The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women
Abstract
OBJECTIVES: To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women. METHODS: This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n = 51), or a supine position modified to 45 degree of semi-fowler (n = 51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups. RESULTS: The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p < 0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit. CONCLUSIONS: In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Previous research has demonstrated maternal position impacts maternal blood flow, labor progression, and patient comfort.
“Previous research efforts have also demonstrated maternal position impacts maternal blood flow, labor progression, and patient comfort (44–46).”
From Comprehensive pregnancy monitoring with a network of wireless, soft, and flexible sensors in high- and low-resource health settings (2021) · cites this paper as [44]
Cites
Position in the second stage of labour for women without epidural anaesthesia
Gupta, J. K., Sood, A., Hofmeyr, G. J., & Vogel, J. P. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002006.pub4 · Cited by 495 · see citing works
A Systematic Review of the Relationship between Blood Loss and Clinical Signs
Pacagnella, R. C., Souza, J. P., Durocher, J. M., Perel, P., Blum, J., Winikoff, B., & Gülmezoglu, A. M. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057594 · Cited by 216 · see citing works
Evidence-based labor and delivery management
Berghella, V., Baxter, J. K., & Chauhan, S. P. (2008) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2008.06.093 · Cited by 194 · see citing works
THE MECHANICAL EFFECTS OF THE GRAVID UTERUS IN LATE PREGNANCY*
Kerr, M. G. (1965) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1965.tb00061.x · Cited by 173 · see citing works
Randomised trial comparing the upright and supine positions for the second stage of labour
Jong, P. R. D., Johanson, R., Baxen, P., Adrians, V. D., van der Westhuisen, S., & Jones, P. W. (1997) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1997.tb11534.x · Cited by 114 · see citing works
MR Obstetric Pelvimetry: Effect of Birthing Position on Pelvic Bony Dimensions
Michel, S. C. A., Rake, A., Treiber, K., Seifert, B., Chaoui, R., Huch, R., Marinček, B., & Huch, R. (2002) · American Journal of Roentgenology · doi:10.2214/ajr.179.4.1791063 · Cited by 99 · see citing works
Birth Position, Accoucheur, and Perineal Outcomes: Informing Women About Choices for Vaginal Birth
Shorten, A., Donsante, J., & Shorten, B. (2002) · Birth · doi:10.1046/j.1523-536x.2002.00151.x · Cited by 95 · see citing works
RANDOMISED, CONTROLLED TRIAL OF SQUATTING IN THE SECOND STAGE OF LABOUR
Gardosi, J. O., Hutson, N., & B‐Lynch, C. (1989) · The Lancet · doi:10.1016/s0140-6736(89)90315-2 · Cited by 91 · see citing works
Best Practices in Second Stage Labor Care: Maternal Bearing Down and Positioning
ROBERTS, J. E., & Hanson, L. (2007) · Journal of Midwifery & Women s Health · doi:10.1016/j.jmwh.2006.12.011 · Cited by 74 · see citing works
A Randomized Trial of Birthing Stool or Conventional Semirecumbent Position for Second‐Stage Labor
Waldenström, U., & Gottvall, K. (1991) · Birth · doi:10.1111/j.1523-536x.1991.tb00045.x · Cited by 57 · see citing works
Gupta, J. K., & Nikodem, C. (2000) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/s0301-2115(99)00272-9 · Cited by 54 · see citing works
Thies‐Lagergren, L., Kvist, L. J., Christensson, K., & Hildingsson, I. (2011) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-11-22 · Cited by 51 · see citing works
Women’s position during labour: influence on maternal and neonatal outcome
Bodner‐Adler, B., Bodner, K., Kimberger, O., Lozanov, P., Husslein, P. W., & Mayerhofer, K. (2003) · Wiener klinische Wochenschrift · doi:10.1007/bf03040889 · Cited by 47 · see citing works
Ragnar, I., Altman, D., Tydén, T., & Olsson, S. (2006) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2005.00824.x · Cited by 44 · see citing works
Child birth in squatting position.
