Women's positions during the second stage of labour: views of primary care midwives.
OBJECTIVE
This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour.


BACKGROUND
Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored.


METHODS
Six focus groups were conducted in 2006-2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice.


RESULTS
The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences.


CONCLUSIONS
To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions.
de Jonge
Ank
A
Department of General Practice, Women Studies Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands. ank.dejonge@tno.nl
Teunissen
Doreth A M
DA
van Diem
Mariet Th
MT
Scheepers
Peer L H
PL
Lagro-Janssen
Antoine L M
AL
D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D007258:Informed Consent / Q000523:psychology; D007748:Labor Stage, Second / Q000523:psychology; D008427:Maternal Health Services / Q000592:standards; D008875:Middle Aged; D008880:Midwifery; D009426:Netherlands; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care / Q000523:psychology; D017060:Patient Satisfaction; D011187:Posture; D011247:Pregnancy