Upright kneeling position during second stage of labor: a pilot study

Abstract

INTRODUCTIONThere is no ideal position for labour and delivery, the standard recommendation is to encourage and support the parturient to deliver in the position she feels most comfortable in.1,2 Although international guidelines advice against being recumbent or supine for long periods of time during labour, women are motivated to deliver in the supine position at most delivery centres in India. Women delivering in the supine position experience comparatively painful prolonged labors with increased incidence of foetal distress due to more aortocaval compression by the gravid uterus.1-5 However, supine position in the second stage of labour is favoured by most obstetricians as they are trained to take delivery in this position. It allows them to monitor the labour process better with ease of providing anaesthesia, enables them to give proper perineal support in the second stage of labour, and conduct operative vaginal deliveries.Upright labour positions have several physiological advantages over the supine position. Historically women were instinctively adopting upright positions for delivery as they experienced stronger, more efficient and less ABSTRACT Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients' satisfaction. Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2 nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction. Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2 nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position. Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis

“…All the included studies were conducted in health facilities. Among the 8 included studies, two studies compare squatting position Vs supine [16, 17], two studies compare sitting position Vs supine, [18, 19], one compare keeling Vs supine [20], two studies compare flexible sacral position Vs supine [21, 22] and one study compare ambulation and birthing ball with supine position. Two studies allowed laboring women for free choice of birthing position [21, 22].…”

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

“…However, a few studies which were done outside India had a sample size ranging from 20 to 30 amongst midwives who met the inclusion criteria. [ 8 ] At the time of this study, about 70 staff nurses were working in the labour room of Government Institutes of Nagpur amongst which 52 were approached for the study on the basis of convenience sampling. The data collected was entered in a spread sheet and analysis was done using Statistical Package for Social Sciences (SPSS) software version 22.…”

“…[ 6 ] Alternative birth positions are associated with lower incidence rates of performing episiotomy, less perineal tears and less use of instrumental deliveries. [ 7 8 ]…”

Effect of maternal birth positions on duration of second stage of labor: Systematic review and meta-analysis

“…All the included studies were conducted in health facilities. Among the 8 included studies, two studies compare squatting position Vs supine (21,22), two studies compare sitting position Vs supine, (23,24) one compare keeling Vs supine (25), two studies compare flexible sacral position Vs supine (26,27) and one study compare ambulation and birthing ball with supine position. Two studies allowed laboring women for free choice of birthing position (26,27).…”