Journal of Education and
Research in Nursing
Original Article

The Effects of Upright Positions in the Second Stage of Labor on Perineal Trauma and Infant Health: A Systematic Review and Meta-Analysis


Department of Pregnant School, Başakşehir State Hospital, İstanbul, Turkey


Department of Newborn Intensive Care Unit, Adnan Menderes University Hospital, Aydın, Turkey


Department of Midwifery, Aydın Adnan Menderes University Faculty of Health Sciences, Aydın, Turkey

Journal of Education and Research in Nursing 2022; 19: 383-395
DOI: 10.5152/jern.2022.09454
Read: 198 Downloads: 160 Published: 01 December 2022

Background: The World Health Organization in its intrapartum care guide states that all women should be encouraged to use different positions according to their preference for a positive birth experience. In evidence-based practices, it is recommended to use vertical positions in which the pelvis is fully mobile and the body’s harmony with gravity, movement, and blood circulation is not restricted.

Aim: This study aimed to determine the effects of vertical positions on perineal trauma and newborn health, based on primary studies on the delivery positions used in the second stage of labor.

Methods: In this study, which is a systematic review and meta-analysis, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used during the establishment of the study protocol and the writing of the article. The searches were carried out between November 2019 and January 2020 from PubMed, National Thesis Center, DergiPark, Ulakbim, MEDLINE, the Cochrane Library, and EBSCO search engines. The keywords “(mother or motherhood) and birth and position” were used in the search. In the quality assessment of the studies, Joanna Briggs Institute Critical Assessment Checklists were used in accordance with the research pattern.

Results: In this study, 16 results were reported about the effect of birth positions on perineal trauma and infant health. The combined results of the studies showed that vertical positions do not have an effect on the intact perineum (P > .05) and reduce the possibility of episiotomy (P < .01). The study showed that vertical positions increased the development of first-degree laceration 1.4 times (P < .01), did not affect the development of second-degree laceration (P > .05), and increased one-/second-degree lacerations 1.5 times (P < .01). In this study, it was determined that vertical positions had no effect on anal sphincter damage with third-degree and third-/fourth-degree lacerations (P > .05). In addition, it was found that vertical positions had no significant effect on the admission to the intensive care unit of the newborn, first minute, and fifth minute (P > .05) APGAR (Activity- Pulse- GrimaceAppereance- Respration) score < 7 (P > .05).

Conclusion: In the study, vertical positions used at birth decrease the possibility of episiotomy application, increase the development of first-degree laser 1.4 times, intact perineum 3-4. grade perineal lacerations, anal sphincter damage did not affect the neonatal APGAR score and intensive care unit admission. In the intrapartum period, the use and dissemination of vertical positions can contribute to the preservation of perineal integrity and the development of women's health.

Cite this article as: Kurnaz D, Balacan Z, Karaçam Z. The effects of upright positions in the second stage of labor on perineal trauma and infant health: A systematic review and meta-analysis. J Educ Res Nurs. 2022;19(4): 383-395.

EISSN 2757-9204