Nasir, A., Korejo, R., & Noorani, K. J. (2007) · PubMed · Cited by 32 · see citing works
CHILDBIRTH CARE-SEEKING BEHAVIOR IN CHIAPAS
Hunt, L. M., Glantz, N. M., & Halperin, D. C. (2002) · Health Care For Women International · doi:10.1080/073993302753428465 · Cited by 32 · see citing works
From social to surgical: Historical perspectives on perineal care during labour and birth
Dahlen, H. G., Homer, C., Leap, N., & Tracy, S. (2010) · Women and Birth · doi:10.1016/j.wombi.2010.09.002 · Cited by 26 · see citing works
Delivery positions and perineal outcome
ROBERTS, J., & KRIZ, D. (1984) · Journal of Nurse-Midwifery · doi:10.1016/0091-2182(84)90202-7 · Cited by 21 · see citing works
Postpartum vulvar edema associated with the birthing chair
Goodlin, R. C., & Frederick, I. B. (1983) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(83)90758-5 · Cited by 15 · see citing works
#5: Non-Supine (e.g., Upright or Side-Lying) Positions for Birth
Keen, R., DiFranco, J. T., Amis, D., & Albers, L. L. (2004) · The Journal of Perinatal Education · doi:10.1624/105812404982376 · Cited by 6 · see citing works
#5: Non-Supine (e.g., Upright or Side-Lying) Positions for Birth.
Keen, R., DiFranco, J. T., Amis, D., et al. (2004) · PubMed · doi:10.1624/105812404x109519 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pushing/bearing down methods for the second stage of labour
Lemos, A., Amorim, M. M. R., de Andrade, A. D., de Souza, A. I., Filho, J. E. C., & Correia, J. B. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009124.pub3 · Cited by 161 · see citing works
Badi, M. B., Lindgren, H. E., Christensson, K., Mekonnen, S., & Adefris, M. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2620-0 · Cited by 108 · see citing works
Ryu, D., Kim, D. H., Price, J. T., Lee, J. Y., Chung, H. U., Allen, E., Walter, J. R., Jeong, H., Cao, J., Kulikova, E., et al. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2100466118 · Cited by 105 · see citing works
Risk Factors for the Development of Obstetric Anal Sphincter Injuries in Modern Obstetric Practice
Ramm, O., Woo, V. G. H., Hung, Y., Chen, H.-C., & Weintraub, M. R. (2018) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000002444 · Cited by 92 · see citing works
A review and comparison of common maternal positions during the second-stage of labor
Huang, J., Zang, Y., Ren, L., Li, F., & Lu, H. S. (2019) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2019.06.007 · Cited by 92 · see citing works
Liese, K. L., Davis‐Floyd, R., Stewart, K., & Cheyney, M. J. (2021) · Anthropology and Medicine · doi:10.1080/13648470.2021.1938510 · Cited by 59 · see citing works
Zang, Y., Lu, H., Zhao, Y., Huang, J., Ren, L.-H., & Li, X. (2020) · Journal of Clinical Nursing · doi:10.1111/jocn.15376 · Cited by 35 · see citing works
Zang, Y., Lu, H. S., Zhang, H., Huang, J., Zhao, Y., & Ren, L. (2020) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2020.103812 · Cited by 35 · see citing works
Zang, Y., Lu, H. S., Zhang, H., Huang, J., Ren, L., & Li, C. (2020) · Journal of Advanced Nursing · doi:10.1111/jan.14587 · Cited by 23 · see citing works
Lin, Y., Gau, M., Kao, G.-H., & Lee, H. (2018) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000262 · Cited by 22 · see citing works
da Silva, M. L., Santos, T. A. B. P. D. S., Leite, L. W. C., da Silva, C. E. C., do Nascimento, A. O., Alves, A. T., Driusso, P., & Cunha, K. D. C. (2023) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2023.02.008 · Cited by 20 · see citing works
Impact of maternal posture on fetal physiology in human pregnancy: a narrative review
Kember, A. J., Anderson, J. L., House, S. C., Reuter, D. G., Goergen, C. J., & Hobson, S. R. (2024) · Frontiers in Physiology · doi:10.3389/fphys.2024.1394707 · Cited by 17 · see citing works
Squatting position in the second stage of labor: A systematic review and meta-analysis
Dokmak, F., Michałek, I. M., Boulvain, M., & Desseauve, D. (2020) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2020.09.015 · Cited by 16 · see citing works
