Ayres-de-Campos D, Spong CY, Chandraharan E FIGO consensus guidelines on intrapartum fetal monitoring: cardiotocography. Int J Gynaecol Obstet.. 2015; 131:(1)13-24

Baldwin A, Harvey C, Willis E, Ferguson B, Capper T Transitioning across professional boundaries in midwifery models of care: a literature review. Women Birth.. 2019; 32:(3)195-203

Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis. BMC Pregnancy Childbirth.. 2019; 19:(1)

Braun V, Clarke V Thematic analysis: a practical guide. 2021;

Desseauve D, Fradet L, Lacouture P, Pierre F Position for labor and birth: state of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol.. 2017; 208:46-54

Diorgu FC, Steen MP, Keeling JJ, Mason-Whitehead E Mothers and midwives perceptions of birthing position and perineal trauma: an exploratory study. Women Birth.. 2016; 29:(6)518-523

Elmir R, Schmied V, Wilkes L, Jackson D Women's perceptions and experiences of a traumatic birth: a meta-ethnography. J Adv Nurs.. 2010; 66:(10)2142-2153

Enteshari Z, Yamani N, Omid A Assessment of knowledge and skills training needs among employed midwives in health and medical centers, compared to expected duties as a part of Health System Reform Program, 2019. J Educ Health Prom.. 2020; 9:(1)

Gaffka K The effect of alternative labor positions versus the lithotomy position on birthing outcomes: an integrative literature review. 2016;

Garbelli L, Lira V Maternal positions during labour: midwives’ knowledge and educational needs in Northern Italy. Eur J Midwifery. 2021; 5:(May)1-9

Gimovsky AC, Berghella V Evidence-based labor management: second stage of labor (part 4). Am J Obstet Gynecol.. 2022; 4:(2)

Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BioMed Res Int.. 2014; 2014:1-7

Gupta JK, Sood A, Hofmeyr GJ, Vogel JP Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev.. 2017; 2017:(5)

Hollins Martin CJ, Martin CR A narrative review of maternal physical activity during labour and its effects upon length of first stage. Complement Ther Clin Pract.. 2013; 19:(1)44-49

Huang J, Zang Y, Ren LH, Li FJ, Lu H A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci.. 2019; 6:(4)460-467

International Confederation of Midwives. Midwifery: an autonomous profession. 2017.

International Confederation of Midwives. Essential competencies for midwifery practice. 2019.

Joanna Briggs Institute. Checklist for systematic reviews and research synthesis. 2017.

Kibuka M, Price A, Onakpoya I, Tierney S, Clarke M Evaluating the effects of maternal positions in childbirth: an overview of Cochrane Systematic Reviews. Eur J Midwifery. 2021; 5:(December)1-14

Kopas ML A review of evidence-based practices for management of the second stage of labor. J Midwifery Womens Health.. 2014; 59:(3)264-276

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev.. 2009;

Lund H, Juhl CB, N0rgaard B Evidence-based research series-paper 3: using an evidence-based research approach to place your results into context after the study is performed to ensure usefulness of the conclusion. J Clin Epidemiol. 2021; 129:167-171

McCauley H, McCauley M, Paul G ‘We are just obsessed with risk’: healthcare providers’ views on choice of place of birth for women. Br J Midwifery.. 2019; 27:(10)633-641

McKenna L Translation of research interviews: do we have a problem with qualitative rigor?. Nurse Author Ed.. 2022; 32:(1)1-3

Modrzejewska E, Torbe D, Torbe A The evolution of maternal birthing positions. J Educ Health Sport.. 2019; 9:(8)807-810

Mselle LT, Eustace L Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. BMC Pregnancy Childbirth.. 2020; 20:(1)

Musie MR, Peu MD, Bhana-Pema V Factors hindering midwives’ utilisation of alternative birth positions during labour in a selected public hospital. Afr J Prim Health Care Fam Med.. 2019; 11:(1)e1-e8

Newton MS, McLachlan HL, Forster DA, Willis KF Understanding the ‘work’ of caseload midwives: a mixed-methods exploration of two caseload midwifery models in Victoria, Australia. Women Birth.. 2016; 29:(3)223-233

Nieuwenhuijze MJ, Low LK, Korstjens I, Lagro-Janssen T The role of maternity care providers in promoting shared decision making regarding birthing positions during the second stage of labor. J Midwifery Womens Health.. 2014; 59:(3)277-285

Nursing Board for Brunei. Code of professional conduct. 2010.

