What are the birthing positions in labour?

Birthing positions

Types of birthing positions

RECUMBENT POSITION (LITHOTOMY)

Women can choose a variety of positions for birth. Use of non lithotomy positions were natural ways of birth as old as origin of man. In modern times about two centuries ago, the use of lithotomy became the norm because it is easier to apply new technology. It is now advocated that women can choose any comfortable position ranging from standing, sitting, squatty, hand and knees or side lying (left lateral) positions

This is more convenient for health workers (midwives and others) to enhance maintenance of asepsis, assessment of fetal heart rate(FHR) and giving of episiotomy and repair. Nevertheless, it has following disadvantages to the comfort of the woman and the fetus

  • 30% decrease in blood pressure in 10%of women.
  • Many women experience breathing difficulty because the uterus presses on the diaphragm.
  • Uterine axis is directed towards the freSymphysis Pubis instead of the pelvic inlet, thus interfering with fetal alignment
  • Aspiration of vomitus may occur
  • The position may be embarrassing for the woman
  • Supine hypotension syndrome may occur
  • The labour may be prolonged and may lead to the use of medications to augment labour
  • Coping may be more difficult because contractions may be more uncomfortable
  • The woman experience tightening of the vagina and perineum as the thighs a flexed and chances of episyor laceration is increased
  • Frequency and intensity (strength of contractions) may be interferred by this position
  • Stirrups cause excessive pressure on the legs
  • The woman works against force of gravity

LEFT LATERAL POSITION

This is a common position some women and birth attendants always use. The woman lies on her left side with the left leg extended and her right knee drawn against her abdomen or flexed by her side. Although frequency of contraction may decrease in this position, the intensity increases leading to greater efficiency

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Advantages

  • Increases over all comfort
  • Does not compromise venous return from lower extremities
  • Put less pressure on the maternal neck
  • Diminishes the chances of aspiration if vomiting occur
  • More natural and comfortable and less intrusive for women
  • Birth attendants have discovered it more effective in management of shoulder dystocias
  • Helpful in delivery of persistent opp, because it directs away uterine weight and fetus away from maternal back
  • Fewer episiotomies are required in this position because the perineum is more relaxed

Disadvantages

  • Difficulty in cutting episiotomy
  • Difficulty in assisted deliveries with forceps and vacuum.
  • However these disadvantages can be corrected by repositioning the woman on her back.

SQUATTING POSITION

Squatting primarily common choice for some women because it favours gravity and the abdominal wall is relaxed. 

Other advantages:

  • It facilitates entrance of the presenting part into the inlet and hastening engagement.
  • It favours descent due to pressure directed on the fetal long axis.
  • Engagement facilities pressure being applied to the cervix with aid in its dilatation.
  • Contraction is more intense and frequency thereby shortens duration of labour.
  • A squatting bar may be placed across the bed or on the floor to increase the woman’s balance and provide some support.
  • During second stage squatting increases the size of pelvic outlet by 1-2cm.
  • It helps the woman’s pushing efforts.
  • The pressure from the thighs against the uterus can also aid in fetal descent and help facilitate favourable fetal position

Disadvantages

  • Some birth attendants abject to this position because the perineum is relatively inaccessible.
  • It is difficult to control birth process
  • Squatting increases difficulty in administration of analgesic.
  • Increases difficulty of using instruments and monitoring of fetal heart rate.
  • Perineal oedema may occur in long squatting.
  • Women with epidural anaesthesia may not be able to use this position because of heaviness of their lower extremities.
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SEMI-FOWLER’S (HALF SITTING) POSITION

Most birth attendants advocate for this position. It is halfway between sitting and recumbent positions

Advantages

  • Associated with short first and second stage of labour than lithotomy position
  • It enhance effectiveness of abdominal muscles while putting thereby shortening the 2nd stage of labour
  • Raising and supporting the tarsals helps the woman to view the birth process
  • The birth attendant has access to the perineum
  • Supporting women in this position is not difficult with most delivery beds

SITTING POSITION

This can be used where there is availability of delivery chairs. This method can be traced back to ancient Egypt and was widely used in Greek and Roman civilizations. 

In the early 19th century use of delivery chairs was discouraged and its use diminished on hygienic grounds due to increase in puerperal fever.

A supported sitting position can be achieved by use of a support person in a delivery bed (couch).

Advantages 

  • Its advantages are similar to squatting positions associated with stronger and more effective contractions. 
  • Weight of the baby exerts sufficient effort to expedite delivery.
  • It leads to spontaneous birth in cases where operative delivery is carried out if it is in a recumbent position.
  • It is helpful for women with severe back pain either diminishing the pain or eliminating it.
  • The woman can curl upwards grasping her knees or ankle during pushing.
  • She can view the birth process with the aid of a mirror.
  • She or attendant can lift the baby up towards her face/ abdomen.
  • Baby is not affected by use of delivery chair
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Disadvantage

It carries a potential for increased blood loss.

HANDS AND KNEES POSITION

  • This is more comfortable for a woman experiencing severe back pain like in opp due to pressure of presenting part on sacral nerves
  • It helps fetus to rotate more easily from occipito posterior due to gravity
  • It is also used when there is cord prolapse to relieve pressure of the fetal head from the cord
  • Extra pillows are provided for the woman to support chest and rest the forearms 

Advantages

  • Less need for episiotomy and less incidence of lacerations due to less pressure on perineum
  • The birth attendant assessed the perineum more easily and can easily asses nose and mouth of the baby at delivery of the head for cleaning
  • Increases placental and umbilical blood flow especially in fetal distress
  • Increases intensity of uterine contractions
  • Increases pelvic diameter thereby facilitates birth of infant with shoulder dystocia

Disadvantages

  • Decrease eye contact between the mother and birth attendant
  • Inability to use instrument
  • Mother is easily fatigued in this position
  • Need to reposition the woman for repair

Tofort’s Recommendation on choice of birthing positions