Reduction of perineal trauma utilizing alternative birthing positions

Prior to the 1900’s women gave birth at home with midwives. During these home births women labored in many ways, utilizing walking, warm water, and emotional support from their community. After the 19th century, obstetrics became widely recognized as a medical discipline and the birthing of babies moved to hospitals. With the move came the widely used lithotomy position. While this is a convenient position for the medical team and it facilitates fetal monitoring, it may not be the most beneficial position for the mother or baby. The focus of this project was to use an integrative literature review to address the question: In laboring women, does using alternative positioning lead to reduced perineal trauma compared to the use of the lithotomy position? Current studies were identified and incorporated into an evidence table which facilitated the analysis and synthesis of the findings from the studies to make recommendations for nursing practice. Results showed a reduction in the incidence of perineal trauma, episiotomies, fetal hypoxia, and other complications when alternative positions were used. Knowing the evidence related to alternative birthing positions can help nurses educate and support those low-risk laboring women in the use of alternative positions such as squatting, kneeling, and hands and knee position. Use of these alternative positions can lead to more natural and comfortable experiences which use the force of gravity to enhance the progression of labor.