No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
An investigation into the perceptions and preferences of birth positions in a Kenyan referral hospital
Abstract
Moi teaching and referral hospital has the largest mother and baby hospital (Riley Mother and Baby hospital (RMBH) in the western region of Kenya. It has convenient labour-and-delivery rooms which are suitable for different labour and birth techniques and positions. Many women delivering in hospitals are not aware of their right to informed choice of birth position and often accept what is offered to them by midwives (Lugina et al, 2004). According to the International Confederation of Midwives (ICM) (2004), the role of the midwife Includes ensuring that the labouring woman is adequately informed of options that may facilitate a more informed choice and a less stressful birth experience. de Jonge et al (2008) assert that the ability of midwives to provide health information related to birth positioning and to support women in their preferred positions will depend largely on their knowledge and experience of various positions, attitudes towards evidence on birth positions, women's preferences and hospital protocols on midwifery care. This study researched midwives' practices and women's perceptions and preferences of birth positions and how these may influence a woman's view of the hospital birth experience or choice of birth place.
... The position nowadays most widely had been used in maternity units is based on the work of the 17 th -century France obstetrician named François Mauriceauan (3). The positions adopted naturally by women in England during birth were described and observed that a primitive woman(not in uenced by western civilizations), would try to avoid the supine position and assume different upright positions such as standing, sitting, kneeling, and squatting (4). ...
Background: The women have been giving birth at health facilities without considering their preference of birth positions. Accordingly, they routinely positioned at lithotomy position as standard medical practices during normal vertex vaginal childbirths, which results in negative maternal and neonatal outcomes. Thus, this study aimed to understand women’s perception of birth positions.
Objective: To explore perception of women toward child birthing positions among women on postnatal unit at Jimma Medical Center, Jimma town, Ethiopia 2020.
Methods and Materials: A descriptive phenomenological approach was employed among women from postnatal and maternity care providers were selected purposively. The audio was transcribed, translated, coded, and categorized to respective identified themes. Then, thematized by Archive for Technology, Lifeworld and Everyday Language.text interpretation (ATLAS.ti version 8) software for thematic analysis in triangulation with the quantitative findings.
Results: The women and health care providers were responded on factors affecting the use of alternative birth positions in the health facility. The women were positioned at common supine positions due to women’s lack of awareness about birth positions, women’s passivity to respect their decision-making on their position of preference, and health care professionals’ knowledge and skill gaps on alternative childbirth positions.
Conclusion and recommendations: The women were coerced and adopted birth positions directed by health care providers. Therefore, health care providers’ practice should be intensified through the provision and implementation of evidence-based alternative birth positions.
... Evidence Based Midwifery 14(2): 64-70 constrained during labour and give birth in the lithotomy position (when a woman during childbirth is on their back, with hips and knees flexed and thighs apart). At present, the lithotomy position is a routinely accepted birth position in many African hospitals (Mwanzia, 2014). In Nigeria, obstetric and midwifery care is regimented and institutionalised, obstetricians and midwives are educated and trained to facilitate women giving birth in the lithotomy position and this, along with the routine use of episiotomy, is commonly practised, which is clearly not based on contemporary evidence. ...
Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy. Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred care. Nevertheless, Nigerian obstetricians’ perceptions and experiences on birthing position and perineal trauma have received
minimal recognition and research.
Aim. To explore the perceptions and experiences of Nigerian obstetricians’ regarding maternal birthing position and perineal trauma following childbirth, and to gain insights as to whether obstetricians clinical decisions and practice were influenced by research evidence.
Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke’s (2006) six-stage thematic framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes were identified. The study obtained ethical approval from the health and social research ethics committee at the University of Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria.
Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians. The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma.
Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their choosing and reduce the risk of a routinely performed episiotomy.
The literature is tentative in establishing links between birth position and perineal outcome. Evidence is inconclusive about risks and benefits of women's options for birth position. The objective of this study was to gain further evidence to inform perinatal caregivers about the effect of birth position on perineal outcome, and to assist birth attendants in providing women with information and opportunities for minimizing perineal trauma.
Data from 2891 normal vaginal births were analyzed. Descriptive statistics were obtained for variables of interest, and cross-tabulations were generated to explore possible relationships between perineal outcomes, birth positions, and accoucheur type. Logistic regression models were used to examine potential confounding and interaction effects of relevant variables.
Multiple regression analysis revealed a statistically significant association between birth position and perineal outcome. Overall, the lateral position was associated with the highest rate of intact perineum (66.6%) and the most favorable perineal outcome profile. The squatting position was associated with the least favorable perineal outcomes (intact rate 42%), especially for primiparas. A statistically significant association was demonstrated between perineal outcome and accoucheur type. The obstetrician group generated an episiotomy rate of 26 percent, which was more than five times higher than episiotomy rates for all midwife categories. The rate for tear requiring suture of 42.1 percent for the obstetric category was 5 to 7 percentage points higher than that for midwives. Intact perineum was achieved for 31.9 percent of women delivered by obstetricians compared with 56 to 61 percent for three midwifery categories.
Findings contribute to growing evidence that birth position may affect perineal outcome. Women's childbirth experiences should reflect decisions made in partnership with midwives and obstetricians who are equipped with knowledge of risks and benefits of birthing options and skills to implement women's choices for birth. Further identification and recognition of the strategies used by midwives to achieve favorable perineal outcomes is warranted.
