Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.

Objective To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience.Design A randomised controlled trial.Setting A county hospital delivery ward.Sample Primiparous subjects (n = 271) were randomly allocated to a kneeling (n = 138) or a sitting (n = 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial.Methods Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis.Main outcome measure Duration of the second stage of labour.Results A comparison of the duration of the second stage of labour (kneeling 48.5 minutes ± 27.6 SD, sitting 41 minutes ± 23.4 SD) revealed no significant difference between the groups.A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P = 0.002), less comfort for giving birth (P = 0.03) and more frequent feelings of vulnerability (P = 0.05) and exposure (P = 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) ( Table 3).Conclusions Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.Keywords Delivery, labour, randomised, second stage.Please cite this paper as: Ragnar I, Altman D, Tydén T, Olsson S-E. Maternal experience and duration of second stage of labour comparing two upright delivery positions-a randomised controlled trial.

A study was carried out in Sweden in 1998 and its purpose was to survey Swedish labour wards and the conditions under which Swedish midwives work. Sweden has a population of almost 9 million and more than 99% of all births take place in hospitals. Sweden has 55 labour units and births annually varying from 214 to 5074. Thirty four per cent of the midwives working in maternity care worked only in the labour ward and 24% worked in integrated labour and postnatal wards. Forty two per cent of the midwives rotated between labour and postnatal, gynaecological or antenatal care units. Thirty one per cent of the maternity clinics used computerized clinical records. Regular internal training for midwives occurred at 78% of the labour wards. Research and development projects carried out by midwives were reported by over half of the clinics. There are many small labour wards in Sweden, but this is a necessity because of the long distances between cities and towns in the northern part of Sweden.