International Journal of Clinical Obstetrics and Gynaecology

Background: Birthing position during labour is a modifiable intrapartum factor that may influence maternal and neonatal outcomes. Despite recommendations supporting upright birthing positions, supine delivery continues to be widely practiced in institutional settings in India. Comparative evidence on outcome differences across birthing positions remains limited. Hence, this study aimed

to evaluate and compare maternal and newborn outcomes associated with supine and upright birthing positions in low-risk multiparous women.

Methods: This prospective observational study was conducted over 18 months at a tertiary care teaching hospital in Loni, Maharashtra. A total of 300 low-risk multiparous women with term, singleton, cephalic pregnancies undergoing vaginal delivery were included. Participants were grouped based on birthing position during the second stage of labour into supine (n = 150) and upright (n = 150) positions, the latter comprising sitting, squatting, kneeling, and standing. Maternal outcomes included duration of labour, episiotomy, perineal trauma, postpartum hemorrhage, instrumental delivery, and maternal satisfaction. Neonatal outcomes included Apgar scores, birth weight, NICU admission, morbidity, and hospital stay.

Results: Baseline sociodemographic and obstetric characteristics were comparable between groups (p>0.05). Upright birthing positions were associated with a significantly shorter mean duration of the second stage of labour (38.6 ± 9.4 vs 52.1 ± 11.8 minutes), lower episiotomy rates (16.0% vs 30.7%), reduced perineal trauma (18.0% vs 34.0%), and lower postpartum hemorrhage incidence (6.0% vs 14.0%) compared to the supine position (p<0.05). Instrumental deliveries were less frequent in upright positions (8.0% vs 18.7%). Maternal satisfaction scores were significantly higher in upright positions, particularly kneeling and standing. Neonatal outcomes were also more favorable in the upright group, with fewer low Apgar scores at one minute (5.3% vs 12.0%), reduced NICU admissions (5.3% vs 12.0%), higher mean birth weight, and shorter hospital stay (p<0.05).

Conclusion: Upright birthing positions, especially kneeling and standing, are associated with significantly improved maternal and neonatal outcomes compared to the supine position and should be encouraged in low-risk deliveries.