Comparison of Maternal and Fetal Outcomes Between Lithotomy with Hands and Knees Positions for Childbirth: A Randomized Clinical Trial

Abstract

Background: The effects of various positions on birth outcomes during the second stage of labor remain a topic of controversy. The hands and knees position, characterized by a mobile sacrum, is considered one of the easier positions, although it is not commonly practiced in Iran. Objectives: The present study aimed to compare maternal and fetal outcomes between the lithotomy and hands and knees birth positions. Methods: The present study was a two-group single-blind clinical trial conducted on 72 primiparous and multiparous parturient women who were referred to selected hospitals in Isfahan, Iran, in 2022. Participants were randomly assigned to either the lithotomy or hands and knees groups after reaching full cervix dilation. Outcomes measured included the duration of the active phase of the second stage of labor, total duration of the second and third stages of labor, shoulder dystocia, bleeding, differences in hemoglobin and hematocrit levels 6 hours after birth and at the time of hospitalization, perineal tears, and neonate outcomes. Data were analyzed using independent t-test, Mann-Whitney, chi-square, and Fisher’s exact test. Results: There were no significant differences between the groups in terms of the mean duration of the active phase of the second stage of labor (P = 0.91), the total duration of the second (P = 0.93) and third stages of labor (P = 0.24), the amount of bleeding during the third and fourth stages of labor (P = 0.15), the difference in hemoglobin (P = 0.26) and hematocrit levels 6 hours after birth compared to the time of hospitalization (P = 0.07), the first- and fifth-minute Apgar scores (P = 0.32 and P = 1, respectively), the frequency of shoulder dystocia (P = 0.50), the degree of perineal tears and episiotomy (P = 0.58), the neonate’s need for hospitalization (P = 1), and the need for neonatal resuscitation (P = 0.50). Conclusions: Maternal and fetal outcomes of the hands and knees position in Iran’s hospitals are similar to the routine position, lithotomy. Therefore, mothers can choose the hands and knees position without any concerns.