Abstract
To be a midwife is to be 'with woman' (Oxford 2000) in pregnancy, childbirth and postpartum period. The title of the thesis 'with women' embraces the study of both the professional midwives and the clientele who are the expectant women to whom this thesis refers. The aim of the thesis is to investigate how mothers and midwives make decisions on the choice of birthing positions during labour and delivery. The extent to which women ought to be involved in making decisions on their specific needs and choices in labour has been hotly debated over the years. One of the most undervalued decision-making issues by the midwives is regarding women's choice of position for delivery. This study was prompted by the need to explore reasons behind the continuing trend in the use of the conventional recumbent or semi-recumbent position. Three factors were considered to have significant influence in the way mothers makes decisions about the choice of positions for childbirth. These are the perception of choice, the availability of information and professional influence over the decisionmaking. There are three studies within the thesis. Firstly, a systematic review, which encompasses an analysis of both qualitative and quantitative studies on the evidence for and against the use of 'upright' versus 'recumbent' position had been carried out. Evidence from the systematic review identified that the upright posture is more effective and beneficial to women in labour. In the second study, a survey of midwife's attitude and preferences on the use of different positions was carried out to identify to what extent are midwives supportive of the use of the upright positions. Results indicated that the majority of midwives prefer to use the semi-recumbent position for delivery and that their preference was not necessarily related to women's choice. The third and final study consisted of a double blind randomised controlled trial between two groups of women: 117 in the controls, 118 in the experimental group. The aim was to test the effectiveness of focussed information on the use of birthing positions on women's knowledge and decision-making process. The results show that given a course of information on birthing positions, women's knowledge increased significantly and this gave rise to reduced conflict in their choice of birthing position. Women in the experimental group were more able to internalise and verbalise their decision to use a particular position to their attending midwives. The trial confirmed that the possession of knowledge reduced decisional conflict in the experimental group and contributed to women's ability to make an informed decision concerning their choice of birthing position.