Emerging research evidence suggests a potential benefit in being upright in the first stage of labour and a systematic review of trials suggests both benefits and harmful effects associated with being upright in the second stage of labour. Implementing evidence-based obstetric care in African countries with scarce resources is particularly challenging, and requires an understanding of the cumulative nature of science and commitment to applying the most up to date evidence to clinical decisions. In this study, we documented current practice rates, explored the barriers and opportunities to implementing these procedures from the provider perspective, and documented women's preferences and satisfaction with care.
This was an exploratory study using quantitative and qualitative methods. Practice rates were determined by exit interviews with a consecutive sample of postnatal women. Provider views were explored using semi-structured interviews (with doctors and traditional birth attendants) and focus group discussions (with midwives). The study was conducted at four government hospitals, two in Dar es Salaam and two in the neighbouring Coast region, Tanzania.
Main outcome measures
Practice rates for mobility during labour and delivery position; women's experiences, preferences and views about the care provided; and provider views of current practice and barriers and opportunities to evidence-based obstetric practice.
Across all study sites more women were mobile at home (15.0%) than in the labour ward (2.9%), but movement was quite restricted at home before women were admitted to labour ward (51.6% chose to rest with little movement). Supine position for delivery was used routinely at all four hospitals; this was consistent with women's preferred choice of position, although very few women are aware of other positions. Qualitative findings suggest obstetricians and midwives favoured confining to bed during the first stage of labour, and supine position for delivery.
The barriers to change appear to be complicated and require providers to want to change, and women to be informed of alternative positions during the first stage of labour and delivery. We believe that highlighting the gap between actual practice and current evidence provides a platform for dialogue with providers to evaluate the threats and opportunities for changing practice.
This paper describes the success of an ongoing community-based maternal and child health project in Njeru, Uganda. The project is a collaboration between the Njeru Town Council and an American university's social work programme and College of Nursing. The goal of the programme is to increase utilization of clinic-based maternity services i.e. pre-natal care and skilled attendant at delivery. Using community mobilization, education and capacitybuilding, community health workers (CHWs) were trained by the university-based nursing professors to educate the community about safe motherhood practices. Traditional birth attendants (TBAs) were trained by a nurse-midwife in techniques to reduce infection and maternal haemorrhage, the two main causes of maternal morbidity and mortality in the region. Over a 2-year span the clinic has doubled utilization of pre-natal services and more than doubled utilization of clinic-based labour and delivery services, resulting in more births at the clinic than by TBAs in the clinic's catchment area—an outstanding achievement in a country where more than 70% of women are assisted at birth by an unskilled attendant, including TBAs.
Two hundred ninety-four women were randomly allocated to a group in which the use of a birthing stool (experimental group) or a conventional semirecumbent position (control group) was encouraged. The birthing stool was 32 cm high and allowed the parturient to sit upright and to squat. The husband could sit close behind his wife and support her back. No differences were observed between the two groups regarding mode of delivery, length of the second stage of labor, oxytocin augmentation, perineal trauma, labial lacerations, or vulvar edema. Infant outcome measured by Apgar scores at 1 and 5 minutes postpartum and numbers of neonatal intensive care unit transfers was the same in both groups. Mean estimated blood loss and the number of mothers with a postpartum hemorrhage 600 ml or more were greater in the experimental group than in the control group. Women in the experimental group reported less pain during the second stage of labor, and they and their spouses were more satisfied with the birth position than were parents in the control group. Midwives were less satisfied with their working posture in the experimental group.
Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations.
A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%).
Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen.
Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported.
This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour.
Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored.
Six focus groups were conducted in 2006-2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice.
The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences.
To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions.
Women's preferences for type of maternity caregiver and birth place have gained importance and have been documented in studies reported from the developed world. The purpose of our study was to identify Syrian women's preferences for birth attendant and place of delivery.
Interviews with 500 women living in Damascus and its suburbs were conducted using a pretested structured questionnaire. Women were asked about their preferences for the birth attendant and place of delivery, and an open-ended question asked them to give an explanation for their preferences. We analyzed preferences and their determinants, and also agreement between actual and preferred place of delivery and birth attendant.
Only a small minority of women (5-10%) had no preference. Most (65.8%) preferred to give birth at the hospital, and 60.4 percent preferred to be attended by doctors compared with midwives (21.2%). More than 85 percent of women preferred the obstetrician to be a female. The actual place of delivery and type of birth attendant did not match the preferred place of delivery and type of birth attendant. Women's reasons for preferences were a perception of safety and competence, and communication style of caregiver.
Most women preferred to be delivered by female doctors at a hospital in this population sample in Syria. The findings suggest that proper understanding of women's preferences is needed, and steps should be taken to enable women to make good choices. Policies about maternity education and services should take into account women's preferences.
Despite evidence of adverse fetal and maternal outcomes from the use of sustained Valsalva bearing down efforts, current second-stage care practices are still characterized by uniform directions to "push" forcefully upon complete dilatation of the cervix while the woman is in a supine position. Directed pushing might slightly shorten the duration of second stage labor, but can also contribute to deoxygenation of the fetus; cause damage to urinary, pelvic, and perineal structures; and challenge a woman's confidence in her body. Research on the second stage of labor care is reviewed, with a focus on recent literature on maternal bearing down efforts, the "laboring down" approach to care, second-stage duration, and maternal position. Clinicians can apply the scientific evidence regarding the detrimental effects of sustained Valsalva bearing down efforts and supine positioning by individualizing second stage labor care and supporting women's involuntary bearing down sensations that can serve to guide her behaviors.
Central Bureau of Statistics, Ministry of Health: Kenya Demographic and Health Survey
- Kenya Demographic
- Health Survey