Knowledge, attitude and practices of upright birthing positions in women from semi-urban and rural areas of Raigad district, Maharashtra: a cross-sectional study

Prerna Kokane; Bela Agrawal; Ramandeep Kaur Saini; Madhulika Singh; Ishika Rakesh Kohli; Anushka Govardhan Koli; Lata Kumari; Sushil Kumar; Esakidas Konar

doi:10.18203/2394-6040.ijcmph20263197

Authors

Prerna Kokane MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Bela Agrawal MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Ramandeep Kaur Saini MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Madhulika Singh MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Ishika Rakesh Kohli MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Anushka Govardhan Koli
Lata Kumari MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
Sushil Kumar Department of Obstetrics and Gynecology, Medical College, MGM Institute of Health Sciences, Kamothe, Navi Mumbai, Maharashtra, India
Esakidas Konar MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263197

Keywords:

Birthing position, Labour outcomes, Maternal health, Perinatal care, Upright posture

Abstract

Background: Maternal-mobility and choice of birthing-position are important components of respectful maternity-care that influence labor-experience and birth-outcomes. Despite growing evidence supporting the use of upright-birthing positions, gap exists about women’s awareness and actual use of different-positions during childbirth. This study aimed to assess the knowledge, attitudes, and practices related to birthing-positions among women of Raigad-district, Maharashtra.

Methods: A community-based cross-sectional-study was conducted among 786 women aged 15-49 years from rural and semi-urban-areas. Data were collected using validated-structured-questionnaire. A standardized-information-booklet containing pictorial-representations of various birthing-positions was used solely to facilitate uniform identification of positions during interviews. Descriptive-statistics were used to summarize participant’s knowledge, perceptions and reported practices.

Results: Awareness of both upright and horizontal birthing-positions was reported by 91% of women in semi-urban areas and 67% of women in rural-areas. However, participants across both settings indicated that they were not offered a choice of birthing-position during labour. During first-stage of labour, dorsal-supine-position was most commonly reported in semi-urban (49%) and rural (32%) women. In the second stage, dorsal-supine remained the predominant-position reported by 54% of semi-urban and 60% of rural-participants. Squatting was the most frequently reported upright-position during second-stage (19% semi-urban and 35% rural women). Dorsal-supine, lithotomy and squatting-positions were commonly perceived as safe-options for childbirth.

Conclusions: Although knowledge of various birthing positions was relatively high, women reported limited-autonomy in choosing their preferred-position during labour. The findings highlight a gap between awareness and practice hence emphasize the need for greater promotion of informed-choice, provider-education and woman-centred maternity care to support the safe use of multiple-birthing positions.

References

Aballa I, Mohamed Ahmed S, Elhassan E, Mirghani O, Adam I. Vacuum versus forceps delivery. Gezira J Health Sci. 2003;1:38-45.

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 766: Approaches to limit intervention during labor and birth. Obstet Gynecol. 2019;133(2):406-8.

Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016;123(5):745-53.

Ajmera P, Kalra S, Mohapatra SC, Yadav J. Health and fitness of postmenopausal women in semi-urban versus rural Gurugram: a cross-sectional study. J Midlife Health. 2022;13(4):317-21.

Bouille L, Sichitiu J, Favre J, Desseauve D. Assessing feasibility and maternal acceptability of a biomechanically-optimized supine birth position: A pilot study. Plos One. 2021;16(9):e0257285.

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):466.

World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.

Ministry of Health and Family Welfare, Government of India. SUMAN: Surakshit Matritva Aashwasan guideline. 2020. Available from: https://nhm.gov.in/New_Updates_2018/NHM_Components/RMNCHA/MH/Guidelines/SUMAN%20Guideline%202020%20Web%20Version.pdf. Accessed on 5 July 2022.

Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017;5:CD002006.

Desseauve D, Fradet L, Gachon B, Cherni Y, Lacouture P, Pierre F. Biomechanical comparison of squatting and optimal supine birth positions. J Biomech. 2020;105:109783.

Watson HL, Cooke A. What influences women's movement and the use of different positions during labour and birth: a systematic review protocol. Syst Rev. 2018;7(1):188.

Borges M, Moura R, Oliveira D, Parente M, Mascarenhas T, Natal R. Effect of the birthing position on its evolution from a biomechanical point of view. Comput Methods Programs Biomed. 2021;200:105921.

Yadav P, Smitha MV, Jacob J, Begum J. Intrapartum respectful maternity care practices and its barriers in eastern India. J Fam Med Prim Care. 2022;11(12):7657-63.

Miles C, Weidner A, Summit AK, Thomson CJ, Zhang Y, Cole AM, et al. Patient opinions on sexual and reproductive health services in primary care in rural and semi-urban clinics. Contraception. 2022;114:26-31.

Shorey S, Chan V, Lalor JG. Perceptions of women and partners on labor and birth positions: a meta-synthesis. Birth. 2022;49(1):19-29.

Mselle LT, Eustace L. Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. BMC Pregnancy Childbirth. 2020;20(1):36.

Haworth L, Kaur I, Ahmed M, Topalidou A. Biomechanical assessment of upright birthing positions using marker-based and markerless motion capture systems. PLoS One. 2025;20(12):e0322970.

Phalswal U, Jha S, Dixit P, Yadav R. Effectiveness of birthing ball exercises therapy in improving labor pain and labor outcomes: a systematic review. J Fam Reprod Health. 2024;18(4):208-16.

Yan L, Mao Y, Lin Q, Xie X, Chen C, Zhong J, et al. Free positions in the second stage of labor for pelvic floor protection: a narrative review. Front Med. 2026;13:1716862.

Fatma ZH, Alvesson HM, Namazzi G, Kyobe JB, Ayebare E. "This is like tradition, lie on your back, hold your leg, and push": understanding midwives’ perspectives on their choice of labour positions in a Ugandan hospital. BMC Pregnancy Childbirth. 2025;25(1):564.

Gorman J, Roberts CA, Newsham S, Bentley GR. Squatting, pelvic morphology and a reconsideration of childbirth difficulties. Evol Med Public Health. 2022;10(1):243-55.