Women Birth. 2026 Feb 26;39(2):102184. doi: 10.1016/j.wombi.2026.102184. Online ahead of print.
ABSTRACT
PROBLEM: Despite evidence supporting benefits of upright and flexible sacral positions during labour, most women continue to birth in supine positions.
BACKGROUND: Historically, women have laboured and birthed in positions that optimise gravity, encouraging physiological birth. However, many women birth in supine positions, even though upright positions are associated with shorter duration of second stage and favourable outcomes.
AIM: To observe the proportion of time nulliparous women spent in upright and supine positions during the active second stage of labour, and to explore associations with birth outcomes.
METHODS: This prospective observational study included term nulliparous women who were planning a vaginal birth. Midwives recorded commencement of, and all position changes during second stage. Data were analysed using descriptive statistics and regression modelling.
FINDINGS: Of 330 participants, 216 (65%) birthed physiologically, 114 (35%) had an instrumental birth. Women who birthed physiological more frequently adopted all-fours position or used a birth stool, whereas those who had an instrumental birth were more often in semi-recumbent or lithotomy positions. For every 10% increase in time spent in upright positions during the active second stage, the likelihood of physiological birth increased by 26%. Conversely, each 10% increase in time spent in a supine position there was a 30% increased likelihood of instrumental birth.
DISCUSSION: Findings indicate a clear association between upright positioning during the active second stage of labour and increased rates of physiological birth.
CONCLUSION: Nulliparous women may benefit from being actively supported to adopt upright positions during the second stage of labour.
PMID:41762541 | DOI:10.1016/j.wombi.2026.102184
