Running head: LABOR POSITIONS

Labor Positions
Annette Ramos
Cedar Crest College

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2
Abstract

The following content will discuss the different positions utilized for the laboring mother. The
main birthing positions that are mentioned are: the upright, hands and knees, lateral, and
recumbent positions. The pros and cons will be measured for each movement, as well as the best
positioning utilized for certain emergency situations. The lithotomy position is the most
predominant labor and delivery position in the United States. The major issues that are pointed
out are the occiput posterior presentation, and variable and late decelerations. The most
important question asked is: does the implementation of different labor positions during the
delivery of a newborn really cause for a much smoother and more rewarding delivery?

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Labor Positions

The gift of pregnancy is just that a gift. It is an up and down roller coaster that can
bring great joy, and also bring unpredictable moments. Labor is a very big example of how
unpredictable pregnancy can be. Sometimes situations can arise that can cause certain
unexpected outcomes. Situations such as an occipito posterior position of a fetus or late and
variable decelerations can cause for a last minute redirection on how a new born baby is
delivered. According to an article on the affects of laboring positions the authors state that A
positive experience contributes to womens sense of accomplishment, self-esteem, feelings of
competence and well-being (Nieuwenhuijze, Jonge, Korstjens, Bude, & Lagro-Janssen, 2012,
p.e107). They also mention that Several studies found that sense of control was the strongest
predictor for satisfaction with childbirth (Nieuwenhuijz et al., 2012, p.e108). A major question
to ask is: does the implementation of different labor positions during the delivery of a newborn
really cause for a much smoother and more rewarding delivery? The following content will
discuss the different labor positions that may be implemented for certain unexpected issues
during the delivery of a newborn. The benefits of the laboring positions will be highlighted as
well as some possible disadvantages.
Significant Labor Positions
Upright Positions
Upright positions during labor are said to be beneficial in the fact that they may allow for
a much quicker delivery. Studies have shown that women who tend to use these positions
shaved about an hour off their labor time (Donovan-Batson, 2013, p.1). A qualitative study
indicated that the midwifes advice was the most important factor that influenced their choice of
birthing position (Nieuwenhuijze et al. 2012, e113). In one other scholarly journal the authors

LABOR POSITIONS

state that in a certain literature report there were both physical and psychological benefits for
women when they are able to adopt physiological positions of labour, and birth in an upright
position of their choice (Dahlen, Dowling, Tracy, Schmied, & Tracy., 2011, p.760). Another
important factor was a study that indicated a sense of control for woman who felt they had more
options in labor positions and movements (Nieuwenhuijze et al., 2012). Some examples of
upright positions are: Standing, standing supported squat, sitting, squatting, and walking. When
utilizing these positions it is important for the nurse to know and teach her client the pros and the
cons.
Benefits of Upright Positions
A big advantage of all upright positions is the use of gravity aiding in the descent of the
baby (Fit Pregnancy, 2013). Contractions are also said to be more effective during upright
positioning. Upright positions can help in speeding up labor delivery, and in giving the mother a
greater need to push. The standing position is said to aid in bringing more oxygen to the baby
(Fit Pregnancy, 2013). The standing supported squat, walking, and the regular squat are all
helpful in realignment of the pelvis. Squatting can help with the rotation and movement of the
baby. The sitting position is good for resting, and can be used with continuous electronic fetal
monitoring (Fit Pregnancy, 2013). Non ambulant upright positions (such as sitting) showed a
reduction in the first stage of labor (Priddis, Dahlen, & Schmied., 2011).
Disadvantages of Upright Positions
Clients who suffer from high blood pressure may have some difficulties in walking and
standing positions during labor (Fit Pregnancy, 2013). Continuous electronic fetal monitoring is
also not possible in the walking position (Fit Pregnancy, 2013). During the standing supported
squat the client is held up and supported by a partner or the nurse, while the mother gently squats

