The Mother-Friendly Childbirth Initiative
References for Mother-Friendly Childbirth Initiative Step 4:
Freedom to Walk and Assume Positions of Choice in Labor
(Links are to abstracts of the papers below)
- Rossi, M., Lindell, S. (1986).Maternal positions and pushing techniques in a non-prescriptive environment. Journal of Obstetric, Gynecological and Neonatal Nursing (15), 203-208.
- Albers, L., Anderson, D., Cragin, L., Daniels, S., Hunter, C., Sedler, K., & Dusty, T., (1997). The relationship of ambulation in labor to operative delivery. The Journal of Nurse-Midwifery 42(1), 4-8.
Summary/Commentary
Given the opportunity, healthy women with healthy babies should have the freedom to walk about and assume any desired position during labor and birth. Ambulation is shown to be associated with fewer operative procedures. Freedom of position has shown no adverse outcomes.
Abstracts:
- Rossi, M., Lindell, S. (1986). Maternal positions and pushing techniques in a non-prescriptive environment. Journal of Obstetric, Gynecological and Neonatal Nursing (15), 203-208.
Premise: Low risk women should be given choice in selecting their birthing positions in second stage labor.
Research Questions:
1) In a nonprescriptive environment, what birthing positions do women assume?
2) In a nonprescriptive environment, what pushing methods do birthing women employ?
3) In a nonprescriptive environment, what are the birth outcomes?
Background: The majority of infants worldwide are born with mothers in an upright position. In contrast, the recumbent position is most often used for labor and birth in Western civilizations.
Variables: Second stage labor pushing positions, pushing techniques, and breathing techniques.
Subjects: 50 women, primarily Caucasian at twenty-eight to forty weeks' gestation with low-risk pregnancy and fetus in cephalic presentation.
Data Collection: Prior to the onset of the second stage of labor, a birth observer was positioned in a room to observe and record birthing positions and breathing techniques, and to identify the director of the events. The nurse-midwife care-providers were under direction to not give any specific instruction or intervention in the positions, breathing, or pushing of the second stage of labor.
Findings: The study subjects chose nine birthing positions. These positions include reclining, sidelying, lateral reclining, supine, sitting, and all-fours. The actual number of position changes ranged from one change for 28 women to seven changes for two women. Regarding position change: 13 women were self-directed, 16 were directed only once by the caregiver, and 44 chose their initial position for pushing. Six of the nine positions were chosen for the actual birth. Three breathing methods were used, 18 women used open glottis, 12 used the closed gottis, and 10 used intermittent exhalation techniques. The mean length of the second stage of labor was 34.1 minutes.
Birthing in a nonprescriptive environment did not lengthen second-stage labor. The incidence of episiotomies, use of drugs, and Apgar scores was not different from the standard practice at the sites selected. Thus, positions and/or breathing chosen by the subjects neither increased nor decreased the incidence of episiotomies or use of drugs nor influenced Apgar scores.
Conclusion: In the subjects studied, no adverse outcomes were attributed to birthing in a nonprescriptive environment. Women chose a variety of positions and breathing patterns.
Research reviewed by Jamie Kates, RN, student at Virginia Commonwealth University, School of Nursing, Richmond, VA.
- Albers, L., Anderson, D., Cragin, L., Daniels, S., Hunter, C., Sedler, K., & Dusty, T., (1997). The relationship of ambulation in labor to operative delivery. The Journal of Nurse-Midwifery 42(1), 4-8.
Premise: Ambulation during first stage labor possibly decreases the incidence of operative deliveries, use of narcotics, and incidence of fetal distress.
Research Question: Does significant ambulation during labor decrease the rate of operative delivery?
Subjects: Data were collected from 1, 678 intrapartum patients from three different practices by certified nurse midwives. The women were low-risk, at term, vertex singleton pregnancies with spontaneous labor and an unremarkable prenatal course.
Data Collection: Ambulation was recorded for those patients who were upright or mobile for at least one-half of the labor. Subjects were not assigned to ambulate but were given choice.
Variables: Specific demographic data on the women such as age, parity, level of education, race, mental status, and source of payment were also recorded. Care measures including fetal monitoring, narcotic analgesic, and fluid intake were included. Outcome variables included type of delivery, fetal distress, infant birth weight, and prolonged first stage and second stage labors.
Findings: Forty-six percent of the intrapartum patients were ambulatory for a significant portion of their labor. Of those who ambulated, there was a 50% reduction in the incidence of operative delivery (defined as cesarean delivery, vacuum extraction, and/or use of forceps). Ambulation was also associated with a lower use of narcotic analgesia and less fetal distress.