Influence of different maternal birth positions on perineal trauma and neonatal parameters during spontaneous vaginal delivery

Purpose: During recent years alternative birth positions have gained more significance. Physiological advantages have been claimed for these birth positions, including the positive effect of the gravity on the uterus, a better alignment of the fetus during passage through the pelvis and an increase in pelvic dimension. The aim of this study was to evaluate possible advantages of the upright birth positions over the supine and the lateral position during spontaneous vaginal delivery. Material and Methods: This retrospective, multicenter trial included 1009 women with spontaneous vaginal delivery. Dependent on the choice of the birth position, we differentiated between women delivering in upright (alternative), supine or lateral position. The following variables were studied: the frequency and severity of vulvo-perineal lacerations, the use of episiotomy, the length of second stage of labour, the donation of oxytocin, the use of epidural anaesthesia, the cord pH and the Apgar score after one and after five minutes. Results: Among 1009 women, 67% decided for the supine position, 16% for the lateral position and 17% for the upright birth position. Our data revealed statistically significant higher rates of episiotomy in women who delivered in supine position compared to other birth positions (p = 0.01). A statistically significant association between the maternal birth position and the occurrence of vulvo-perineal lacerations and the neonatal outcome could not be observed (p > 0.05). The median length of the second stage of labour was 30 minutes in all 3 birth positions. Our results showed that oxytocin (p = 0.001) as well as epidural anaesthesia (p = 0.001) were used statistically significant more frequently in women delivering in supine position. Conclusion: The maternal birth position seem not to have any influence on the frequency and severity of vulvo-perineal lacerations and on the neonatale outcome. A significant higher rate of episiotomy and use of oxytocin in women who delivered in supine position could be observed. However, in our opinion the best recommendation is to give the mothers the option of bearing in the position that is most comfortable for them.