Effect of Upright (‘all Fours’) Versus Lithotomy Birth Position on Obstetric Outcomes Among Low-risk Parturients at Kenyatta National Hospital; a Mixed Method Study

Abstract

Introduction The World Health Organisation endorsed that parturients, without epidural anaesthesia, should deliver in a position of their preference including upright positions during the delivery process. Studies from high-, middle- and low-income countries found upright positions (foe example the ‗all fours‘) to be beneficial due to its documented significant benefits such as a reduction in instrumental deliveries, perineal tears and duration of second stage over recumbent positions (lithotomy) position. Parturient‘s in Kenya are still encouraged to adopt lithotomy birth position during childbirth. The acceptability and effect of upright birth position on labour and delivery outcomes has not been evaluated in Kenya. The findings of this study will provide insight on local and regional policy and guide providers on the health outcomes associated with parturient birthing position, if adopted. Objective To compare obstetric outcomes in the ‗all-fours‘ versus lithotomy birth positions among low risk parturients during second stage of labour at Kenyatta National Hospital (KNH) Methodology Study design: Mixed method study with a hospital based, two arm, open label parallel randomised controlled trial and qualitative component In-Depth Interviews (IDI) and Focus Group Discussion (FGD). Study population: 490 low-risk parturients in whom vaginal delivery is anticipated. Intervention: ‗all fours‘ (experimental group) birth position Control: lithotomy (control group) birth position Outcomes: Primary – mean duration of second stage, incidence of composite adverse maternal outcomes (perineal tears, postpartum haemorrhage, Caesarean Section (C/S), assisted vaginal deliveries, episiotomies and shoulder dystocia) and neonatal outcomes (5 minute APGAR score <7, resuscitation, and admission to New-Born Unit. Secondary - parturients‘ and midwives‘ perceptions of the birth positions.