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)

Borg S, Hill C Midwives' views on upright birthing positions. MIDIRS Midwifery Digest. 2023; 33

Brown W, Hayman M, Haakstad L Australian guidelines for physical activity and postpartum. J Sc Med Sport. 2022; 25:(6)511-519

Carroll L, Thompson S, Coughlan B ‘Labour hopscotch’: women's evaluation of using the steps during labor. Eur J Midwifery. 2022; 6

Catov J, Parker C, Gibbs B Patterns of leisure-time physical activity across pregnancy and adverse pregnancy outcomes. Int J Behav Nutrition Physical Activity. 2019; 15

Chan C, Yeung E, Law B Effectiveness of physical activity interventions on pregnancy-related outcomes among pregnant women: a systematic review. Int J Environ Res Public Health. 2019; 16

Clarke-Patterson G, Domingo M, Miller K Biomechanics of pregnancy and vaginal delivery. Curr Opinion Biomed Eng. 2022;

Cohen S, Thomas C Rebozo technique for fetal malposition in labor. J Midwifery Womens Health. 2015; 60:(4)445-451

Conder R, Zamani R, Akrami M The biomechanics of pregnancy: a systematic review. J Funct Morphol Kinesiol. 2019; 4:(4)

Côrtes CT, Oliveira SMJV, Santos RCSD, Francisco AA, Riesco MLG, Shimoda GT Implementation of evidence-based practices in normal delivery care. Rev Lat Am Enfermagem. 2018; 26

Delgado A, Maia T, Melo R, Lemos A Birth ball use in labor: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019; 35:92-101

Desseauve D, Frader L, Lacouture P, Pierre F Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. Pregnancy Childbirth. 2019; 19:(1)

Feltovich H Labour and delivery: a clinician's perspective on a biomechanics problem. Interface Focus. 2019; 9:(5)

Gascoigne E, Webster C, Honart A, Wang P, Smith-Ryan A, Manuck T Physical activity and pregnancy outcomes: an expert review. Am J Obstet Gynecol. 2023; 5

Golawski K, Wojtyla C Impact of physical activity of pregnant women on obstetric outcomes. Environ Res Public Health. 2022; 19:(19)

Grenvik J, Coleman L, Berghella V Birthing balls to ease labor pain and peanut balls to decrease length of labor: what is the evidence?. Am J Obstet Gynecol. 2023; 228:(5S)S1270-S1273

Grimm M Forces involved with labor and delivery-a biomechanical perspective. Annals of Biomechanical Engineering. 2021; 49:(8)1819-1835

Hemmerich A, Bandrowska Dumas G The effects of squatting while pregnant on pelvic dimensions: a computational simulation to understand childbirth. J Biomechanics. 2019; 87:64-74

Iversen M, Midtgaard J, Ekelin M, Hegaard H Danish women's experiences of the rebozo technique during labour: a qualitative explorative study. Sex Reprod Healthcare. 2016; 11:79-85

Makvandi S, Mirzaiinajmabadi K, Tehranian N, Mirteimouri M, Sadeghi R The impact of birth ball exercises on mode of delivery and length of labor: a systematic review and meta-analysis. J Midwifery Reprod Health. 2019; 7:(3)1718-1727

O'Brien M Teaching midwives about physiology-based care: going beyond the core curriculum. AIMS J. 2023; 35

O'Brien D, Coughlan B, Thompson S Exploring midwives ‘experiences of implementing the labour hopscotch framework: a midwifery innovation. Eur J Midwifery. 2022; 6

O'Connell M, O'Connell R History of fear and childbearing. In: Gutteridge K (ed). Switzerland: Springer, Cham; 2020

O'Connell M, Martin C, Dahlen H Time to rectify past mistakes and take a woman-centred approach to labour progress. Obstet Gynecol Reprod Med. 2022; 32:(11)259-261

Saolta. Women's and children's managed clinical and academic network annual clinical report 2022. 2023. https// (accessed 10 April 2024)

Wadhwa Y, Alghadir A, Iqbal Z Effect of antenatal exercises, including yoga, on the course of labor, delivery and pregnancy: a retrospective study. Int J Environ Res Public Health. 2020; 17:(15)

Yeung M, Tsang K, Yip B Birth ball for pregnant women in labour research protocol: a multi-centre randomised controlled trial. BMC Pregnancy Childbirth. 2019; 19

Zhang R, Xiao Y, Wei W, Wu B Effect of birth ball abdominal core training on pregnancy fatigue, waist pain and delivery outcomes. Int J Gynecol Obstet. 2022; 158:613-618

Bouncing your way to labour and birth using biomechanics and fetal optimal positioning

02 May 2024
Volume 32 · Issue 5



‘Labour hopscotch’ is a visual tool that encourages activity during pregnancy and childbirth. It has been used in one advanced midwife practitioner service since 2017 and more widely across in Ireland since 2020. The biomechanics for birth toolkit was added to advanced midwife practitioner care in 2022. This study's aim was to ascertain if the biomechanics for birth toolkit impacted gestation of spontaneous onset of labour rates and birth outcomes.


A retrospective study of onset of labour and birth outcomes was conducted for women before (n=155) and after (n=154) the biomechanics for birth toolkit was incorporated into care.


Before the toolkit was included, there was a 57.2% spontaneous onset of labour rate, with 33.2% birthing before 41 weeks. After the kit's inclusion, there was a 72.2% spontaneous onset of labour, with 91.8% birthing before 41 weeks. Induction rates dropped from 42.8% to 27.8%, with emergency caesarean section rates following induction dropping from 33.1% to 23.8%.


Using the biomechanics for birth toolkit alongside the labour hopscotch tool could increase spontaneous onset of labour rates, optimise physiological birth, reduce inductions and emergency caesarean section following induction.

Historically in Ireland, pregnancy was viewed as a normal physiological event with female relatives, friends and the local midwife being present and assisting during the labour and birth (O'Connell and O'Connell, 2020). By the early 1900s, women began to opt for a hospital birth, believing that modern medicine would improve safety and wellbeing (O'Connell et al, 2022). Over time, this move has resulted in a loss of unique midwifery skills and a rise in the medicalisation of pregnancy and birth (O'Connell et al, 2022). This has led to childbirth being viewed as an illness, resulting in the use of routine, inappropriate interventions and practices that affect normal physiological labour (Côrtes et al, 2018). To reclaim childbirth as a normal physiological event, the World Health Organization want midwives to take ownership of and be the lead healthcare professionals in supporting normal pregnancy and birth (Côrtes et al, 2018).

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