The management framework of upright position in the second stage of labour: A qualitative study

Upright positions, as a non-pharmacological, have been well documented in multiple studies to promote normal labor, facilitate favourable birth outcomes and positive childbirth experience. Yet, the application status of upright positions in China, and even globally, is unfavourable. Thus, we have developed the Program for Upright Positions in the Second Stage of Labor (UPSSL program) for the widespread application of upright positions. While there is limited research evidence on the areas of improvement and corresponding strategies for embedding the evidence into midwifery practice.

To explore perspectives of health care providers on improvement areas of upright positions in the second stage of labor, and to identify corresponding strategies in order to develop a management framework for successful implementation of upright positions.

A qualitative descriptive design with semi-structured interviews was conducted in the study. The participants involving 13 midwives, six obstetricians and six department managers were selected from three hospitals in Beijing, China. ATLAS.TI 8 software was utilized to manage, identify the transcript data, and the thematic analysis method guided the data analysis.

A management framework of upright positions in the second stage of labor was developed based on our study, which included five improvement areas : (1) promoting the renewal of midwifery notions and the professional training;(2) strengthening maternal health education based on the "trinity" approach; (3) promoting multidisciplinary cooperation and refining the labor procedures in upright positions; (4) optimizing midwifery human resource allocation and formulating incentive policies; (5) encouraging partner involvement and improving the birth environment.

The study findings could provide a comprehensive view to promote UPSSL Program to be utilized in practice. Our study also provided a way for midwives, obstetricians, and other healthcare providers to work together to facilitate high quality maternal care.

Our findings will be useful for nursing managers to carry out the UPSSL program through several strategies, such as strengthening the professional training for assisting labor in the upright positions, reallocating midwifery human resources, and developing the childbirth education on the upright positions.