Journal of Contemporary Academic Research and Methodologies (JCARM)
Published April 10, 2026 | Version v1
Journal article Open

Promotion of Upright Birthing Positions, Clinical Benefits, Barriers to Implementation and the Path to Woman-Centered Care in Health Facilities

Authors/Creators

  • 1. Claritian University Nekede, Owerri, Nigeria. https://orcid.org/0009-0003-6465-3764

Description

Background: Upright birthing positions offer physiological advantages during labor, yet their implementation in health facilities remains inconsistent globally. This review synthesizes evidence on clinical outcomes, barriers, and facilitators associated with upright birthing positions. Methods: A mixed-methods convergent integrated review was conducted. Seven databases were searched for studies published up to March 2026. Of 2,063 different studies, 70 studies (50 qualitative, 20 quantitative) were included. Random-effects models pooled effect estimates, and thematic analysis identified implementation determinants using the Consolidated Framework for Implementation Research. Results: Upright positions significantly reduced instrumental vaginal births (RR 0.74–0.75), shortened second stage duration by 6–8 minutes, and lowered episiotomy rates (RR 0.50–0.80) among women without epidural analgesia. Second-degree perineal tears increased (RR 1.20–1.45). Neonatal outcomes were comparable or slightly improved. Implementation remained suboptimal, with only 22.6% of midwives regularly practicing dynamic positions. Major barriers included inadequate training, infrastructure deficits, and institutional norms favoring supine positioning. Training participation was the strongest predictor of implementation success. Conclusion: Upright birthing positions confer meaningful maternal benefits without neonatal harm. Addressing multi-level implementation barriers through structured training, supportive policies, and infrastructure investment is essential for translating evidence into routine practice and advancing woman-centered maternity care.

Notes

Copyright © 2026 by the authors. | Repository URL: https://journal.jcarm.in/index.php/home/issue/archive | Development Status: Active

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References

  • Aryani, Z., Orabi, A., & Fouly, H. (2022). Examining the impact of upright and recumbent positions on labor outcomes in Saudi Arabia: A quasi-experiment. Belitung Nursing Journal, 8, 316 - 324. https://doi.org/10.33546/bnj.2114
  • Chinasa, E., Abdul, H., Kingdom, D., & Agonsi, C. (2025). Maternal and newborn outcomes of upright versus supine birthing position in Sub-Saharan Africa: A systematic review. International journal of health sciences. https://doi.org/10.53730/ijhs.v9ns1.15788
  • Deliktas, A., & Kukulu, K. (2018). A meta‐analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia. Journal of Advanced Nursing, 74, 263–278. https://doi.org/10.1111/jan.13447
  • El-Glil, A., Ibrahim, H., & Kandeel, H. (2025). Effect of Upright Versus Recumbent Positions During on Feto-maternal Outcomes During the Active Phase of Labor Among Primiparae. Egyptian Journal of Health Care. https://doi.org/10.21608/ejhc.2025.456360
  • Gupta, J., Sood, A., Hofmeyr, G., & Vogel, J. (2017). Position in the second stage of labour for women without epidural anaesthesia.. The Cochrane database of systematic reviews, 5, CD002006. https://doi.org/10.1002/14651858.cd002006.pub4
  • Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230
  • Jyoti, R., Sharma, M., & Pareek, S. (2022). The effects and outcomes of different maternal positions on the second stage of labor. MRIMS Journal of Health Sciences, 10, 21 - 24. https://doi.org/10.4103/mjhs.mjhs_49_21
  • Kibuka, M., & Thornton, J. (2017). Position in the second stage of labour for women with epidural anaesthesia.. The Cochrane database of systematic reviews, 2, CD008070. https://doi.org/10.1002/14651858.cd008070.pub3
  • Kibuka, M., Price, A., Onakpoya, I., Tierney, S., & Clarke, M. (2021). Evaluating the effects of maternal positions in childbirth: An overview of Cochrane Systematic Reviews. European Journal of Midwifery, 5. https://doi.org/10.18332/ejm/142781
  • Liu, H., Li, L., Wang, X., Zhu, X., Sun, L., Zhu, C., Min, H., & Gu, C. (2025). Effectiveness of nulliparous women's different childbirth positions during the second stage of labor: A systematic review and network meta-analysis. International Journal of Nursing Sciences, 12, 268 - 275. https://doi.org/10.1016/j.ijnss.2025.04.006
  • Mtatina, A., Mselle, L., Mwakawanga, D., Sando, D., & Mkoka, D. (2022). Maternal and New-Born Outcomes When Using Upright and Supine Birth Positions During Labour and Delivery: A Quasi-Experimental Study. American Journal of Health, Medicine and Nursing Practice. https://doi.org/10.47672/ajhmn.1076
  • Rani, K., Ravi, R., Attri, V., Kaur, H., Pareek, B., & Baby, P. (2024). Impact of Upright Position during the First Stage of Labour on Maternal Outcomes: A Randomized Controlled Trial.. Reviews on recent clinical trials. https://doi.org/10.2174/0115748871320194240820202103
  • Shahriari, A., Nataj-Majd, M., Akrami, M., Khooshideh, M., & Soleimani, M. (2024). Upright Versus Recumbent Position in the Second Stage of Labor for Women With Epidural Analgesia: A Randomized Clinical Trial. ACTA MEDICA IRANICA. https://doi.org/10.18502/acta.v61i11.16076
  • Wagh, R., Bangal, V., & Jondhale, P. (2025). A COMPARATIVE ANALYSIS OF MATERNAL AND PERINATAL OUTCOMES IN SUPINE VERSUS UPRIGHT BIRTHING POSITIONS AT A TERTIARY CARE TEACHING HOSPITAL IN MAHARASHTRA. International Journal of Advanced Research. https://doi.org/10.21474/ijar01/20483
  • Walker, K., Kibuka, M., Thornton, J., & Jones, N. (2018). Maternal position in the second stage of labour for women with epidural anaesthesia.. The Cochrane database of systematic reviews, 11, CD008070. https://doi.org/10.1002/14651858.cd008070.pub4
  • X, N., Chanchal, A., & Subhashini, K. (2024). Effect of Upright Position versus Conventional Labour Position on Selected Feto - Maternal Outcomes. International Journal of Science and Research (IJSR). https://doi.org/10.21275/sr24524172246
  • Yeturi, S., Yaliwal, R., Bidri, S., Mudanur, S., Shiragur, S., & Malapure, P. (2023). A randomized parallel group trial to assess the impact of maternal birthing position on maternal and Fetal outcome. International Journal of Clinical Obstetrics and Gynaecology. https://doi.org/10.33545/gynae.2023.v7.i3a.1345
  • Zang, Y., Lu, H., Zhang, H., Huang, J., Ren, L., & Li, C. (2020). Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta-analysis.. Journal of advanced nursing. https://doi.org/10.1111/jan.14587
  • Zang, Y., Lu, H., Zhang, H., Huang, J., Zhao, Y., & Ren, L. (2020). Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews.. International journal of nursing studies, 114, 103812. https://doi.org/10.1016/j.ijnurstu.2020.103812.
  • © 2026 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by-nc-sa/4.0/).