Positions during the first stage and the passive second stage of labor: A survey of French midwives

Abstract

Objective: the objective of our study was to describe the practices reported by French midwives during labor (first stage and passive phase of the second stage).

Design: this cross-sectional internet questionnaire surveyed French midwives who attended at least one delivery in 2013.

Setting: this open survey was posted on a website from June 15 through December 1, 2014.

Participants: 1496 midwives from 377 maternity units participated in the study. Nearly 93% of the midwives worked in an obstetric unit, 5.9% had a mixed practice, and 1.3% worked in private practice.

Measurements and findings: during the first stage of labor, midwives reported suggesting that women without epidural analgesia use a birthing ball (98.1%) and that they walk around (97.4%). For women with epidural analgesia, most suggested motion in horizontal positions. Epidural analgesia was proposed more often by midwives from level II (75.7%) and level III (73.5%) maternity wards than by those at level 1 units (57.7%) (p<0.0001). The midwives preferred a lateral position during the first stage for women with epidural analgesia and during the second stage for women both with and without it. Midwives in practice for 5 years or less suggested a kneeling position for women with epidural analgesia more often than more experienced midwives.

Key conclusion: the practices of French midwives vary with their place of practice and their experience.

Implications for practice: to promote normal labor, French midwives must reappropriate vertical positions and analgesic alternatives to epidurals.

Keywords: Labor; Lateral position; Maternal position; Medicalization of childbirth; Midwifery practice.