Women can choose various positions during childbirth like lying on their back, sitting upright, squatting or being on all fours. However, until now no research had specifically looked at how these positions affect a mother’s satisfaction with her birth experience. Researchers from University Hospital Bonn (UKB), the University of Bonn and the University of Cologne have now examined this question and also considered if the position was chosen freely.
The study found that women were more satisfied when they were able to pick their birthing position. About three-quarters of the mothers surveyed gave birth while lying down. Those who felt they hadn’t made this choice themselves were often less satisfied. On the other hand, women who chose the supine (lying on the back) or lateral supine (side-lying) positions on their own generally reported higher satisfaction. The study was published in the journal Archives of Gynecology.
For years, the supine position was the most common in Western countries giving doctors easy access to both mother and baby. In other cultures, upright positions like squatting or sitting are also popular. There is no universal agreement on the “best” birthing position.
“international guidelines generally recommend that women adopt their preferred birthing position,” explains Prof. Dr. Nadine Scholten, head of UKB’s Health Communication and Health Services Research Unit.
German guidelines suggest that women should adopt the most comfortable position for them but encourage upright positions in the final phase.
“Ultimately, whether women lie, sit, or squat depends on their wishes, along with guidance from midwives, doctors, and medical needs,” notes Prof. Dr. Brigitte Strizek, Director of Obstetrics and Prenatal Medicine at UKB.
Focus on Women’s Satisfaction
The study led by Prof. Scholten, surveyed nearly 800 mothers about their birthing position and overall satisfaction. All respondents had given birth vaginally in a hospital eight to twelve months before the survey and had not used vacuum extraction or forceps. Researchers wanted to understand the connection between satisfaction and whether the position was chosen freely.
Over 75% of mothers surveyed gave birth lying down but up to 40% of them said this position wasn’t their choice.
“The most common reason given was instructions from medical staff,” says Prof. Scholten.
The supine position was most frequently assigned by doctors. Satisfaction was higher when women chose their position freely especially when they chose to lie on their backs. However, if medical staff dictated the position, some women felt a lack of control which led to lower satisfaction.
Importance of Self-Determination in Birth
“The number of women who did not choose the birth position themselves is significant, as is the link to lower satisfaction,” summarizes Prof. Strizek.
However, it’s unclear if allowing more voluntary choices would lead to fewer women using the supine position.
To improve women’s birth satisfaction, researchers recommend allowing them to pick their preferred position.
“The first step is to raise awareness among medical staff and empower women to communicate their preferences,” says Prof. Scholten.
Prof. Strizek adds, “If a certain position is better for the mother medically, the obstetric team should explain this to her more clearly, so she feels involved in the decision-making about her birthing position.”