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.