US Nurses' Practices on Maternal Position Changes During Labor

The purpose of this study was to describe US nurses' perspectives and practices on maternal position changes during labor.

We conducted a national survey of nurses working in labor and delivery units in the past year.

The survey was disseminated through social media and email with snowball sampling. Our primary objective was to characterize the proportion of nurses using position changes during labor and nurses' reported indications for position changes. Secondary outcomes included the use of position change circuits and reasons position changes were not initiated. We used descriptive statistics to characterize responses and bivariate analyses to compare respondents who reported circuit use in their practice to those who did not.

Among 498 respondents, 99% reported using maternal position changes during labor and 96% believed labor maneuvers are effective and improve outcomes. Nurses routinely reported using positional maneuvers for indications of slow labor progress, suspected occiput posterior, and suspected asynclitic fetal position. Commonly reported reasons for not using position changes included patient BMI, patient preference, fetal monitoring, and a lack of knowledge. Approximately two-thirds of nurses using maneuvers included a circuit of positions. Of the 20 listed maneuvers in the survey, seven were used by >50% of respondents and most likely to be used in a circuit of position changes. Use of circuits was more common among younger nurses. Region of the country was not a factor in use of circuits.

Position changes are a frequently used intrapartum intervention with limited high-quality supporting evidence linking specific positions or circuits of positions to specific labor and birth outcomes. Further research is needed on the effectiveness of circuit-based position changes in labor, especially in cases of prolonged first stage of labor.