Exploring Nigerian obstetricians' perspectives on maternal birthing positions and perineal trauma

Diorgu, Faith; Steen, Mary; Keeling, June; Whitehead, Elizabeth

Abstract

Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having
a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women
to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an
entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy.
Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred
care. Nevertheless, Nigerian obstetricians’ perceptions and experiences on birthing position and perineal trauma have received
minimal recognition and research.
Aim. To explore perceptions and experiences of Nigerian obstetricians regarding maternal birthing position and perineal trauma
following childbirth, and to gain insights as to whether obstetricians’ clinical decisions and practice were influenced by evidence.
Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from
two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview
schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke’s (2006) six-stage thematic
framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the
transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes
were identified. The study obtained ethical approval from the health and social research ethics committee at the University of
Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria.
Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians.
The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and
professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position
and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated
that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma.
Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their
clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not
supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing
practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach
would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their
choosing and reduce the risk of a routinely performed episiotomy.

• Journal Article Type: Article
• Online Publication Date: Jun 1, 2016
• Publication Date: Jun 1, 2016
• Deposit Date: Dec 8, 2023
• Journal: Evidence Based Midwifery
• Print ISSN: 1479-4489
• Publisher: Royal College of Midwives
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 2
• Pages: 64-70