NulliparityNCT07918872
Effect of Squatting Position in the Second Stage of Labor on Birth Outcomes
A study testing Experimental (Squatting Position) and Routin Care (Lithotomy Position) in people with Nulliparity and Labor Stage, Second, run by Ege University at 1 site in Turkey (Türkiye).
Trial summary
The second stage of labor is a crucial phase during which the fetus progresses through the birth canal, a process significantly influenced by maternal positions. While adopting specific birthing positions during the second stage offers potential benefits for maternal and neonatal health, inappropriate positions can… Read more about this study
- Who is it for?
- Ages 18 to 45 years, women only
- Conditions the study is for
- Nulliparity, Labor Stage, Second, Birth Position
- What is being tested?
- Experimental (Squatting Position) and Routin Care (Lithotomy Position)
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 27 Feb 2026to 31 Jan 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 45 years
- Women only
- No healthy volunteers
- Adult
Who may be able to join
- Pregnant women who have read, understood, and voluntarily accepted the informed consent form both verbally and in writing,
- Individuals aged 18 years and older,
- Nulliparous pregnant women who will give birth for the first time,
- Gestational age between 37+0 and 41+6 weeks,
- Having a singleton, live fetus in vertex presentation,
- Pregnant women with intact membranes upon hospital admission (no observed amniotic fluid leakage).
Who cannot join
- Having a diagnosis of high-risk pregnancy either previously or during hospital admission for normal delivery,
- Having a body mass index (BMI) of 30 kg/m² or above,
- Having a fetus with a detected congenital anomaly,
- Having any chronic disease (such as hypertension or diabetes),
- Having a mental or cognitive illness,
- Having any type of disability (such as orthopedic, hearing, visual, or speech impairment),
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- Detection of pelvic contraction findings during the vaginal examination upon admission (such as reaching the promontory or palpating the ischial spines during vaginal examination),
- Estimated fetal weight of 4000 grams or above based on ultrasonography measurements,
- Estimated fetal weight of 2500 grams or below based on ultrasonography measurements,
- Term infants diagnosed with intrauterine growth restriction (IUGR)
- Unfollowed pregnancies without routine ultrasonography measurements and screening tests.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site, 1 recruiting
- Recruiting
Cigli Training and Research Hospital
Izmir, İzmir
Meryem Ozdemir, +905451787789, meryem.4214@gmail.com
About this study
Official title: Effect of Squatting Position on Birth Outcomes in the Second Stage of Labor in Nulliparous Women: A Randomized Controlled Trial/ Nullipar Kadınlarda Doğumun İkinci Evresinde Çömelme Pozisyonu Uygulamasının Doğum Sonuçlarına Etkisi: Randomize Kontrollü Çalışma
The second stage of labor is a crucial phase during which the fetus progresses through the birth canal, a process significantly influenced by maternal positions. While adopting specific birthing positions during the second stage offers potential benefits for maternal and neonatal health, inappropriate positions can lead to negative short- and long-term consequences. These include severe perineal lacerations, postpartum hemorrhage, an increased risk of neonatal complications, and postpartum urinary incontinence.
Birthing positions are considered non-medical interventions because they alter physiological and anatomical adaptations during labor. These adaptations, related to pelvic dimensions, intrauterine pressure, and the progression of the fetal head through the birth canal, directly influence maternal and fetal outcomes. Studies have reported that horizontal positioning during labor increases the likelihood of cesarean delivery, assisted vaginal delivery, episiotomy, and abnormal fetal heart rates.
Read more
Conversely, upright positions offer several advantages during labor. They facilitate fetal descent by utilizing gravity, strengthen uterine contractions, reduce the risk of aortocaval compression, increase pelvic dimensions, and help maintain fetal flexion in the narrowest parts of the birth canal. In the squatting position, maternal hip flexion significantly alters the pelvic axis angles through which the fetal head progresses, facilitating spontaneous vaginal delivery. Furthermore, uterine contractions are stronger and more effective in achieving effacement and dilation in the squatting position, thereby significantly contributing to the progression of labor.
The World Health Organization (2018) Intrapartum Care Management Guidelines recommend supporting upright positions in the second stage of labor for a more positive birth experience. However, data remains limited regarding the optimal upright position for women during this stage. Accordingly, this randomized controlled experimental study was designed to examine the effects of the squatting position during the second stage of labor on obstetric, maternal, and neonatal outcomes in nulliparous women with low-risk pregnancies planning a vaginal delivery.
