References

Aromataris E, Pearson A. The Systematic Review. Am Jf Nurs. 2014; 114:(3)

Aromataris E, Riitano D. Systematic Reviews. Am J Nurs. 2014; 114:(5)49-56

Atsali E, Russell K. Hospital midwives' barriers when facilitating upright positions during a normal second stage of labour. Africa Journal of Nursing And Midwifery. 2018; 20:(1)

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3:(2)77-101

Critical Appraisal Skills Programme. CASP Systematic Review Checklist. 2018. https://casp-uk.net (accessed 19 August 2020)

Deliktas A, Kukulu K. A meta-analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia. Journal of Advanced Nursing. 2018; 74:(2)263-278

Gizzo S, Di GS, 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 Research International. 2014; 638093-638093

Green T. Exploring the influence that midwives have on women's position in childbirth: a review of the literature. Evidence Based Midwifery. 2015; 13:(4)132-137

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

Hammond A, Homer CSE, Foureur M. Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting. Midwifery. 2017; 50:133-138

Huang J, Zang Y, Ren L, Li-Hua F, Lu H. A review and comparison of common maternal positions during the second-stage of labour. International Journal of Nursing Sciences. 2019; 6:(4)460-467

Lee N, Tracy S. Disturbances in the rhythm of labour (Chapter 36). In: Pairman S, Tracy SK, Dahlen HG, Dixon L (eds). Chatswood, Australia: Elsevier; 2019

Moher D, Liberatui A, Tetziaff J, Altman D. Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. PLoS Med. 2009; 6:(7)

Mselle L, 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 And Childbirth. 2020; 20:(1)

Munn Z, Tufanaru C, Aromataris E. JBI's Systematic Reviews: Data Extraction and Synthesis. American Journal Of Nursing. 2014; 114:(7)49-54

Musie M, Peu M, Bhana-Pema V. Factors hindering midwives' utilisation of alternative birth positions during labour in a selected public hospital. African Journal Of Primary Health Care & Family Medicine. 2019; 11:(1)

Porritt K, Gomersall J, Lockwood C. JBI's Systematic Reviews. American Journal Of Nursing. 2014; 114:(6)47-52

Robertson-Malt S. JBI's Systematic Reviews. American Journal Of Nursing. 2014; 114:(8)49-54

Stern C, Jordan Z, McArthur A. Developing the Review Question and Inclusion Criteria. American Journal Of Nursing. 2014; 114:(4)53-56

Tracy S. Interventions in pregnancy, labour and birth (Chapter 37). In: Pairman S, Tracy SK, Dahlen HG, Dixon L (eds). Chatswood, Australia: Elsevier; 2019

World Health Organization. WHO recommendation on birth position (for women without epidural analgesia). 2018. https://bit.ly/3sNv09T (accessed 15 February 2022)

Stand and deliver: an integrative review of the evidence around birthing upright

02 March 2022
11 min read
Volume 30 · Issue 3

Abstract

Background

The benefits of upright birth positions are well-established in the literature, yet women are persistently challenged to assume the lithotomy or supine birth positions. This study aimed to explore what is known about women's capacity to assume upright birth positions in hospital environments, and its effect on physiological birth.

Methods

A structured five-step approach was employed to conduct an integrative review of the literature. The Cumulative Index to Nursing and Allied Health Literature and MEDLINE were searched for articles on women's position during labour and birth in hospital settings. Four articles were selected for inclusion and subjected to thematic analysis to elicit themes and subthemes.

Results

Three core themes emerged from this review: ‘the biomedical model of care and workplace culture impact the positions women adopt during labour and birth’, ‘midwives' philosophy and views support physiological birth’ and ‘clinical settings are not conducive to physiological birth’.

Conclusions

Midwives are losing the skills and confidence to support women into upright birth positions. Improved education and training around upright birthing may see a rise in women adopting these positions in hospital environments.

A woman's physiological instinct to assume upright positions during labour and birth is increasingly challenged in hospital settings, despite recommendations from the World Health Organization (2018) that women should have the autonomy to adopt any position deemed safe and comfortable during birth. Acknowledged as an evidence-based practice, adopting upright birth positions is known to positively impact maternal and fetal birth outcomes (Deliktas and Kukulu, 2018; Huang et al, 2019), yet labouring women are often encouraged into supine or semi-recumbent positions, which are known to increase the likelihood of epidurals and obstetric intervention (Gizzo et al, 2014). While medical intervention is acknowledged to be beneficial at times, the risk of these becoming routine practices has undoubtedly influenced the normal processes of birth (Gizzo et al, 2014; Lee and Tracy, 2019). Arguably, the rise in perineal trauma, prolonged labours (Huang et al, 2019) and increased rates of assisted birth worldwide (Atsali and Russel, 2018) are evidence that medical intervention during labour and birth are increasingly common practices.

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