Hospital Midwives' Barriers when Facilitating Upright Positions during a Normal Second Stage of Labour

Abstract

Despite evidence that supports the utilisation of upright positions in the second stage of labour, women who choose to give birth in a hospital are more likely to give birth supine on a bed. Little evidence about this aspect of midwifery practice exists currently. The focus of this review is on identifying the barriers midwives face in the promotion of upright positions during the second stage of normal labour. Bhaskar’s critical realist ontology was used to answer the question: “What are the barriers that midwives face when facilitating upright positions during normal birth?” Institutionalisation of birth engendered a practice that is dominated by medical policies and procedures, thereby making it difficult for midwives to offer women alternatives to bed birth. The midwifery labour ward culture together with an expectation that practitioners would conform to perceived norms further inhibited midwives’ promotion of upright positions in the second stage of labour. The findings of this study support existing research in the difficulties that midwives face in promoting normal birth in institutional settings dominated by obstetrics. Given the paucity of literature in Africa, more research in African midwives’ promotion and facilitation of upright positions in the second stage of labour is required. However, given the similarities in the role of the midwife and maternity systems the findings of this review can be applied and understood within an African midwifery context.