Duration of second stage of labour less in squatting position than in the lateral position among Multigravida: Study
Labor is a physiological process. The more crucial part of labour is the SSL. In ancient times, upright positions was adopted, which are more physiological for SSL. They enlarged the pelvic exit, allowing for easier passage for the infant, but with time, supine positions were adopted, which are more convenient for the persons monitoring and conducting labour. Horizontal position was standard for deliveries from the eighteenth to the twentieth centuries. The birthing position that a mother feels most comfortable is her choice, which improves the quality of the birth and her level of labour satisfaction. These positions include kneeling, standing, squatting, and sitting. They permit the coccyx to move. On the other hand, non-flexible sacrum postures include those in which the weight is on the sacrum, such as lithotomy, supine, dorsal and semi-recumbent position. Despite evidence to the contrary, the supine posture is the most prevalent one that mothers adopt globally during labour.
In the lithotomy position, nerve compression is a drawback, especially in the femoral or common peroneal nerves. In the lower limbs, acute compartment syndrome may be brought on by inadequate perfusion. There was an increase in the incidence of episiotomies when people were given a supine position. There are several benefits of remaining upright.
Gravity helps in the descent of the fetus. Flexion of the hip, strengthening of pelvic floor muscles, spontaneous vaginal birth, and positioning of fetal head angle via the pelvic axis is also possible by adopting a squatting position. Benefits of the lateral position include less tension in the perineal muscles, enhanced relaxation, and enhanced control over the fetal head during birth. Assist the mother in finding a dignified and comfortable resting position in between contractions, minimizes the risk of supine hypotensive syndrome, enhance fetal oxygenation, and facilitate easier vaginal examinations and perineal inspections. There are many adverse maternal outcomes, including the need for a caesarean section and instrumental assistance during delivery, are linked to a "prolonged second stage". Research on the effects of sitting position on mothers' and newborns' outcomes has recently gained more attention.
The study was conducted in a tertiary care hospital from 1/9/2023 to 30/4/2024. A total of 140 multigravidas in labour participated in this study. The type of study was a randomized parallel group. Participants were divided into two groups after randomization. Group A – the participants were given a squatting position, and Group B – were given a lateral position during SSL. The parameters noted were second-stage duration, perineal injury, preference of birthing position, blood loss, and the immediate effect on the neonate, which were noted in both groups and compared.
The second stage mean duration for the squatting position was 25.93 minutes, while for the lateral position was 32.95 minutes (p > 0.001). In other parameters like perineal tears with or without episiotomy, intensity of pain, and blood loss, no significant difference were seen in both groups. Both groups had similar neonatal outcomes, including APGAR score, incidence of transient tachypnea of newborns and incidence of NICU admission. The preference rate for the same position in future deliveries was similar among both groups.
There are a variety of birthing positions that are used to help the delivering woman feel comfortable during the SSL. One such position is squatting. This study revealed that upright birthing positions, like squatting positions, shorten the duration of SSL. This reduction in second-stage duration has more significant benefits for the mother and her child because it reduces the need for unnecessary interventions and lowers abnormalities in the fetal heart rate. Neonatal outcomes were not affected by the choice between horizontal and vertical birthing positions.
Source: Jain et al. / Indian Journal of Obstetrics and Gynecology Research 2025;12(2):243–248