Zang, Y., Hu, Y., & Lu, H. S. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16276 · Cited by 14 · see citing works
Zanfini, B. A., Catarci, S., Vassalli, F., Longo, V. L., Biancone, M., Carducci, B., Frassanito, L., Lanzone, A., & Draisci, G. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11206124 · Cited by 14 · see citing works
Upright kneeling position during second stage of labor: a pilot study
Dabral, A., Pawar, P., Bharti, R., Kumari, A., Batra, A., & Arora, R. (2017) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20175930 · Cited by 12 · see citing works
Zang, Y., Lu, H. S., Zhang, H., Zhang, X., Yang, M., & Huang, J. (2021) · Midwifery · doi:10.1016/j.midw.2021.102993 · Cited by 11 · see citing works
Exploring the perspective of nursing staff or caregivers on birthing positions in Central India
Yadav, A., Kamath, A. A., Mundle, S. R., Baghel, J., Sharma, C., & Prakash, A. (2021) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_2066_20 · Cited by 10 · see citing works
Badi, M. B., Abebe, S. M., Weldetsadic, M. A., Christensson, K., & Lindgren, H. E. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159637 · Cited by 8 · see citing works
Sayıner, F. D., Öztürk, D. M., Ulupınar, E., Velipaşaoğlu, M., & Çorumlu, E. P. (2019) · The Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2019.1670162 · Cited by 8 · see citing works
Familiari, A., Neri, C., Passananti, E., Marco, G. D., Felici, F., Ranieri, E., Flacco, M. E., & Lanzone, A. (2023) · AJOG Global Reports · doi:10.1016/j.xagr.2023.100160 · Cited by 7 · see citing works
Carpenter, J., Burns, E., & Smith, L. (2022) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13315 · Cited by 6 · see citing works
Şahın, D., Tanaçan, A., & Tekın, Ö. M. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.07.016 · Cited by 6 · see citing works
Shedmake, P., & Wakode, S. R. (2021) · The Journal of Obstetrics and Gynecology of India · doi:10.1007/s13224-021-01439-4 · Cited by 5 · see citing works
Savla, R., Mullerpatan, R., Agarwal, B. M., Kuttan, V., & Kumar, S. (2024) · International journal of exercise science · doi:10.70252/vgak1504 · Cited by 4 · see citing works
Martín‐Vázquez, C., Goás-Gómez, N., Calvo‐Ayuso, N., Matilla, L. R., Sánchez, E. Q., & Fernández, R. G. (2024) · Healthcare · doi:10.3390/healthcare12040441 · Cited by 3 · see citing works
Redefining Second Stage of Labor: Number of Pushing Contractions
Bok, S. M., Carmona, G. P., Crawford, J., Eskander, R., Desai, M., & Ross, M. G. (2020) · American Journal of Perinatology Reports · doi:10.1055/s-0040-1709982 · Cited by 3 · see citing works
Zang, Y., Huang, J., Zhang, H., Sun, K., Li, X., Wang, D., Tao, W. Y., Xing, L., Fu, L., Hou, R., et al. (2023) · Midwifery · doi:10.1016/j.midw.2023.103801 · Cited by 4 · see citing works
Liu, H., Li, L., Wang, X., Zhu, X., Sun, L. L., Zhu, C., Min, H., & Gu, C. (2025) · International Journal of Nursing Sciences · doi:10.1016/j.ijnss.2025.04.006 · Cited by 2 · see citing works
Free positions in the second stage of labor for pelvic floor protection: a narrative review
Yan, L., Mao, Y., Lin, Q., Xie, X., Chen, C., Zhong, J., & Tao, E. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1716862 · Cited by 2 · see citing works
Mtatina, A. V., Mselle, L. T., Mwakawanga, D. L., Sando, D. M., & Mkoka, D. A. (2022) · American Journal of Health Medicine and Nursing Practice · doi:10.47672/ajhmn.1076 · Cited by 2 · see citing works
Dunmez, F., & Yılmaz, T. (2023) · Japan Journal of Nursing Science · doi:10.1111/jjns.12580 · Cited by 2 · see citing works
Management of the third stage of labour by Basotho traditional birth attendants
Fobo, K. N., Kovane, G. P., & Minnie, K. (2024) · Health SA Gesondheid · doi:10.4102/hsag.v29i0.2372 · Cited by 2 · see citing works
Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes
Siriwardena, S. M. A., Perera, P. A. M., & Karunasingha, J. (2024) · Open Journal of Obstetrics and Gynecology · doi:10.4236/ojog.2024.142026 · Cited by 2 · see citing works
The effects and outcomes of different maternal positions on the second stage of labor