Read the detailed description
It has been reported that upright positions during the second stage of labor are more beneficial than horizontal positions in improving maternal and neonatal birth outcomes and reducing certain obstetric complications. Upright positions are those in which the woman's third and fifth lumbar vertebrae are aligned vertically rather than horizontally, a practice recommended by numerous international organizations.
Upright and horizontal positions are defined based on the angle formed between the horizontal plane and the line connecting the midpoints of the maternal third and fifth lumbar vertebrae. Accordingly, an upright position is defined when the spine is vertical and this angle exceeds 45°, whereas an angle of less than 45° is considered horizontal. Despite the proven advantages of upright birthing positions during the second stage of labor, the majority of women today still commonly give birth in the supine lithotomy position. The lithotomy position is considered a risk factor for a prolonged second stage of labor due to its negative impact on uterine function and its limitation of the effects of gravity. A prolonged second stage is significantly associated with adverse maternal and neonatal outcomes, such as postpartum hemorrhage, assisted delivery, cesarean section, third- and fourth-degree perineal lacerations, and low Apgar scores. These negative outcomes can lead women to perceive their birthing experience negatively, making them more likely to develop birth anxiety in future pregnancies, prefer cesarean delivery, or avoid future childbirth altogether.
Although evidence definitively evaluating the absolute benefits and risks of various upright positions remains limited, studies suggest that positions that do not restrict sacral flexibility during labor have the potential to support superior maternal and neonatal outcomes. Upright positions that maintain sacral flexibility are considered more favorable for promoting natural childbirth because they allow for pelvic outlet expansion. Based on this literature, an ideal birthing position should positively contribute to delivery outcomes by preserving sacral flexibility, allowing full mobility of the bony pelvis to expand pelvic dimensions, and maximizing the utilization of gravity. Accordingly, the squatting position, which falls into both the upright and flexible sacrum categories, may uniquely contribute to improving outcomes in spontaneous vaginal deliveries. However, further structured research is emphasized to better define and comprehensively evaluate the specific clinical effects of the squatting position during delivery.
Hip flexion during squatting significantly alters the pelvic axis, cervical, and pelvic floor angles along which the fetal head progresses. This mechanical advantage creates additional space for the fetal rotations required during descent through the birth canal. Furthermore, it allows the fetus to benefit maximally from gravity, facilitating a faster and smoother descent while stretching the perineum gradually. By relaxing the woman's diaphragm and chest cavity, the squatting position also optimizes respiration and generates better intra-abdominal pressure. This enables more effective use of maternal abdominal muscles with less physical effort, thereby contributing to improved delivery outcomes, fewer medical interventions, and a reduced rate of intrapartum emergency cesarean sections.
In Turkey, the Ministry of Health actively promotes the expansion of "Mother-Friendly Hospital" practices. However, although the modern birthing beds used in single-patient delivery rooms within these frameworks offer women the opportunity to assume diverse positions, standard deliveries routinely continue to be performed in the conventional lithotomy position, mirroring the limitations of previously used gynecological exam tables. Consequently, research on the effects of the squatting position on the anatomy and physiology of labor, and how it alters intrapartum dynamics, is critical for guiding clinical practices in childbirth. Therefore, this study, entitled "The Effect of Squatting Position Application in the Second Stage of Labor on Birth Outcomes in Nulliparous Women: A Randomized Controlled Trial," aims to examine the effects of the squatting position during the second stage of labor in nulliparous women with low-risk pregnancies, comparing it to the widely used lithotomy position on modern birthing beds in Mother-Friendly Hospitals, on obstetric, maternal, and fetal-neonatal delivery outcomes.
- Conditions
- Nulliparity, Labor Stage, Second, Birth Position, Squatting Position
- Being tested
- Experimental (Squatting Position), Routin Care (Lithotomy Position)
- Keywords
- Birthing positions, midwifery, nulliparous, second stage of labor, Squatting position
- Medical subject headings
- Neoplasm Metastasis
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Experimental (Squatting Position)Other
Also called second stage of labor, maternal position, birth position, squatting position
Until the second stage of labor (until cervical dilation reaches 10 cm), routine clinical care will continue to be provided.
During the second stage of labor, in the active phase when the pregnant woman begins to feel spontaneous urges to push, she will be supported to assume a squatting position on the birthing bed. The woman will adopt the squatting position during uterine contractions and will be allowed to rest in any position she desires on the bed between contractions.
