A review and comparison of common maternal positions during the second-stage of labor

Abstract

The second-stage of labor is the most stressful part of childbirth process and the proper maternal position during this period is paramount for women's safe vaginal birth. Midwives play a pivotal role in managing maternal positions during the second-stage of labor. However, there is limited evidence to support an ideal maternal position during the second-stage of labor. Further, the difference between different maternal positions might not be apparent. This paper aims to review and compare the benefits and risks of common maternal positions during the second-stage of labor, thereby to provide midwives evidence-based practical guidelines.

Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters

“…Pelvic mobility is one of the labor factors and permits safe childbirth: the contracted pelvis leads to obstructed labor and operative deliveries [2][3][4][5][6]9,10]. The freedom to move, the standing positions throughout labor, and giving birth in non-recumbent situations allow women to have better comfort during labor and labor to proceed physiologically [9,10]. Studies demonstrated the pelvic space diameters adaptation to patients' postures [2][3][4][5][6].…”

“…Consistent with their statement, our study shows that all the posterior pelvic diameters increase in the "hands-and-knees" position. Hemmerich and colleagues' simulating study had considered a woman's loading conditions on feet squat position without hands support, which is an unusual position for parturients to maintain for a long time [10]. They have emphasized the importance of the squat position on the feet to investigate pelvic biomechanics during the second stage of labor to prevent childbirth complications, such as obstructed labor [5].…”

“…Most obstructed labor and cephalo-pelvic disproportion are diagnosed during uterine cervix dilation in the first and active phase of labor, whilst the fetal head glides on the pelvic inlet for engaging in the pelvic midlet. Women often utilize the standing and kneeling "all-4" position during the first stage to release the uterine contraction pain and facilitate the fetal descend, but the squat positions are not recommended [10]. The anteroposterior and transverse inlet diameters need to modify to support the fetal descend favorably.…”

“…Studies and research with magnetic resonance (MR), optoelectronic devices, and 3-D reconstruction computational analysis attempted to elucidate the biomechanics and dynamics of the maternal pelvic tissue anatomy during pregnancy for safe childbirth [2][3][4][5][6][7][8]. The freedom to move and standing positions throughout labor allows women to have better comfort during labor and the labor to proceed physiologically [9,10]. Shifting positions enables women to modulate the pelvic inlet, midlet, and outlet space, influencing and assisting the fetal head's passage during the descent.…”

Perception of women toward childbirth positions among women on postnatal unit at Jimma Medical Center, Jimma town, South West Ethiopia: A Phenomenological Qualitative Study

“…The women need to have different positions during labour, and delivery like sitting, squatting, walking, standing, and lying down of reducing the labour duration; this also relieves discomfort because of reducing the need for painkillers and operative procedures to aid childbirth. Especially if seen from the angle of gravity it assists in the descent of the baby mainly when the mother assumes upright positions for childbirth (33).…”