District hospitals in Tanzania.
 Methodology: A quasi-experimental study design using a quantitative approach was conducted to assess the maternal and new-born outcomes in the in intervention study group (upright) and non-intervention group (supine). A convenient sample of 150 parturient were included, among them 73 formed an intervention group and 77 were in the non-intervention group. Data analysis was done using SPSS version 23 whereby STATA software was used to assess the effect of the independent variables (birth positions) to the dependent variables (maternal and new-born outcomes). Results were compared using chi-square test at P-value <0. 05
 Findings: Among of women who assumed upright birth position were experienced good maternal and new-born outcomes more than those in supine position. 93% and 96% of women in upright had short labour in 1st and 2nd stage respectively compered 24.68% and 44% in supine respectively (P-value <0.001). Maternal blood loss and perineum status had no significant differences in both positions while the APGAR score of the new-born in upright (p=0.018) were more advanced than those in supine group. The study revealed that, Upright birth positions provides positive effects to maternal and new-born more than supine positions. The findings of this study will help pregnant women to have choice on birthing position they feel comfortable to use during labour and delivery.
 Recommendation: The Ministry of Health should build capacity of midwives to be able to conduct labour using alternative birthing positions including upright position.

Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana

BackgroundEvidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility.MethodsWe employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study.ResultsThe findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building.ConclusionWe conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.

Midwives\u2019 experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

BackgroundIn Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices 4 months after the training workshop.MethodsThrough a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes.ResultsThe findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice.ConclusionDespite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

Exploring the perspective of nursing staff or caregivers on birthing positions in Central India.

Introduction:Maternal birthing positions refer to the various physical postures a pregnant mother may assume at the time of delivery. The World Health Organisation recommends that woman should be given an opportunity to make a choice on the type of position to use during labour. Alternative birth positions are associated with lower incidence rates of performing episiotomy, less perineal tears and less use of instrumental deliveries. Nurses' perspective on women's positions has rarely been explored in India. Present study aims at assessing the knowledge regarding alternative birth positions among nursing officers.Materials and Methods:This cross-sectional observational study was conducted on 52 nursing officers who were posted in the labour room. A pretested questionnaire was administered to them. Data analysis was done using SPSS software version 22.Results:Majority (82.7%) of nursing officers felt that there is a need of giving a choice to the woman regarding alternate birth position. 76.9% of them were aware of position other than lithotomy. Around 48.1% would recommend squatting position to a woman in labour. Ease and convenience in conducting the delivery was the foremost reason chosen in advocating a birth position. Whereas overcrowding in the labour room, ignorance about alternate positions and difficulty in converting to instrumental delivery were cited as reasons of not recommending these positions.Conclusion:Educating nursing officers about emerging evidence regarding birthing positions will enable them to give accurate information to women.

Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania

BackgroundBefore the advent of Western medicine in Tanzania, women gave birth in an upright position either by sitting, squatting or kneeling. Birthing women would hold ropes or trees as a way of gaining strength and stability in order to push the baby with sufficient force. Despite the evidence supporting the upright position as beneficial to the woman and her unborn child, healthcare facilities consistently promote the use of the supine position. The purpose of this study was to explore the perceptions and experiences of mothers and nurse-midwives regarding the use of the supine position during labour and delivery.MethodsWe used a descriptive qualitative design. We conducted seven semi-structured interviews with nurse-midwives and two focus group discussions with postnatal mothers who were purposively recruited for the study. Qualitative content analysis guided the analysis.ResultsFour themes emerged from mothers’ and midwives’ description of their experiences and perceptions of using supine position during childbirth. These were: women adopted the supine position as instructed by midwives; women experience of using alternative birthing positions; midwives commonly decide birthing positions for labouring women and supine position is the best-known birthing position.ConclusionWomen use the supine position during childbirth because they are instructed to do so by the nurse-midwives. Nurse-midwives believe that the supine position is the universally known and practised birthing position, and prefer it because it provides flexibility for them to continuously monitor the progress of labour and assist delivery most efficiently. Mothers in this study had no other choice than to labour and deliver their babies in the supine position as instructed because they trusted midwives as skilled professionals who knew what was best given the condition of the mother and her baby.

Factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital.

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.

Intact Perineum: What are the Predictive Factors in Spontaneous Vaginal Birth?

