Midwives willing to adopt alternative labour positions if they trust their safety and effectiveness: Study

Upright positions and mobility during labor are pivotal for improved maternal and fetal outcomes; however, such practices remain underutilized, particularly in low-income settings like Uganda. Despite recommendations from the World Health Organization for varied upright positions such as sitting, squatting, and walking during labor, cultural inertia often results in women being confined to supine positions. Midwives serve as key facilitators in labor, and their practices heavily influence women's choices and experiences during childbirth. Recent study sought to explore midwives' viewpoints and the rationale behind their selection of birthing positions during labor.

Historical Context of Labor Positions

Historically, numerous labor positions existed that allowed women to customize their birthing experience, emphasizing comfort and empowerment. However, the shift to institutionalized births introduced norms that often prioritize supine deliveries, reflecting a biomedically-centric approach. Research evidences the benefits of active and upright positions, including increased control for the birthing woman, decreased cesarean rates, and improved fetal conditions, yet limiting beliefs and institutional practices present substantial barriers to their adoption.

Challenges in Uganda's Birthing Practices

In Uganda, the ongoing reinforcement of traditional practices—often led by midwives—while acknowledging women's preferences for alternative birthing positions is crucial for enhancing maternal care. As cited, a high percentage of women prefer positions other than lying on their backs, indicating a disconnect between practice and preference. Yet, midwives often feel bound by institutional norms, fearing complications or a lack of resources to effectively support non-supine positions.

Midwives' Perspectives and Institutional Barriers

A model employing qualitative thematic analysis of midwives' perspectives reveals a complex interplay of professional responsibility, established norms, and individual agency. Midwives exhibit varying degrees of comfort with upright positions, often defaulting to supine due to fears regarding safety and efficacy, particularly during the second stage of labor. Their clinical practices reflect a risk-averse mentality shaped by institutional protocols that prioritize standardized procedures. Importantly, while midwives expressed a desire to respect women's birthing choices, they frequently hesitated to advocate for these due to uncertainties around potential complications.

Recommendations for Enhancing Midwifery Education

The discussion underscores the need for enhanced midwifery education focused on various birthing positions and addressing common misconceptions about risks associated with upright labor. By fostering a systemic approach to overcome resource limitations and facilitating continued professional development, stakeholders can empower midwives to promote a more woman-centered care paradigm reflective of women's preferences. The historical context of colonialism and its lasting impacts on birthing practices also highlight the importance of integrating traditional knowledge and practices into modern clinical care. Establishing a supportive environment, where midwives can empower women’s choices while ensuring safety, is critical to transforming labor experiences in Uganda.

Key Points

- Mobility and upright positions during labor are crucial for enhancing maternal and fetal outcomes, yet many women in low-income settings, such as Uganda, remain confined to supine positions due to cultural inertia despite WHO recommendations.

- Historically, diverse labor positions provided women opportunities for personalized and empowering birthing experiences, yet modern medical practices have largely shifted towards supine deliveries, which are often rooted in a biomedically-centric approach despite evidence supporting the benefits of active labor positions.

- In Uganda, a significant proportion of women express preference for laboring in upright positions rather than lying supine; however, midwives often reinforce traditional practices, feeling constrained by institutional norms and a lack of resources to support these preferences.

- Thematic analysis of midwives' perspectives indicates a complex dynamic where professional responsibility, established norms, and personal agency influence their practice, resulting in a tendency towards risk-averse behavior that defaults to supine positions, primarily due to safety concerns.

- Recommendations for midwifery education highlight the urgent need to address misconceptions around upright labor, enhance knowledge of diverse birthing positions, and foster continuous professional development to empower midwives in championing women-centered practices.

- The discourse connects the historical context of colonialism with current birthing practices, emphasizing the importance of integrating traditional knowledge into modern healthcare frameworks to create supportive environments in which midwives can encourage women's choices while maintaining safety.

Reference –

Z. H. Fatma et al. (2025). ‘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 And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07657-2.