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Changing Attitudes

Women need to be supported in comfortable positions during labour and birth

As easy as 1 2 3 :

1. Frame

2. Orientations

3. Cushions

Many Positions

for Better Birth

Designed for Hospital Birth

All women benefit from comfortable positions in labour. With cushions placed only where they are needed, there is plenty of access to the mother's abdomen for monitoring purposes, whether using hand held devices or EFM leads.

Evidence and Guidelines

Cochrane 1st stage and 2nd stage summaries,

links

 

RCM Normal Active Birth Positions

 

RCM survey on maternal position:

Get her off the bed

"Gravity is our greatest aid in giving birth, but for historical and cultural reasons (now obsolete) in this society we make women give birth on their backs. We need to help women understand and practise alternative positions antenatally, feel free to be mobile and try different positions during labour and birth. Once she is comfortable, try not to move her unless she wants to, or unless the position becomes inadvisable for maternal or fetal (and not organisational!) reasons.”

 

RCOG guidelines:

"The Royal College of Obstetricians and Gynaecologists (RCOG) encourages women to mobilise and remain upright as much as possible during the first stage of labour." ...

 

NICE Intrapartum Care:

Mobilisation in labour

1.2.3 Encourage and help the woman to move and adopt whatever positions she finds most comfortable throughout labour.

1.9.7 Encourage women with regional analgesia to move and adopt whatever upright positions they find comfortable throughout labour.

1.10.3 …thinking about the whole clinical picture, including the woman's position and hydration, the strength and frequency of contractions and maternal observations.

Telemetry

1.10.9 Offer telemetry to any woman who needs continuous cardiotocography during labour.

1.10.11 encourage and help the woman to be as mobile as possible and to change position as often as she wishes

 

Conservative measures

1.10.34 If there are any concerns about the baby's wellbeing, be aware of the possible underlying causes and start one or more of the following conservative measures based on an assessment of the most likely cause(s):

  • encourage the woman to mobilise or adopt an alternative position (and to avoid being supine)

The woman's position and pushing in the second stage

1.13.9 Discourage the woman from lying supine or semi‑supine in the second stage of labour and encourage her to adopt any other position that she finds most comfortable. 

1.13.11 If pushing is ineffective or if requested by the woman, offer strategies to assist birth, such as support, change of position, emptying of the bladder and encouragement.

'Very comfortable and adaptable'  'Sturdy'  'Should be one in every labour unit' 'Compact, comfortable, promotes upright positions' 'Great for labour wards,'
STOP PRESS  'EFM is useful but freedom of maternal movement is more important '
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.15026