Keywords
maternal positioning
implementation barriers
neonatal outcomes
mixed-methods review
Abstract
Background: Upright birthing positions offer physiological advantages during labor, yet their implementation in health facilities remains inconsistent globally. This review synthesizes evidence on clinical outcomes, barriers, and facilitators associated with upright birthing positions.
Methods: A mixed-methods convergent integrated review was conducted. Seven databases were searched for studies published up to March 2026. Of 2,063 different studies, 70 studies (50 qualitative, 20 quantitative) were included. Random-effects models pooled effect estimates, and thematic analysis identified implementation determinants using the Consolidated Framework for Implementation Research.
Results: Upright positions significantly reduced instrumental vaginal births (RR 0.74–0.75), shortened second stage duration by 6–8 minutes, and lowered episiotomy rates (RR 0.50–0.80) among women without epidural analgesia. Second-degree perineal tears increased (RR 1.20–1.45). Neonatal outcomes were comparable or slightly improved. Implementation remained suboptimal, with only 22.6% of midwives regularly practicing dynamic positions. Major barriers included inadequate training, infrastructure deficits, and institutional norms favoring supine positioning. Training participation was the strongest predictor of implementation success.
Conclusion: Upright birthing positions confer meaningful maternal benefits without neonatal harm. Addressing multi-level implementation barriers through structured training, supportive policies, and infrastructure investment is essential for translating evidence into routine practice and advancing woman-centered maternity care.
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