Determinants and outcomes of birthing positions among women giving birth in Nakuru county referral hospital, Nakuru county, Kenya

Abstract

Introduction: Birth position is a common determinant for the comfort of the mother and the neonate. Further, birthing positions influence maternal and neonatal outcomes. Birth position may reduce labor augmentation, operative delivery, hospital stay, and therefore the cost in general. Alternative Birth positions are associated with better perineal outcomes as compared to supine position which is commonly used in most Kenyan hospitals. Objectives: To determine birth positions used in the hospital, identify factors influencing the choice, and determine outcomes of birth positions among women giving birth and finally to explore the perceptions, and practices of midwives in Nakuru County Referral Hospital. Method: A hospital-based prospective cohort study design was employed. The study was carried out at the Nakuru County Referral Hospital (NCRH).A total of 240 low risk pregnant women in established labour were recruited using systematic sampling to answer the quantitative objectives. In addition 12 midwives working in the labor ward were purposively sampled for the qualitative aspect of this study. Questionnaires and observation checklist were used to collect quantitative data from the mothers while an interview guide was used to collect qualitative data from the midwives. Data were analyzed using both descriptive and inferential statistics. Results: The study has showed that the common position used for birth is supine. Majority of the pregnant mothers gave birth in supine position (n=203) (84.6%).The main factors associated with birth positions adopted during labor are; knowledge p<0.001, antenatal training p<0.001, education p=0.004 and having delivered in the hospital p<0.001.Outcomes after birth mainly relate to perineal integrity and time taken to deliver. Majority of the mothers in supine position had perineal tears (n=103) (50.7%) and there was a difference in the meantime to delivery among the different positions. Regarding perceptions from midwives, most of the midwives had knowledge of other birthing positions but preferred supine position because it makes it easier for them to examine their patients. Conclusion: The main position adopted by birthing mothers at NCRH was supine position. Knowledge on birth positions, mothers education, antenatal education and, place of previous birth were the main determinants in the choice and adoption of birthing position. Further, there was a significant difference in the meantime delivery among the birth positions. Although midwives are aware of birth positions, they preferred the supine position. Recommendations: Women should be educated on different birth position and their outcomes during antenatal clinic. There is need for training, mentorship, and coaching of midwives in order for them to effectively support women with a range of birth positions so as to create a more client-centered maternity service.