Delivery Phase: After the fetal head crowns, the upper section (head section) of the birthing bed will be elevated to an angle between 45 and 60 degrees. The pregnant woman will lean against the backrest, position her buttocks on the seating area, and place her legs in flexion at the knees, pressing her feet onto the edges of the bed. While the pregnant woman is held in this position, the delivery of the fetus will be performed by Meryem Özdemir, a specialist midwife who is part of the research team.
Routin Care (Lithotomy Position)Other
Also called second stage of labor, birth position, maternal position, lithotomy position
Nulliparous pregnant women included in this control group will receive routine clinical care, and no experimental intervention will be performed until the crowning stage (when the fetal scalp becomes visible at the perineum). For this group, following standard intrapartum protocols, the upper section (head section) of the birthing bed is elevated to an angle of less than 45 degrees during delivery. The pregnant woman is placed in the conventional lithotomy position by positioning her legs on the foot supports attached to the right and left sides of the birthing bed. The deliveries of the pregnant women included in this control group will be conducted in the lithotomy position by the researcher, Expert Midwife Meryem Ozdemir.
| Study group | Role | What they receive |
|---|---|---|
| Routine Care | Active comparator | For this group, following the hospital's routine clinical practices and standard intrapartum care, the upper section (head section) of the birthing bed is elevated to an angle of less than 45 degrees during delivery. The pregnant woman is placed in the lithotomy position by positioning her legs on the foot supports attached to the right and left sides of the birthing bed. The deliveries of the pregnant women included in this control group will be conducted in the lithotomy position by the researcher. Receives: Other: Routin Care (Lithotomy Position) |
| Squatting Position | Experimental | After the fetal head crowns from the perineum, the upper section (head section) of the birthing bed will be elevated to an angle between 45 and 60 degrees. The pregnant woman will lean against the backrest of the birthing bed and position her buttocks on the seating area. She will be assisted to place her legs in flexion at the knees, with the soles of her feet pressing firmly onto the edges of the seating area. While the pregnant woman is maintained in this position, the delivery of the fetus will be conducted by the researcher. Receives: Other: Experimental (Squatting Position) |
What is being measured
The primary outcome is the main question the study is designed to answer.
Duration of the second stage of labor
The time elapsed from the completion of cervical dilation (full dilation - 10 cm) to the birth of the baby will be recorded.
Measured: From the exact moment of full cervical dilation (10 cm) until the complete delivery of the fetus (measured in minutes)
Need for operative or obstetric interventions during delivery
The occurrence of any obstetric or operative interventions (such as episiotomy incision, vacuum extraction/Kiwi device use, or fundal pressure/Kristeller maneuver) will be recorded as a binary outcome (yes or no).
Measured: From the onset of labor (and after the crowning of the fetal head) until the complete delivery of the infant's entire body (measured in minutes).
Secondary outcomes (12)
Perineal Laceration Degree and Episiotomy Status
The severity of perineal lacerations will be evaluated based on clinical definitions: first-degree (injury to the perineal skin and/or vaginal mucosa); second-degree (injury to the perineal muscles); third-degree (injury to the anal sphincter complex and anorectal mucosa); and fourth-degree (obstetric anal sphincter injuries involving anatomical and physiological damage to the anal sphincter). If no laceration occurs, the perineum will be recorded as intact. Additionally, whether an episiotomy incision was performed by the researcher during delivery, and if so, its severity/degree will be evaluated and recorded in accordance with the clinical definitions specified above.
Measured: Immediately following the delivery of the placenta.
Maternal Pain Level at the Onset of the Second Stage of Labor
Maternal pain levels during uterine contractions will be assessed at the exact onset of the second stage of labor (full cervical dilation) using the Visual Analog Scale (VAS), where scores range from 1 (least pain) to 10 (most severe pain). Measurements will be obtained by asking the pregnant woman during the resting period between contractions.
Measured: Immediately after the procedure/intervention (During the interval between uterine contractions following the onset of the second stage)
Maternal Pain Level at the Crowning Stage of the Fetal Head
Maternal pain levels during uterine contractions will be assessed at the crowning stage of the fetal head using the Visual Analog Scale (VAS), where scores range from 1 (least pain) to 10 (most severe pain). Measurements will be obtained by asking the pregnant woman during the resting period between contractions.
