Determinants of the utilisation of alternative birthing positions during the second stage of labour among parturient women in Western Kenya: A cross-sectional study

Abstract

The position chosen by mothers during labour’s second stage plays a vital but frequently neglected role in determining labour outcomes. Despite the link between alternative birthing positions like squatting, kneeling and side-lying with better maternal comfort and neonatal results along with faster labor durations, the lithotomy position continues to be the primary practice at many Kenyan health institutions. The identification of variables that affect the use of alternative birthing positions is a foundational element in developing interventions that support evidence-based and respectful maternity care. This study aims to identify the determinants that affect the use of alternative birthing positions during the second stage of labour among pregnant women in Western Kenya. The research was cross-sectional analytical study with 396 postpartum women at two referral hospitals located in Western Kenya. Participants were selected using systematic random sampling. Structured interviewer-administered questionnaires collected data, which were then analysed using SPSS version 28. The study employed descriptive statistics to summarize socio-demographic characteristics and applied chi-square tests along with multivariate logistic regression to identify factors linked to the utilization of alternative birthing positions. Statistical significance was determined by p-values lower than 0.05. A minority of 25.8% of women selected alternative birthing positions for delivery compared to the majority who chose the lithotomy position with 74.2%. Women who had access to information about birthing positions (AOR = 3.88, p < .001), received provider encouragement (AOR = 4.91, p < .001), used birthing aids (AOR = 2.76, p = .007), and chose upright positions (AOR = 3.42, p < .001) showed significant increases in their use of alternative birthing positions. The use of alternative birthing positions was not significantly related to socio-demographic factors such as age or parity, though there were weak associations with marital status and level of education. The use of alternative positions depends on healthcare provider practices in giving information and support to parturient mothers, together with the preparedness of healthcare facilities with available birthing aids to support alternative birthing positions and women's understanding on alternative birthing options. Socio-demographic factors had no significant influence in the utilization of alternative birthing positions. Antenatal education programs need to provide information about different birthing position choices. Healthcare facilities should be adequately equipped with appropriate birthing aids and resources to support the use of alternative birthing positions.