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Table of Contents   
EDITORIAL COMMENTARY  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1421-1422
Encouraging pregnant women to deliver in upright position: UnitedNations Population Fund


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

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Date of Web Publication11-Jan-2018
 

How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Encouraging pregnant women to deliver in upright position: UnitedNations Population Fund. Ann Trop Med Public Health 2017;10:1421-2

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Encouraging pregnant women to deliver in upright position: UnitedNations Population Fund. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Aug 18];10:1421-2. Available from: http://www.atmph.org/text.asp?2017/10/6/1421/222712


Prevention of maternal deaths during the prenatal period and childbirths has attracted immense attention from the global leaders, as evidenced by the priority given to them in all formulated development goals.[1] Even though a wide range of factors(like personal, sociodemographic, poor awareness, ignorance, etc.) play a major role in the causation of any maternal deaths, nevertheless limitations in the maternal health care centers are the most critical ones.[1],[2] In fact, unattended childbirth is the most important determinant for maternal deaths and childbirth-related maternal or neonatal complications.[2] Furthermore, the best way to negate this is by facilitating and encouraging women and their family members for an institutional delivery.[1],[2]

There are different reasons identified that prevent a pregnant female to avail the childbirth-related services in a health facility such as ignorance, limited knowledge about the services offered in health center, accessibility, financial constraints, absence of a trained health care personnel, poor attitude of health workers, logistics or equipment shortage, timings of the health establishments, and socio-cultural attributes(not given a chance to opt for their labor preferences).[1],[2],[3] In fact, it has been observed in some of the settings that women chose to deliver at home instead of health facilities, as they were compelled to discard their traditional birth practices, including the practice of giving birth in an upright posture.[3]

A great proportion of women find the supine position of delivery as undignified and unwelcoming as they are expected to take off their clothes in front of strangers, and are then put on a stretcher exposing their genitalia.[3] At the same time, pregnant women are not allowed to walk in between and often verbally abused.[3] Thus, often some of the indigenous women are reluctant to avail childbirth services in a health center.[3] It will not be wrong to say that it has been debated for quite a while to decide for an appropriate delivery position, but still a final opinion remains inconclusive.[4] Though the findings of studies associate an upright delivery position with a heightened risk of postpartum hemorrhage or anal sphincter lacerations and hence episiotomy, it has also been linked with various merits like less pain, better pelvic dimensions, efficient uterine contractions, and minimal risk of aortocaval compression.[3],[4],[5]

In order to deal with the issue, the UnitedNations Population Fund in collaboration with the health ministry of Peru and a women's group is working to ensure childbirth safe and culturally sensitive.[3] The decision to perform childbirth in an upright position was taken to assure comfort to women, safeguard their rights, and maintain their pride.[3] Furthermore, it has been declared that pregnant women can decide for their birth position to draw more number of them to the health centers for delivery and even doctors have been trained to understand and perform deliveries in upright position.[3]

In addition, logistics(viz. modified beds, ropes, etc.) have been supplied to the health care facilities.[3] Moreover, women have been encouraged to bring their loved ones during labor to support them in the entire process.[1],[3] Also, midwives in the region have been assigned the responsibility to inform the pregnant women about the change in approach and hence encourage them to deliver at the health facility.[3]

In conclusion, the approach to allow women to prefer an upright position for delivery is a safe, prompt, less painful, and more humane way to conduct a delivery. This not only increases the chances of a woman to avail health care services, but also is a significant step to reduce the risk of maternal deaths.

Acknowledgment

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work.

PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

JR contributed in revising the draft, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. Maternal mortality–Fact sheet N°348; 2015. Available from: http://www.who.int/mediacentre/factsheets/fs348/en/[Last accessed on 2016Oct9].  Back to cited text no. 1
    
2.
ShrivastavaSR, ShrivastavaPS, RamasamyJ. Public health approach towards reduction in maternal mortality in South Asia. Int J Gynec Obst Res 2013;1:17-27.  Back to cited text no. 2
    
3.
UNFPA. Giving birth upright, with maté–Peru clinics open arms to indigenous women; 2016. Available from: http://www.unfpa.org/news/giving-birth-upright-mat%C3%A9-%E2%80%93-peru-clinics-open-arms-indigenous-women[Last accessed on 2016Oct10].  Back to cited text no. 3
    
4.
AltmanD, RagnarI, Ekström A, Tydén T, OlssonSE. Anal sphincter lacerations and upright delivery postures-a risk analysis from a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 2007;18:141-6.  Back to cited text no. 4
    
5.
RagnarI, AltmanD, Tydén T, OlssonSE. Comparison of the maternal experience and duration of labour in two upright delivery positions–A randomised controlled trial. BJOG 2006;113:165-70.  Back to cited text no. 5
    

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Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur – Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_625_16

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