Published: 2018-01-23

Upright kneeling position during second stage of labor: a pilot study

Anjali Dabral, Pallavi Pawar, Rekha Bharti, Archana Kumari, Achla Batra, Renu Arora


Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.

Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.

Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.

Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.


Apgar Score, Delivery, Labor, Neonatal Intensive Care Unit, Patient satisfaction, Second stage

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Munro J, Jokinen M, Gutteridge K, Macdonald S, Day-Stirk F. The Royal College of Midwives’ Survey of positions used in labour and birth. London: Royal College of Midwives (RCM) 2010.

Lavender T Mlay R. Position in the second stage of labour for women without epidural anesthesia: RHL commentary (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.

Kerr MG, Scott DB, Samuel E. Studies of the Inferior Vena Cava in Late Pregnancy. Br Med J 1964;1(5382):522-4, 532-533.

Caldeyro-Barcia R, Noriega-Guerra L, Cibils LA, Alvarez H, Poseiro JJ, Pose SV, et al. Effect of position changes on the intensity and frequency of uterine contractions during labor. Am J Obstet Gynecol 1960;80(2):284– 90.

Méndez-Bauer C, Arroyo J, García Ramos C, Menéndez A, Lavilla M, Izquierdo F, et al. Effects of standing position on spontaneous uterine contractility and other aspects of labor. J Perinat Med 1975;3(2):89-100.

Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2012 May 16;(5):CD002006. doi: 10.1002/14651858.

Gupta JK, Glanville JN, Johnson N, Lilford RJ, Dunham RJ, Watters JK. The effect of squatting on pelvic dimensions. Eur J Obstet Gynecol Reprod Biol 1991;42(1):19-22.

Ragnar I, Altman D, Tydén T, Olsson SE. Comparison of the maternal experience and duration of labour in two upright delivery positions--a randomised controlled trial. BJOG 2006;113(2):165-70.

Gardosi J, Sylvester S, B-Lynch C. Alternative positions in the second stage of labour: a randomized controlled trial. Br J Obstet Gynaecol 1989;96(11):1290-6.

Stewart P, Spiby H. A randomized study of the sitting position for delivery using a newly designed obstetric chair. BJOG 1989;96(3):327–33.

Crowley P, Elbourne D, Ashurst H, Garcia J, Murphy D, Duignan N. Delivery in an obstetric birth chair: a randomized controlled trial. BJOG 1991;98(7):667-74.

Waldenström U, Gottvall K. A randomized trial of birthing stool or conventional semirecumbent position for second-stage labor. Birth. 1991;18(1):5-10.

Bomfim-Hyppólito S. Influence of the position of the mother at delivery over some maternal and neonatal outcomes. Int J Gynaecol Obstet. 1998;63 Suppl 1:S67-73.

Racinet C, Eymery P, Philibert L, Lucas C. Labor in the squatting position. [A randomized trial comparing the squatting position with the classical position for the expulsion phase] [abstract]. J Gynecol Obstet Biol Reprod (Paris). 1999;28(3):263-70.

Jahanfar S, Amini L, Jamshidi R. Third and fourth stages of labour: sitting position. BJM 2004;12(7):437-46.

Moraloglu O, Kansu-Celik H, Tasci Y, Karakaya BK, Yilmaz Y, Cakir E, et al. The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women. J Matern Fetal Neonatal Med 2017;30(2):245-9.

Gardosi J, Hutson N, B-Lynch C. Randomised, controlled trial of squatting in the second stage of labour. Lancet 1989;2(8654):74-7.

Suwanakam S, Linasmita V, Phuapradit W, Pongruengphant P. The effects of sitting position on the second stage of labor. J Med Assoc Thai 1988;71(Suppl 1):72-5.

Ganapathy T. Childbirth in Supported Sitting maternal position. IJONE 2012;4(2):87-91.

Bhardwaj N, Kukade JA, Patil S, Bhardwaj S. Randomised controlled trial on modified squatting position of delivery. Indian J Matern Child Health 1995;6(2):33-9.

Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev 2017;5:CD002006. doi: 10.1002/14651858.

Nasir A, Korejo R, Noorani KJ. Child birth in squatting position. J Pak Med Assoc. 2007;57(1):19-22.

Radkey AL, Liston RM, Scott KE, Young C. Squatting: Preventive medicine in childbirth? [abstract]. In: Proceedings of the annual meeting of the Society of Obstetricians and Gynaecologists of Canada. Toronto: Canada, 1991:76.

de Jong PR, Johanson RB, Baxen P, Adrians VD, van der Westhuisen S, Jones PW. Randomised trial comparing the upright and supine positions for the second stage of labour. Br J Obstet Gynaecol. 1997;104(5):567-71.

Turner MJ, Romney ML, Webb JB, Gordon H. The birthing chair: an obstetric hazard? J Obstet Gynaecol 1986;6:232–5.

Allahbadia GN, Vaidya PR. Why deliver in the supine position? Aust N Z J Obstet Gynaecol. 1992;32(2):104-6.

Terry RR, Westcott J, O'Shea L, Kelly F. Postpartum outcomes in supine delivery by physicians vs nonsupine delivery by midwives. J Am Osteopath Assoc. 2006;106(4):199-202.