A review and comparison of common maternal positions during the second-stage of labor.
Jing Huang, Yu Zang, Li-Hua Ren and 2 others
PMID 31728401WHAT IT FOUND
Upright and lateral positions may shorten labor and reduce pain, but squatting and sitting carry higher risks of severe tears.
Lithotomy and supine positions are linked to more trauma and fetal heart issues. Midwives should prioritize patient comfort while monitoring perineal integrity closely.
Key findings
01Upright positions may reduce the duration of the second stage of labor compared to supine positions.
02Squatting and sitting positions are associated with an increased risk of obstetric anal sphincter injuries in some populations.
03Lithotomy and supine positions are identified as risk factors for severe perineal trauma and abnormal fetal heart rates.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a systematic review, so the selection of studies may introduce bias. Evidence quality varies, with some findings (like blood loss) disappearing when low-quality trials are excluded. Results are often specific to parities (primiparous vs. multiparous) or cultural contexts, limiting generalizability. The review notes a lack of consensus on the protective effects of specific upright positions like squatting and sitting on perineal trauma.
Declared interests
None declared.
The easy way to misread this
Do not assume all upright positions are equally safe for the perineum. Squatting and sitting, while beneficial for labor duration and pain, were associated with increased risks of severe tears (OASIS) in some studies, requiring heightened vigilance compared to kneeling or lateral positions.