Introduction:Perineal trauma at birth is distressing for women and can cause serious short and long term morbidity.Aim:Investigate the prevalence and predictive factors of intact perineum after normal vaginal birth among Portuguese women who had spontaneous vaginal births. Methods:A descriptive, cross-sectional, retrospective study was carried out among pregnant women who had spontaneous vaginal births, between January 1, 2017, and December 31, 2017, in a single birth centre in Portugal. Following ethical approval, the prevalence of intact perineum was calculated and multivariate analysis with logistic regression was carried out, to identify the predictive factors of having an intact perineum after spontaneous vaginal birth. Results:A total of 1748 pregnant women had spontaneous vaginal births. Four hundred and forty-one women (25.2%) had intact perineum whereas in 1307 (74.8%) of women, the perineum was not intact. First-degree tears occurred in 23.2% (405/1748) of women, second-degree tears occurred in 4% (70/1748) of women while three women (0.2%) experienced a third-degree tear. The rate of episiotomies was 43.8% (766/1748). Episiotomy and first-degree tears occurred in 2.6% (45/1748), episiotomy and second-degree tears occurred in 0.7% (12/1748), while episiotomy and third-degree tears occurred in 0.3% (6/1748) of women. Having a previous caesarean section reduced the odds of intact perineum by 60%, while nulliparity reduced the odds by 70%. For every 250 grams increase in birth weight, the odds of sustaining an intact perineum were decreased by 13%. Alternative birth positions (excluding lithotomy) doubled the odds of maintaining an intact perineum. Conclusion:The prevalence of intact perineum is 25,2%. Predictive factors for intact perineum include birth weight, parity, previous caesarean section and birthing position. Recognizing these factors could support and facilitate the management of spontaneous vaginal birth to promote an intact perineum. Further research is needed to gain better understanding of this phenomenon.

The effect of maternal position at birth on perineal trauma: A systematic review

Perineal trauma is associated with short- and long-term maternal morbidity. Research has found that maternal position at birth can influence perineal trauma. However, there is a dearth of evidence examining specific maternal positions, including waterbirth, and how these can influence incidence and degree of perineal trauma. Such evidence is important to help reduce trauma rates and improve information for women and midwives. To address this gap in reliable evidence, a systematic review was conducted. Seven studies met the inclusion criteria. Compared to land birth, waterbirth was found to cause an increase in perineal trauma. Kneeling and all-fours positions were most protective of an intact perineum. Allowing for different variables, sitting, squatting and using a birth-stool caused the greatest incidence of trauma. The findings of this review demonstrate that further research is required around perineal guarding in alternative birth positions and how parity affects trauma rates with waterbirth, so that women may be advised appropriately. It also suggests findings that midwives can use when discussing alternative birth positions with women.

Need for and consequences of episiotomy in vaginal birth: a critical approach

Objective to describe and explain the short-term effects of lateral episiotomy, and determine the factors associated with more/less common use of episiotomy. Design prospective cross-sectional survey using a postal questionnaire. Setting the study was conducted at two university hospitals and one regional hospital in Finland between October and December 2006. The hospitals were chosen using cluster sampling. The sample consisted of 1000 vaginal births, and data were collected using questionnaires which were completed by midwives or student midwives. The overall response rate was 88%. Participants midwives or student midwives who took care of the women in labour provided information about childbearing women ( n=879), obstetric factors and details of staff experience. Findings episiotomies were more common among primiparous than multiparous women (55% vs 12%, p⩽0.001). More common use of episiotomy was also associated with induced births compared with spontaneous births in primiparous women (66% vs 53%, p=0.036), assisted vaginal births in all women (89% vs 25%, p⩽0.001), and a prolonged active second stage of labour and epidural analgesia (17% vs 10%, p=0.036) in multiparous women. Correspondingly, episiotomies were less common among primiparous (44% vs 57%, p=0.041) and multiparous (7% vs 16%, p=0.003) women using spontaneous pushing compared with coached pushing. In the active second stage of labour, alternative birth positions (lateral, squatting, all fours, sitting) were associated with less common use of episiotomy than half-sitting or lithotomy positions among primiparous women (22% vs 48% vs 85%, p⩽0.001). There were no differences between primiparous women with and without episiotomy in low Apgar score at 1 minute (10.6% vs 6.4%, p=0.131) or 5 minutes (1.8% vs 1.1%, p=0.557), or between multiparous women with and without episiotomy in low Apgar score at 1 minute (1.9% vs 2.2%, p=0.855) or 5 minutes (0% vs 0.5%, p=0.603). There were more first- and second-degree perineal injuries as well as injuries to the vagina, labia minora and urethra in births performed without episiotomies among primiparous women ( p⩽0.001). Correspondingly, third-degree perineal injuries were more common if episiotomy was performed in both primiparous (2.2% vs 1.6%) and multiparous women (3.7% vs 0%). The maternity hospital was the most significant determinant of the episiotomy rate (odds ratio 1 vs 1.9 vs 2.6, p=0.049). Key conclusions episiotomy rates can be reduced without causing harm to women or newborn babies. Episiotomies can be avoided if induction and vacuum assistance are used sparingly, and if spontaneous pushing techniques and alternative birth positions (lateral, sitting, squatting, all fours) are used more often during labour.

