Who decides the position for birth? A follow-up study of a randomised controlled trial

Thies-Lagergren, Li; Hildingsson, Ingegerd; Christensson, Kyllike; Kvist, Linda J.

doi:10.1016/j.wombi.2013.06.004

Cited by 41 publications

(28 citation statements)

References 25 publications

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“…Quality in childbirth care [10] can be examined with care variables such as maternal position for birth [24], number of carers and number of vaginal examinations. All of these care indicators were lower in the MLU, showing that providing care in MLUs is one way to improve the quality of childbirth care for healthy, low risk women [2, 5].…”

Section: Discussionmentioning

confidence: 99%

“…All of these care indicators were lower in the MLU, showing that providing care in MLUs is one way to improve the quality of childbirth care for healthy, low risk women [2, 5]. Being able to choose a comfortable position may influence the birth experience for women and using a variety of birth positions indicates that birthing women have more influence and control over their births [24] and may explain why women are more satisfied with midwife-led care [1, 2, 5, 15]. A low rate of vaginal examinations could also be used as a quality of care indicator because they are often experienced as uncomfortable and do not benefit the progress of labour [25].…”

Section: Discussionmentioning

confidence: 99%

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Midwife-led maternity care in Ireland – a retrospective cohort study

Dencker

Smith

McCann

et al. 2017

BMC Pregnancy Childbirth

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Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods: MLU data for the six years 2008-2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results: During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman's wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/ forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1-2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions: Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Midwife-led maternity care in Ireland – a retrospective cohort study

Dencker

Smith

McCann

et al. 2017

BMC Pregnancy Childbirth

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“…This way, the parturient receives fewer opportunities to labour and deliver in a preferred position, assuming the recumbent one as standard because of its easier monitoring of fetal wellbeing, administration of intravenous therapy, loco-regional anaesthesia, and performance of medical procedures, perineal support, and birth assistance [2, 3]. …”

Section: Introductionmentioning

confidence: 99%

“…Conversely, because of increased risk of maternal abdominal blood vessels compression, less effectiveness of uterine contractions, less perineal muscle relaxation, high rate of analgesia request, and long labour length, recumbent position seems associated with more operative deliveries, severe pain [1, 3, 16], abnormal fetal heart trace, and greater episiotomy rate [1, 10, 11, 17, 18]. …”

Section: Introductionmentioning

confidence: 99%

Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy

Gizzo

Gangi

Noventa

et al. 2014

BioMed Research International

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Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.

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“…1,2 This is in assumption that it would be easier to monitor the fetal wellbeing and process of labor followed by the administration of analgesia if required. 2,3 In the present literature there has never been any consensus regarding the best position of labor and its agreement on the betterment of maternal-fetal outcome although the The upright position makes us unique amongst mammals. However we do not even take the advantage of the help that gravity can provide as an upright position is associated with more effective uterine contractions, better alignment of birth canal, increase pelvic outlet diameters and thereby reducing maternal and neonatal morbidity.…”

Section: Introductionmentioning

confidence: 99%

Will women’s choice of position in first stage of labor affect labor process?

Rao

Sridharan

Vasudeva

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Controlling the process of childbirth has disabled the parturient to embrace the most spontaneous position of delivery but constricting her to assume a recumbent position. Objective of this study was to study if alternating comfortable maternal positioning i.e., recumbent and alternative position have any influence in the process of labor, type of delivery, neonatal well-being. Methods: Study conducted an observation study on term pregnant women. Study inclusion criteria included all term pregnant women. Exclusion criteria included multiple pregnancies, preterm patient, severe pre-eclampsia, and eclampsia, preterm premature rupture of membranes, sever intrauterine growth restricted fetus. The measured date were maternal general characteristics, duration of labor process, type of delivery and neonatal outcome. Patients were divided into two groups. Group A -if they spent more than 50% in a recumbent position and Group B -any other alternating position. Results: A total 250 women were equally included in this study. The demographic characteristics were matched in both groups and found no significant difference. In the process of labor, Group B had a difference of 1 hours as compared to Group A and the rate of cervical dilation was also faster in Group B. Both of these variables were found to be statistically significant. However, there were no significant difference in the terms of type of delivery and neonatal outcome. Conclusions: The ancient practice of recumbent position during labor is to be discarded as alternating maternal position during the process of labor may a positive influence on the total duration labor. However even though it may or may not have an influence on the other outcome such as route of delivery and neonatal outcome, it is best to encourage women to move and deliver in the most comfortable position.

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Who decides the position for birth? A follow-up study of a randomised controlled trial

Cited by 41 publications

References 25 publications

Midwife-led maternity care in Ireland – a retrospective cohort study

Midwife-led maternity care in Ireland – a retrospective cohort study

Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy

Will women’s choice of position in first stage of labor affect labor process?

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