A key component of implementing respectful maternity care is protecting the woman’s right to assume the position of her choice during labor and birth. Freedom to choose labor and birth positions impacts the woman’s comfort level and the speed of progression of labor. Giving a woman the freedom to choose labor and birth positions has benefits for the woman, the baby, and the health system. A woman’s lack of choice in birthing position is recognized as a barrier to some women’s use of facility-based childbirth care. Building providers’ competence and confidence to support a range of birth positions can help to create more client-centered maternity services that may be associated with better satisfaction and utilization of facility childbirth services.

This package of materials on alternative birth positions was developed in 2016 to be used in sensitization, training, and follow-up. The materials can be used in three ways:

1) as a “standalone” training, for example, as continuing professional development;

2) integrated with basic emergency obstetric and newborn care (BEmONC) or other maternal and newborn health training; or

3) in sections, in “on-the-job/on-site” training as part of facility-based quality improvement efforts.

The materials and job aids to support alternative birth positions include the following:

• A session outline, which explains the session objectives, suggested times, content, teaching methodology, and resources to be used.
• An overview presentation, which highlights the background, evidence, and rationale for supporting birth (and labor) in alternative positions as a key component of respectful maternity care. The presentation guides participants in skills demonstration and practice on supporting birth in alternative positions. It also provides key references and other useful resources for supporting birth (and labor) in alternative positions.
• Role play guidance (directions, participant roles, situation, discussion questions), which provides an opportunity for learners to appreciate the importance of good communication and respectful care when providing information and supporting women in their rights and choices in childbirth.
• A guide for doctors and midwives with instructions and pictures on how to facilitate birth in an all-fours (“birth in hands-knees”) position. This position in particular can be challenging to support without additional practice; therefore, this guide is meant to build providers’ skills and confidence. Assisting birth in other positions (sitting up, squatting, etc.) is very similar to the semi-supine position and standard guidelines should be followed.
• A job aid with pictures demonstrating various alternative labor and birth positions.
• Zip files of additional images tailored for Asia and Uganda contexts.

You may download individual materials below, or download the entire package from the Maternal and Child Survival Program website.