Nursing Board for Brunei. Core competency standards for registered nurses and midwives in Brunei Darussalam. 2013.

Page MJ, McKenzie JE, Bossuyt PM The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ.. 2021; 372:(71)

Patino CM, Ferreira JC Inclusion and exclusion criteria in research studies: definitions and why they matter. J Bras Pneumol.. 2018; 44:(2)84-84

Paul J, Barari M Meta-analysis and traditional systematic literature reviews - what, why, when, where, and how? Psychol Marketing. 2022; 39:(6)1099-1115

Rethlefsen ML, Kirtley S, Waffenschmidt S PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev.. 2021; 10:(1)

Sandall J The contribution of continuity of midwifery care to high quality maternity care. 2017;

Souza MT, Silva MD, Carvalho R Integrative review: what is it? How to do it? Einstein (Sao Paulo). 2010; 8:(1)102-106

Tura MR, Fage SG, Birhanu A, Kolola T, Zerihun E, Mideksa L Perceptions toward the nursing profession among Ethiopian nurses: a mixed-method study. Clin Epidemiol Glob Health.. 2022; 15

Ubbink DT, Guyatt GH, Vermeulen H Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open.. 2013; 3:(1)

United Nations. Women's autonomy, equality and reproductive health in international human rights: between recognition, backlash and regressive trends. 2017.

Weckend M, Davison C, Bayes S Physiological plateaus during normal labor and birth: a scoping review of contemporary concepts and definitions. Birth.. 2022; 49:(2)310-328

Westbury B Mobility and upright positioning in labour. Pract Midwife.. 2014; 17:(4)24-26

Whittemore R, Knafl K The integrative review: updated methodology. J Adv Nurs.. 2005; 52:(5)546-553

World Health Organization. WHO recommendation on birth position (for women with epidural analgesia). 2021a.

World Health Organization. New report sounds the alarm on global shortage of 900 000 midwives. 2021b.

World Health Organization. Nursing and midwifery. 2022.

Zang Y, Lu H, Zhang H, Zhang X, Yang M, Huang J Chinese midwives’ perceptions on upright positions during the second stage of labour: a qualitative study. Midwifery.. 2021; 98

Zdçba-Mozola A, Rybarczyk-Szwajkowska A, Czapla T, Marczak M, Kozlowski R Implementation of lean management in a multi-specialist hospital in Poland and the analysis of waste. Int J Environ Res Public Health.. 2022; 19:(2)

Zileni BD, Glover P, Jones M, Teoh KK, Zileni CW, Muller A Malawi women's knowledge and use of labour and birthing positions: a cross-sectional descriptive survey. Women Birth.. 2017; 30:(1)e1-e8

Midwives’ practice of maternal positions throughout active second stage labour: an integrative review

02 August 2023
Volume 31 · Issue 8



Extensive research focuses on the advantages and disadvantages of various positions throughout active second stage labour, but there is limited focus on midwives’ practice. This study aimed to explore midwives’ practice of maternal positions throughout the active phase of second stage labour.


An integrative review of three databases was carried out for research papers published between 2015 and 2022. Thematic analysis was used for data analysis and synthesis.


Five eligible research papers were included. There were four key findings: maternal positions practised by midwives, midwives as the prime decision maker, midwives’ personal convenience and comfort, and barriers to practising maternal positions.


Midwives were seen as prime decision makers, who hindered informed decision making on maternal positions during active second stage labour. Inadequate knowledge, skills and confidence were barriers to practice and attributed to midwives adopting positions that were convenient and comfortable for themselves. Strategies are needed to enhance practice through review and evaluation of current clinical settings, regular updates to evidence-based practice and refreshing essential midwifery skills.

Appropriate maternal positions in the active phase of second stage labour play a vital role in enhancing positive maternal and fetal outcomes (Garbelli and Lira, 2021; Kibuka et al, 2021). During early first stage labour, women are encouraged to be as mobile as possible and embrace positions that they are comfortable with in the active phase, in preparation for the birth of their baby. Possible positions include supine or recumbent positions, where the woman lies on her back with her knees flexed and legs apart, with (such as in the lithotomy position) or without supported feet (Mselle and Eustace, 2020). A horizontal or lateral position has the woman lying on her side (Gupta et al, 2017), while standing, squatting, seated and kneeling are categorised as upright positions, including ‘all fours position’ where the woman is kneeling and bent forward to support her weight with her arms (Gizzo et al, 2014; Desseauve et al, 2017).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month