Jyoti, R. C., Sharma, M., & Pareek, S. (2022) · MRIMS Journal of Health Sciences · doi:10.4103/mjhs.mjhs_49_21 · Cited by 2 · see citing works
Yetişmiş, H. Y., & Derya, Y. A. (2023) · Journal of Clinical Obstetrics & Gynecology · doi:10.5336/jcog.2023-99511 · Cited by 1 · see citing works
Das, D., & Kaur, G. (2025) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20250550 · Cited by 1 · see citing works
Mohammed, O. Y., Erlandsson, K., Seyoum, T., Hailemeskel, S., Gezie, L. D., & Lindgren, H. E. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-025-08051-8 · Cited by 1 · see citing works
Melito, C., Rizzo, L., Yurhel, L., Corno, E., Renzetti, S., Malvezzi, M., Frati, F., Neri, S., Ghi, T., & Dall’Asta, A. (2026) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.70230 · Cited by 1 · see citing works
Variables clínicas del parto en posición vertical y horizontal: Revisión exhaustiva de literatura
Cuy-Chaparro, L., Jiménez, D. R. S., Riaño-Carreño, D. M., Villalba, G. E. C., Sánchez-Capacho, N., & Bringas, R. S. (2021) · Revista Investigación en Salud Universidad de Boyacá · doi:10.24267/23897325.601 · Cited by 1 · see citing works
Çömelme pozisyonunun doğum süresi ve ağrı algılama düzeyine etkisi
Taşgın, Z. D. Ü. (2023) · Anatolian Journal of Health Research · doi:10.29228/anatoljhr.71307 · Cited by 1 · see citing works
A comparative study on child birth experience of mothers at tertiary care hospital
Lovely, L., Gokhale, A. V., & Agarwal, S. N. (2024) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20241435 · Cited by 1 · see citing works
Veazie, S., Gilbert, J., Winchell, K. A., Paynter, R. A., & Guise, J. (2019)
Effect of an Ergonomic Ankle Support for Squatting Position on Labor progress and maternal outcome
Ahmed, A. H., Alam, T. H. M., & Hassan, N. M. (2021) · Egyptian Journal of Health Care · doi:10.21608/ejhc.2021.159853
Chávez, S. S., Trujillo, R. V., Armenta, J. A. A., González-Aldeco, P. M., & Ayala, C. R. (2022) · Acta Médica Grupo Ángeles · doi:10.35366/103555
Uka, V. K. (2023) · Journal of Pharmaceutical Negative Results · doi:10.47750/pnr.2023.14.03.28
Samakya, S., V, Pati, S., & Acharya, S. K. (2024) · Nursing & Midwifery Research Journal · doi:10.1177/0974150x241236654
Alkan, G. Z., Kaya, H. D., & Günaydın, S. (2024) · Kastamonu Üniversitesi Sağlık Bilimleri Fakültesi Dergisi · doi:10.59778/sbfdergisi.1521278
Birthing Position: The Impact on Second Stage of Labor— A Randomized Parallel Trial
Shiragur, S. S., Jain, S., Yaliwal, R. G., & Bidri, S. R. (2025) · Journal of South Asian Federation of Obstetrics and Gynaecology · doi:10.5005/jp-journals-10006-2664
Gong, J., Xie, B., Wei, Y., Fu, L., Xing, L., Liu, X. H., & Li, X. (2026) · Healthcare · doi:10.3390/healthcare14121681
- Authors
- Moraloglu, O., Kansu-Celik, H., Tasci, Y., Karakaya, B. K., Yilmaz, Y., Cakir, E., & Yakut, H. I.
- Affiliations
- Zekai Tahir Burak Kadın Sağlığı Eğitim ve Araştırma Hastanesi (TR)
- Corresponding author
- Kansu-Celik, Hatice
- Venue
- The Journal of Maternal-Fetal & Neonatal Medicine
- Publisher
- Informa UK Limited
- Published
- 2016-04-19
- Volume
- 30
- Issue
- 2
- Pages
- 245-249
- ISSN
- 1476-4954 (ISSN-L)
- 1476-7058
- OpenAlex
- W2334553203
- Cited by
- 52
- References
- 20
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 6 · 2019: 4 · 2018: 3 · 2017: 2
- FWCI
- 3.87
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Maternal-Fetal & Neonatal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Health Sciences › Medicine › Epidemiology › Breastfeeding Practices and Influences
- Keywords
- squatting position, supine position, second stage of labor, nulliparous women, labor duration, maternal pain, oxytocin requirement, postpartum blood loss, neonatal outcomes, fetal heart rate monitoring, Turkish women
- MeSH terms
- Adult, Female, Humans, Infant, Newborn, Labor Stage, Second, Pregnancy, Prospective Studies, Time Factors, Turkey, Supine Position, Delivery, Obstetric, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