Measured: At crowning of the fetal head, during the second stage of labor
Maternal Fatigue Level at the Onset of the Second Stage of Labor
Maternal fatigue levels will be assessed at the exact onset of the second stage of labor (full cervical dilation) using the Visual Analog Scale (VAS), where scores range from 1 (least fatigue) to 10 (most severe fatigue). Measurements will be obtained by asking the pregnant woman during the resting period between contractions.
Measured: At the onset of the second stage of labor (full cervical dilation)
Maternal Fatigue Level at the Crowning Stage of the Fetal Head
Maternal fatigue levels will be assessed at the crowning stage of the fetal head using the Visual Analog Scale (VAS), where scores range from 1 (least fatigue) to 10 (most severe fatigue). Measurements will be obtained by asking the pregnant woman during the resting period between contractions.
Measured: At crowning of the fetal head, during the second stage of labor
Maternal Childbirth Experience
Maternal childbirth experience will be evaluated using the Childbirth Experience Questionnaire (CEQ). Participants in both the intervention and control groups will be asked to complete the questionnaire postpartum, specifically after they have breastfed their babies and achieved adequate rest, prior to hospital discharge. The total score obtained from the scale will be evaluated. Higher scores on the questionnaire indicate a more positive and better childbirth experience. There is no specific cut-off score for this scale.
Measured: Within the first 24 hours postpartum, prior to hospital discharge
Newborn 1st Minute APGAR Score
The newborn's health status and transition to extrauterine life will be evaluated at the 1st minute after birth using the standard APGAR scoring system. The score ranges from 0 to 10, with higher scores indicating a better clinical condition of the newborn.
Measured: At 1 minute after birth
Newborn 5th Minute APGAR Score
The newborn's health status and adaptation to extrauterine life will be evaluated at 5 minutes after delivery using the standard APGAR scoring system. The score ranges from 0 to 10, with higher scores indicating a better clinical condition of the newborn.
Measured: At 5 minutes after birth
Umbilical Cord Blood Gas Parameters
Umbilical cord blood gas analysis will be performed to evaluate the oxygenation and acid-base status of the newborn. Immediately after the complete delivery of the baby and prior to placental separation, a blood sample will be collected from the maternal side of the umbilical cord using a blood gas syringe by the researcher. The clinical parameters to be evaluated from the hospital's laboratory computer system include: umbilical artery pH, partial pressure of carbon dioxide (pCO2, measured in mmHg), partial pressure of oxygen (pO2, measured in mmHg), and base excess (BE, measured in mEq/L)
Measured: Immediately after the delivery of the baby and prior to placental separation
Requirement for Neonatal Resuscitation
Whether the newborn requires any level of neonatal resuscitation (such as positive pressure ventilation, endotracheal intubation, or administration of medications) during the immediate stabilization period in the delivery room will be recorded as a binary outcome (yes or no).
Measured: During the immediate stabilization period within the first minutes after birth
Status of Being Placed in Maternal Skin-to-Skin Contact Without Intervention
Whether the newborn can be placed directly in skin-to-skin contact with the mother or routine healthy newborn care can be provided without requiring any special medical interventions or admission to the neonatal intensive care unit (NICU) will be recorded as a binary outcome (yes or no).
Measured: Immediately following the delivery of the baby
Newborn Clinical Status and Physical Examination Findings
Comprehensive newborn physical examination and clinical status findings will be evaluated and recorded by a neonatologist to ensure safety and monitor neonatal adaptation within the first hour following delivery. The evaluated parameters will include: cardiovascular findings (heart rate, preductal SpO2, and perfusion index); respiratory findings (respiratory rate, presence of chest retractions, and nasal flaring); gastrointestinal findings (presence of meconium); integumentary/skeletal findings (normal condition of the clavicle); and neurological findings (muscle tone and brachial plexus status). Any deviations from normal clinical values will be recorded.
Measured: Within the first hour after birth
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted5 Nov 2026
- Study start27 Feb 2026
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Jan 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for NulliparityStudies of the same condition, open and under way.