LABOR POSITIONS

in a standing position. This technique requires strength by the supporting partner, and can be
fatiguing on both ends (Fit Pregnancy, 2013). During the squatting position a squatting bar or
large yoga ball can help in assisting the mothers. Squatting is often tiring on the mother, and can
be difficult in assisting delivery (Fit Pregnancy, 2013).
Hands and Knees
The hands and knees position (also known as all fours) is said to be beneficial when the
fetus is in a occipito posterior position (Lowdermilk, 2012). The occipito posterior position is
defined as a baby that is head-down but facing your abdomen (Baby Center Medical Advisory
Board, 2011, p. 1). This mal-presentation can lead to certain risk factors such as: cesarean birth,
use of birthing instruments, longer labor, and third and fourth degree perineal lacerations (Sen,
Sakamoto, Nakabayashi, Takeda, Nakayama, Adachi, & Nakabayashi, 2013). It can also be very
painful on the mother, and cause for severe back pain due to the babys head pressing on the
lower spine. Hands and knees position involves the laboring woman on all fours, so that her
abdomen is suspended and her hips are at right angles to the floor or bed. (Stremler, Halpern,
Weston, Yee, & Hodnett, 2009, p. 391). During a randomized controlled trial (RCT) it was found
that women who were in labor felt a reduction in back pain, as well as an increase in fetal head
rotation when placed in the hands and knees position (Stremler et al., 2009). It has also been
found that this position increases the chance for a spontaneous vaginal birth (Stremler et al.,
2009). Hands and knee positioning improves blood flow to the uterus, and also aids in relieving
compression of the inferior vena cava which can cause maternal hypotension (Stremler et al.,
2009).
Disadvantages of all fours

LABOR POSITIONS

Very little is known on the benefits hands and knees positioning can bring for a woman
laboring with an epidural. Orthostatic hypotension as well as possible dislodgement of the
epidural catheter (upon shifting positions) are also risk factors when considering hands and knees
positioning for a woman laboring with an epidural (Stremler et al., 2009). Continuous fetal heart
monitoring, regional analgesia, and intravenous oxytocin can also cause restrictions in movement
that could hinder any sort of positioning movements for the laboring mother (Stremler et al.,
2009).
Lateral Position
The lateral position is a good position for providing rest to the mother. It can be
performed with a partner supporting the mothers leg. It helps bring more oxygen to the baby,
and is helps in aiding mothers with elevated blood pressure (Fit Pregnancy, 2013). This position
is beneficial in providing more useful contractions. It is also useful in slowing down a speedy
delivery. Physicians are able to have good access of the perineum when clients are resting in this
position. There are certain disadvantages to the lateral position as well. One disadvantage is the
fact that the physician may have a difficult time accessing fetal heart tones. Another
disadvantage is that there is no help from gravity in aiding in the lowering of the baby (Fit
Pregnancy, 2013). There is also the chance that the mother would have to support and hold up
her own leg if she does not have a partner to hold it up for her (Fit Pregnancy, 2013). The lateral
position is typically used for late and variable decelerations caused by uteroplacental
insufficiency (late) and umbilical cord compression (variable) (Shahzad, 2012). In a nursing
journal that discusses the implications of birthing positions the authors mention that upright or
lateral positions showed a reduced duration of second stage labor compared to supine and
lithotomy positions (Priddis et al., 2011).

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Recumbent
During the recumbent position the mother lays flat on her back for the delivery of the
child. This position is also known as the supine position, and can result in poor alignment of
the presenting fetal part with the pelvic canal (Stremler et al., 2009, p. 391). While in
recumbent position the client can be in a laying down or semi-sitting position which can cause
restriction to the posterior movement of the sacrum, which results in reduced pelvic dimensions
(Stremler et al., 2009). Supine positioning can also cause compression of the inferior vena cava
which can lead to maternal hypotension, and poor oxygenation to the fetus (Stremler et al.,
2009). Lithotomy position is a type of recumbent position usually performed in the semirecumbent form. This type of labor position is the most widely used position for laboring women
throughout the United States.
Conclusion
The question originally asked was: does the implementation of different labor positions
during the delivery of a newborn really cause for a much smoother and more rewarding
delivery? According to most research the answer would be yes. Continuous overall movement
for the laboring mother is important in providing better maternal circulation, fetal oxygenation,
and overall comfort. The positions considered are also greatly determined by the laboring
mother. It is important for the nurse to discuss with the client the different options of laboring
positions, what the positions can aid the client with, and methods of proper teaching. Overall the
benefits in different laboring positions seem to outweigh the disadvantages. The implementation
of different laboring positions (especially upright positions) can be helpful for certain maternal
and fetal issues, as well as providing better control and comfort measures within the mother.

