Effect of an Alternative Birthing Positions Educational Intervention on Birth Outcomes among Parturient Women in Western Kenya

Resumen

Context: The second stage of labor is a critical phase that significantly influences maternal and neonatal outcomes. Although alternative birthing positions such as squatting, side-lying, kneeling, and all-fours have been shown to improve birth outcomes, their adoption in many low-resource settings remains low. In Kenya, most women deliver in the lithotomy position, often due to limited awareness, lack of provider support, and restrictive facility practices. Antenatal education may play a vital role in empowering women to adopt evidence-based birthing positions that improve delivery outcomes.

Aim: The study aims to assess the effect of an educational intervention regarding alternative birthing positions on birth outcomes among parturient women in Western Kenya.

Methods: This study utilized a (nonequivalent control group) quasi-experimental design. A total of 481 pregnant women in their third trimester were enrolled from two comparable referral hospitals, with 238 allocated to the intervention group and 243 to the control group. The intervention group received a structured antenatal educational program on alternative birthing positions, while the control group received routine antenatal care. Data was collected using structured questionnaires, observational checklists, and maternity records.

Results: The intervention group experienced a significantly shorter mean duration of second-stage labor (18.9 minutes vs. 62.1 minutes in the control group; t=-18.8, p<0.0001). There was a significant reduction in the rate of episiotomy among the intervention group (4.7% compared to the control group (95.3%), which remained high (χ2 = 306.7, p<0.0001) and intact perineum (62.1.1% vs. 37.9%, p <0.0001) in the intervention versus the control group. Spontaneous vaginal delivery was 56.0% among the intervention group vs. 44% in the control group with p<0.0001. Neonates born to mothers in the intervention group had higher Apgar scores at one minute (≥7) compared to those in the control group (57.4% vs. 42.6%, χ2 = 20.8, p<0.0001).

Conclusion: The educational intervention significantly improved maternal and neonatal outcomes by promoting the use of alternative birthing positions. The use of alternative birthing positions during the second stage of labor results in shorter labor, fewer medical interventions, and improved maternal and neonatal outcomes.