A review of alternative birthing positions.

This article reviews a number of nonevidenced-based studies that have been conducted on the different physical positions of labor and delivery. A review of the literature disclosed that the traditional supine position appeared to be associated with a prolonged second stage of labor and persistence of occiput posterior presentations. However, the supine and left lateral positions are excellent for providing anesthesia and access, although there may be a little added benefit for the parturient's comfort. The sitting, squatting, and hands-and-knees positions offer superior patient participation. The squatting position held for a long time may be physically stressful. The sitting and standing positions are known for occasional excessive hemorrhage and added expense. The hands-and-knees position offers the advantages of the gravitation effect of the upright positions and may be associated with less perineal damage. Overall, there has been no report of any harm to the infant when alternative positions are used.

A Randomized Controlled Study of Birth Center Care versus Standard Maternity Care: Effects on Women's Health

ABSTRACT: Background: The safety of birth center care for low‐risk women is an important issue, but it has not yet been studied in randomized controlled trials. Our purpose was to evaluate the effect of birth center care on women's health during pregnancy, birth, and 2 months postpartum by comparing the outcomes with those of women experiencing standard maternity care in the greater Stockholm area. Methods: Of 1860 women, 928 were randomly allocated to birth center care and 932 to standard antenatal, intrapartum, and postpartum care. Information about medical procedures and health outcomes was collected from clinical records, and a questionnaire was mailed to women 2 months after the birth. Analysis was by “intention to treat;” that is, all antenatal, intrapartum, and postpartum transfers were included in the birth center group. Results: During pregnancy, birth center women made fewer visits to midwives and doctors, experienced fewer tests, and reported fewer health problems. No statistical difference occurred in hospital admissions (4.8%) compared with the control group (4.7%). During labor, birth center women used more alternative birth positions, had longer labors, and did not differ inperineal lacerations. In both groups 1.7 percent of women developed complications, requiring more than 7 days of hospital care after the birth. During the first 2 postpartum months, about 20 percent of women in both groups saw a doctor for similar types of health problems, and no statistical difference occurred in hospital readmissions, 1.4 and 0.8 percent in the birth center and control groups, respectively, Conclusion: The results suggest that birth center care is effective in identifying signijicant maternal complications and as safe for women as standard maternity care.

Delivery on the hands and knees: A case study approach

This article uses a case study approach to describe two deliveries on the hands and knees. This alternative birthing position is suggested as a means of preserving the perineal floor at the time of delivery. Explicit instruction in the conduct of a hands and knees delivery position is offered. Both advantages and disadvantages of this birth position are outlined. The primary advantage of preserving the perineum may come at the expense of the vulvar structures. Further study is urged on the use of alternative birthing positions and their effect on the birthing process.

An experiment of squatting birth

Women throughout the ages have preferred to be delivered with their trunks vertical and most delivery positions illustrated in historical texts show birth in an upright posture with abducted thighs [1]. A consumer attitude study in our hospital showed that patients have considerable interest in alternative birth positions [2]. Squatting has been advocated to prevent caval compression [3], increase the diameter of the pelvic outlet [4] and, perhaps with least justification, to enlist the force of gravity and thereby facilitate maternal expulsive effort [5]. Despite the extensive literature advocating squatting birth, the suggested advantages of this method have not been examined in any formal, let alone unbiased study. We therefore conducted a randomised trial to examine the effect of squatting on the duration of second stage of labour, the duration of pushing, and several other variables.