During childbirth, women commonly choose varying positions such as lying on their backs, being on all fours, sitting up, or squatting. However, little research has been conducted on how these final birthing positions influence the satisfaction of the delivering woman. A recent study conducted by researchers at the University Hospital Bonn, the University of Bonn, and the University of Cologne focused specifically on this issue, including whether women had a say in choosing their birthing position. The findings revealed that women reported higher satisfaction levels when they could choose their position freely. Among the respondents, about 75% gave birth while lying down and tended to feel dissatisfied if they felt they weren’t given a choice. Conversely, those who opted for the supine or lateral supine position themselves generally felt more satisfied. The study results were published in the journal Archives of Gynecology.
Historically, the supine position has been the predominant birthing posture in Western nations, allowing healthcare providers unobstructed access to the mother and child. Nevertheless, in many cultures, upright positions like sitting or squatting are just as common. The best birthing position for both mothers and their unborn children remains a topic of debate. “To date, global guidelines primarily suggest that women should pick a birthing position that feels right for them,” says Prof. Dr. Nadine Scholten, who has recently taken charge of the UKB’s Research Unit for Health Communication and Health Services Research, and also serves as a professor in psychosomatic and psycho-oncological health services research at the University of Bonn. The German guidelines similarly recommend that women choose whichever position is most comfortable for them, while also encouraging an upright position during the final stages of labor. “Ultimately, the decision to lie down, sit, or squat often hinges on the preferences of expectant mothers and the recommendations of midwives and obstetricians, as well as any essential medical interventions,” explains Prof. Dr. Brigitte Strizek, the Director of the Clinic for Obstetrics and Prenatal Medicine at the UKB.
Focusing on Women’s Satisfaction
A research group led by Prof. Scholten, the primary and corresponding author, sought to understand which birthing positions left mothers feeling most satisfied. Nearly 800 women who had given birth were surveyed using an anonymous questionnaire to determine their final birthing position and overall satisfaction with the delivery experience. All analyzed data were sourced from women who had experienced vaginal births in a hospital setting without assistance from vacuum extraction or forceps, and who gave birth eight to twelve months prior to the survey. The researchers also looked into the mothers’ satisfaction levels based on whether they had the option to choose their birthing position freely, and they collected information on the reasons behind any lack of autonomy in this decision.
The analysis revealed that over 75% of mothers gave birth either lying on their side or back. Among these women, nearly 40% reported that they had not voluntarily chosen their birthing position. “The predominant reason cited by these women was guidance from medical personnel,” notes Prof. Scholten. The supine position was the most frequently assigned position by obstetricians. Notably, women expressed greater satisfaction with their birthing experience when they had the option to select their position voluntarily, especially when opting for the supine position themselves. Those who felt they were compelled into a specific position by medical staff were particularly dissatisfied, particularly when neither the CTG monitoring the fetal heart rate and labor activity nor the use of an epidural—pain-relieving medication—allowed them to adopt their desired posture.
Self-Determination Often Lacking in Delivery Rooms
“It’s alarming how many women did not have the opportunity to choose their birthing position and the corresponding drop in satisfaction levels,” summarizes co-author Prof. Strizek. However, the team could not ascertain whether a greater ability to choose birthing positions would lead to fewer women opting for the supine position in the future. “To enhance women’s satisfaction with their birthing experience, it is crucial to allow them to choose their preferred position,” urges lead author Prof. Scholten. “Raising awareness among medical personnel and helping women articulate their preferences better is the first step.” Prof. Strizek adds that if a particular position benefits the mother from a medical standpoint, healthcare teams should communicate this more effectively so that women feel they can control their birthing positions.
Funding: This research was financed by the Federal Ministry of Education and Research (BMBF) and supported by Techniker Krankenkasse and AOK Rheinland/Hamburg for recruitment and administrative tasks.