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8
References

Baby Center Medical Advisory Board. (2011). Posterior Position. Baby center, 1-2.
www.babycenter.com/0_posterior-position_1454005.bc?page=1
Dahlen, G. H., Dowling, H., Tracy, M., Schmied, V., & Tracy, S. (2012). Maternal and perinatal
outcomes amongst low risk women giving birth in water compared to six birth positions on
land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery, 759-764.
http://dx.doi.org/10.1016/j.midw.2012.07.002
Donovan-Batson, C. (2013). Positions for labor and birth. Babycenter, 1-2.
www.babycenter.com/0_positions-for-labor-and-birth_10309507.bc?page=1
Fit Pregnancy. (2013). Labor and Delivery Position Statement. Fitpregnancy, 1-3.
www.fitpregnancy.com/pregnancy/labor-delivery/position-statement?page=2&_ami_m=
Lowdermilk, L. D., Perry, E.S., Cashion, K., & Alden, R. K. (2012). Maternity & Womens
Health Care 10th Edition. St. Louis, MO: Elsevier Mosby
Nieuwenhuijze, J. M., de Jonge, A., Korstjens, I., Bude, L., & Lagro-Janssen, T. (2012).
Influence on birthing positions affects womens sense of control in second stage of labour.
Midwifery, e107-e114. http://dx.doi.org/10.1016/j.midw.2012.12.007
Priddis, H., Dahlen, H., & Schmied, V., (2011). What are the facilitators, inhibitors, and
implications of birth positioning? A review of the literature. ScienceDirect, 100-106. doi:
10.1016/j.wombi.2011.05.001
Sen, K., Sakamoto, H., Nakabayashi, Y., Takeda, Y., Nakayama, S., Adachi, T., & Nakabayashi,
M., (2013). Management of the occiput posterior presentation: A single institute experience.
Obstetrics and Gynaecology Research, 160-165. doi: 10.1111/j.1447-0756.2012.01935.x

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Stremler, R., Halpern, S., Weston, J., Yee, J., & Hodnett, E., (2009). Hands-and-Knees
Positioning During Labor With Epidural Analgesia. JOGNN, 391-398. doi: 10.1111/j.15526909.2009.01038.x

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Grading Criteria
Nur320 Issue Paper
Name______________________________________________________________
Total Grade______________
Abstract: 5 points
120 words or less, clearly
delineates content of paper
5
Introduction: 5 points
Purpose of paper well
developed and clearly stated

5
Presentation of Issue: 50
points
Content relevant to purpose
of paper, comprehensive and
in depth

5

Purpose apparent, but not

sufficiently developed
4 3 2

Poorly developed

1

Purpose apparent but not

developed sufficiently

4 3 2

Purpose poorly developed,

not clear

1

Some content not relevant to

purpose of paper, lacks
depth


1
Sound background
Background relevant to topic Background not developed,
developed from concepts,
but limited development
limited support for ideas
theories and literature


5
4 3 2
1
Content accurate
Most of content accurate
Major errors in content
10 9 8
7 6 5 4
3 2 1
Current research
Relevant research
Limited research in paper,
synthesized and integrated
summarized in paper
not used to support ideas
effectively into paper


10 9 8
7 6 5 4
3 2 1
Ideas well organized and
Clear organization of main
Poorly organized, ideas not
logically presented,
points and ideas
developed adequately in
organization supports

paper
arguments and development

of ideas


10 9 8
7 6 5 4
3 2 1
Thorough discussion of
Adequate discussion of
Discussion not thorough,
ideas, includes multiple
ideas, some alternate
lacks detail, no alternate
perspectives and new
perspectives considered
perspectives considered
approaches
7 6 5 4
3 2 1
10 9 8

Content relevant to purpose

of paper


4 3 2

LABOR POSITIONS
Conclusion: 10 points
Effective conclusion and
Adequate conclusion,
integration of ideas in
summary of main ideas
summary

10 9 8
7 6 5 4

Spelling, grammar and organization: 10 points
Sentence structure clear,
Adequate sentence structure
smooth transitions, correct
and transitions; few
grammar and punctuation,
grammar, punctuation and
no spelling errors
spelling errors


10 9 8 7
6 5 4

APA Format: 10 points
APA style and format correct Some errors in APA style
throughout the paper
throughout the paper


10 9 8 7 6 5 4

References: 10 Points
References used
Most references current,
appropriately in paper,
some citations or references
references current (less than with errors
5 years old, unless a

landmark study), no errors

in references, correct use of
APA style for references

10 9 8 7 6 5 4

COMMENTS:

11

Poor conclusion, no
integration of ideas

3 2 1
Poor sentence structure and
transitions: errors in
grammar, and spelling


3 2 1
Major citation errors, many
APA format and style errors

3 2 1
Few references and limited
breadth, old references (not
classic)




3 2 1