Effect of Maternal Positioning with Occipito-posterior Fetal Position during Labor on Pain Intensity and Satisfaction of Mothers

Document Type : Original Article


1 M.Sc. Student of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Ph.D. in Reproductive Health, Reproductive Health Promotion Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 M.Sc. in Midwifery, Reproductive Health Promotion Research Center, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

4 M.Sc. in Biostatistics, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran..


Introduction: The occipito-posterior fetal positions are the most common type of malposition of the occiput. Increasing maternal pain and need for epidural anesthesia are among the complications of this condition. Maternal position during labor can influence her pain intensity. This study aimed to investigate the effect of maternal position in the active phase of labor on the pain intensity and satisfaction.
Method: This randomized controlled trial was conducted among 180 primiparous pregnant women with a singleton pregnancy and occipito-posterior fetal position referred to a maternity hospital in Ramhormoz, Iran, 2017. The samples were selected based on the purpose using a random number generating software. They were randomly assigned into three groups of semiprone position (n=45), knee-chest position (n=45), and control group (n=90). The control group gave birth in the supine position. From half an hour after randomization until delivery, all the participants were alternately (15 to 30 minutes per hour) located in defined positions. Data were collected using a visual analog scale for pain, observation, and examination of the record form. Data analysis was performed using Chi-squared and analysis of variance tests in SPSS software, version 24. The significance level was considered as P≤0.05.
Results: According to the results, the intensity of pain in the intervention groups was significantly lower than the control group. Additionally, the satisfaction level of mothers in the intervention group was higher than the control group (P<0.0001).
Conclusion: It seems that semiprone and knee-chest positions in mothers with occipito-posterior fetal position during the active phase and the second stage of labor were useful for relieving labor pain and increasing the satisfaction of mothers.


  1. Marshall JE, Raynor MD. Myles textbook for midwives. Trans: Brahimi N, Taghizadeh Z. 16th ed. Tehran: Jamee Negar; 2014. (Persian).
  2. Barth Jr WH. Persistent occiput posterior. Obstet Gynecol 2015; 126(1):213-4.
  3. Garry G, Leveno C, Bloom E. Williams obstetric. Trans: Ghazi Jahani B, Gotbi R. 24th ed. Tehran: Golban; 2014.
  4. Dehcheshmeh FS, Rafiei H. Complementary and alternative therapies to relieve labor pain: a comparative study between music therapy and Hoku point ice massage. Complement Ther Clin Pract 2015; 21(4):229-32.
  5. Goodman P, Mackey M, Tavakoli AS. Factors related to childbirth satisfaction. J Adv Nurs 2004; 46(2):212-9.
  6. Sadeghieh Ahari S, Tazakori Z, Habibzadeh S, Yahyavi O, Novrozi V, Namadi Vosogh M. Respecting patients’ rights and expectations’ of patients in hospitals of medical sciences university of Ardabil in 2012. J Sabzevar Univ Med Sci 2015; 22(3):472-80.
  7. Lundgren I. Swedish women’s experience of childbirth 2 years after birth. Midwifery 2005; 21(4):346-54.
  8. Waldenstrom U, Hildingson I, Ryding EL. Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth. BJOG 2006; 113(6):633-46.
  9. Nazarpour S. Physiological delivery without pain. Tehran: Golban; 2017.
  10. Oreily B, Bottomley C, Rymer J. Essentials of obstetrics and gynecology 2010. Trans: Ghazi Jahani B. Tehran: Golban; 2015.
  11. Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. J Midwifery Womens Health 2004; 49(6):489-504.
  12. Zwelling E. Overcoming the challenges: maternal movement and positioning to facilitate labor progress. MCN Am J Matern Child Nurs 2010; 35(2):72-8.
  13. Akbarzadeh M, Moradi Z, Jowkar A, Zare N, Hadianfard MJ. Comparing the effects of acupressure at the Jian Jing-Gall Bladder Meridian (GB-21) point on the severity of labor pain, duration and cesarean rate in mono-and bi-stage interventions. Womens Health Bull 2015; 2(1):e24981.
  14. Susan OA. Maternity, newborn and women’s health nursing. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 2008.
  15. Guittier MJ, Othenin-Girard V, de Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG 2016; 123(13):2199-207.
  16. Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB. Women’s choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BioMed Res Int 2014; 2014:638093.
  17. Desbriere R, Blanc J, Le Dû R, Renner J, Carcopino X, Loundou A, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol 2013; 208(1):60.e1-8.
  18. Le Ray C, Lepleux F, De La Calle A, Guerin J, Sellam N, Dreyfus M, et al. Lateral asymmetric decubitus position for the rotation of occipito-posterior positions: multicenter randomized controlled trial EVADELA. Am J Obstet Gynecol 2016; 215(4):511-e1-7.
  19. Shamaeian Razavi N, Bahri Binabaj N, Hoseiny Shahidy L, PourHeidari M. The effect of maternal position on labor pain. Horizon Med Sci 2006; 12(2):16-21.
  20. Zaky NH. Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress. IOSR J Nurs 2016; 5(4):19-27.
  21. Al-Seady MY, Fadel EA, El-Gohary AM, Marzouk T. Labour Pain and Satisfaction of Primipara Assume Upright versus Recumbent Positions during First Stage of Labour. IOSR J Nurs Health Sci 2017; 6(4):24-30.
  22. Meena P. A study to assess the effect of ambulation in reduction of labour pain among pregnant women in the regional hospital Kullu (HP). IJAR 2017; 3(6):291-4.
  23. Hosseini Amiri M, Manzari ZS, Tavoosi H. Effect of transcranial direct current stimulation on pain intensity and quality of burn dressing. J Mazandaran Univ Med Sci 2015; 24(120):75-87. (Persian).
  24. Wall PD, Melzack R. Textbook of pain. 4th ed. London: Churchill Living Stone; 2005. P. 56.
  25. Sajjadian I, Neshat Dost HT, Molavi H, Bagherian Sararoudi R. Cognitive and emotional factors effective on chronic low back pain in women: explanation the role of fear-avoidance believes, pain catastrophizing and anxiety. J Res Behav Sci 2011; 9(5):79-90.
  26. Taavoni S, Abdolahian S, Haghani H, Neysani L. Effect of birth ball usage on pain in the active phase of labor. a randomized controlled trial. J Midwifery Womens Health 2011; 56(2):137-40.
  27. Vaijayanthimala M, Judie A. Effectiveness of birth ball usage during labour on pain and childbirth experience among primi parturient mothers: a randomized interventional study. Int J Sci Res 2014; 33(7):416-8.
  28. Azhari S, Khalilian Muvahhed H, Tara F, Esmaeli H. Comparison the effect of sitting and kneeling positions during the second stage of labor on pain and duration of second stage of labor in nulliparous women. Iran J Obstet Gynecol Infertil 2013; 15(38):7-16. (Persian).
  29. Hodnett ED, Stremler R, Halpern SH, Weston J, Windrim R. Repeated hands-and-knees positioning during labour: a randomized pilot study. Peer J 2013; 1:e25.