Maternal positions adopted during the expulsive second stage of labour in homebirth: a cross-sectional study in a rural Northern Nigerian community.

introductionTraditionally, women in northern Nigeria have often given birth at home and in the squatting position; this differs from what is obtainable in the contemporary practice of midwifery in Nigeria. One of the main reasons for homebirth in rural northern Nigeria is the lack of birthing options in labour at the hospitals; hence, this study sought to identify the common positions assumed in the second stage of labour and the factors associated with it during homebirth.

methodsThis was a cross-sectional study among women attending antenatal clinics at a primary, secondary, and tertiary health facilities in Birnin Kudu Local Government Area, Jigawa State, Nigeria. Using an interviewer-administered, pretested questionnaire, the positions assumed during the expulsive phase of the second stage and the factors associated with it were identified among 827 women who had previously experienced homebirth, using a systematic sampling method. The data obtained was analysed using IBM SPSS Statistics version 25. Pearson’s chi-square test was used to determine a significant association between maternal positions assumed in the second stage of labour and socio-demographic characteristics, and the regression model was used to identify the factors associated with upright position in the second stage of labour, with a significance level of the test set at p < 0.05.

resultThe upright position and its modifications were assumed by 722 (87.3%) women, which includes the squatting position in 557 (67.4%) of the cases, 84 (10.2%) were on their knees, and 81 (9.8%) sat on a stool, while 105 (12.7%) assumed the horizontal position. Factors associated with upright positions adopted in the second stage during homebirth observed at the bivariate level were no formal education and non-midwives as the birth attendant (p < 0.05). They remained independent factors associated with adopting an upright position in labour after controlling for confounders {Adjusted Odds ratio (aOR) = 2.55 and 95% confidence interval (CI) = 1.54–4.21; aOR = 23.41 95% CI 12.99–42.22; respectively}.

conclusionThe squatting position is the preferred position assumed by most women in this rural community during childbirth at home; being assisted during the birthing process by non-midwives and not having formal education are strongly associated with the adoption of the upright position in the second stage of labour at home. Efforts should be made to support women to assume their preferred second-stage position by midwives whenever the need arises.