Midwife Rebecca Tinker’s research into how simple changes in position during labour significantly improve birth outcomes for women has tapped into a career-long concern. Moving for better births
In 2020, she was working on a workplace audit as part of a project for her Clinical Midwife Specialist role at Royal North Shore Hospital (RNSH). “I feel really passionate about women being able to birth as normally as possible and about trying to reduce unnecessary medical intervention where we can,” she says. “A lot of the time we can’t, because it could be [a case of] fetal distress or something out of our control, but I really felt that midwives could do a bit more with our skills, that we can help women to push more effectively using positioning, which is quite simple but underrated.” As part of her project, Rebecca decided to audit the birth experiences of 426 women to look at what positions they used during labour and the outcomes, such as tearing in the perineum, which is the area between the vagina and the anus. “I made up a form so that during the pushing period, midwives would jot down when the woman changed position and what position they changed into.” From here, Rebecca could calculate how long women spent in each position and how often they moved or changed position. “There was fantastic support for the project form my midwifery sisters.” Encouraged to do a more formal study, in 2022, Rebecca looked at 330 first-time mothers, again focusing on positioning during the second stage of labour. Her findings showed that women who spent more time in upright positions were more likely to have a normal vaginal birth, while those who spent more time on their backs had higher rates of instrumental delivery. “For every [additional] 10 per cent of the women’s pushing time spent in upright positions, they had a 26 per cent greater chance of having a physiological birth or a vaginal birth without intervention.”
“For every 10 per cent of their time they spent in a supine position, so on their back, they had a 30 per cent greater chance of having an instrumental delivery.” Rebecca says the results highlight the importance of movement and positioning during labour. If a woman is upright, there will be better blood flow to the placenta, which means the baby has less stress. “It’s just one factor,” she says. “There’s nothing in having a baby or obstetrics that’s 100 per cent. Everything is very individual. You’ll never get a straight answer.” Rebecca says the findings are already beginning to influence practice, with more midwives encouraging women to move into different positions and to use a birth stool. “It’s very effective to sit on a birth stool. It’s a really good position,” she says. She says the registrars are also taking on some of the findings of the research. “There is slow, slow change,” she says. “It’s a cultural change as well.” Part of the challenge is that expectations around birth are still often shaped by media portrayals that do not reflect clinical reality. “What people see in the media is women with their legs up in stirrups. That’s how it is on TV but it’s not like that at all.” Rebecca hopes the research will help strengthen
evidence-based practice and encourage a broader understanding of what supports safer, more positive birth experiences. “There’s a lot of value in some of the old practices before the
medicalisation of birth but also value in testing them properly.”
Rebecca Tinker
32 Tomorrow’s medicine today
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