- More trials run by Ege UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Ege University
- Sponsor type
- University, hospital or other
- Collaborators
- Cigli Regional Training Hospital
- Responsible party
- Principal investigator, Meryem ÖZDEMİR, Ege University
- Investigators
- İbrahim Karaca, Prof., Study director, Çiğli Training and Research HospitalEsin Ceber Turfan, Prof., Study chair, Ege University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07918872
- Sponsor's protocol ID
- 25-AKD-354
- Other IDs
- 25-AKD-354
- Status last verified
- May 2026
- First submitted
- 27 May 2026
- Last updated
- 5 Nov 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Fu L, Huang J, Li D, Wang H, Xing L, Wei T, Hou R, Lu H. Effects of Using Sitting Position versus Lithotomy Position during the Second Stage of Labour on Maternal and Neonatal Outcomes and the Childbirth Experience of Chinese Women: A Prospective Cohort Study. Healthcare (Basel). 2023 Nov 20;11(22):2996. doi: 10.3390/healthcare11222996.
PubMed 37998488WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Available from http://www.ncbi.nlm.nih.gov/books/NBK513809/
PubMed 30070803Desseauve D, Fradet L, Lacouture P, Pierre F. Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. BMC Pregnancy Childbirth. 2019 Jul 19;19(1):251. doi: 10.1186/s12884-019-2408-2.
PubMed 31324160Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017 May 25;5(5):CD002006. doi: 10.1002/14651858.CD002006.pub4.
PubMed 28539008
Study at a glance
From the registry record, last updated by the sponsor on 5 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Squatting Position on Birth Outcomes in the Second Stage of Labor in Nulliparous Women: A Randomized Controlled Trial/ Nullipar Kadınlarda Doğumun İkinci Evresinde Çömelme Pozisyonu Uygulamasının Doğum Sonuçlarına Etkisi: Randomize Kontrollü Çalışma
- ClinicalTrials.gov ID
- NCT07918872
- Acronym / sponsor ID
- 25-AKD-354
- Conditions
- Nulliparity, Labor Stage, Second, Birth Position, Squatting Position
- Keywords
- Birthing positions, midwifery, nulliparous, second stage of labor, Squatting position
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Ege UniversityUniversity, hospital or other
- Collaborators
- Cigli Regional Training Hospital
- Study start
- 27 Feb 2026 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Jan 2027 (estimated)
- First posted
- 5 Nov 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The second stage of labor is a crucial phase during which the fetus progresses through the birth canal, a process significantly influenced by maternal positions. While adopting specific birthing positions during the second stage offers potential benefits for maternal and neonatal health, inappropriate positions can lead to negative short- and long-term consequences. These include severe perineal lacerations, postpartum hemorrhage, an increased risk of neonatal complications, and postpartum urinary incontinence.
Birthing positions are considered non-medical interventions because they alter physiological and anatomical adaptations during labor. These adaptations, related to pelvic dimensions, intrauterine pressure, and the progression of the fetal head through the birth canal, directly influence maternal and fetal outcomes. Studies have reported that horizontal positioning during labor increases the likelihood of cesarean delivery, assisted vaginal delivery, episiotomy, and abnormal fetal heart rates.
Conversely, upright positions offer several advantages during labor. They facilitate fetal descent by utilizing gravity, strengthen uterine contractions, reduce the risk of aortocaval compression, increase pelvic dimensions, and help maintain fetal flexion in the narrowest parts of the birth canal. In the squatting position, maternal hip flexion significantly alters the pelvic axis angles through which the fetal head progresses, facilitating spontaneous vaginal delivery. Furthermore, uterine contractions are stronger and more effective in achieving effacement and dilation in the squatting position, thereby significantly contributing to the progression of labor.
The World Health Organization (2018) Intrapartum Care Management Guidelines recommend supporting upright positions in the second stage of labor for a more positive birth experience. However, data remains limited regarding the optimal upright position for women during this stage. Accordingly, this randomized controlled experimental study was designed to examine the effects of the squatting position during the second stage of labor on obstetric, maternal, and neonatal outcomes in nulliparous women with low-risk pregnancies planning a vaginal delivery.
Detailed description
It has been reported that upright positions during the second stage of labor are more beneficial than horizontal positions in improving maternal and neonatal birth outcomes and reducing certain obstetric complications. Upright positions are those in which the woman's third and fifth lumbar vertebrae are aligned vertically rather than horizontally, a practice recommended by numerous international organizations.
Upright and horizontal positions are defined based on the angle formed between the horizontal plane and the line connecting the midpoints of the maternal third and fifth lumbar vertebrae. Accordingly, an upright position is defined when the spine is vertical and this angle exceeds 45°, whereas an angle of less than 45° is considered horizontal. Despite the proven advantages of upright birthing positions during the second stage of labor, the majority of women today still commonly give birth in the supine lithotomy position. The lithotomy position is considered a risk factor for a prolonged second stage of labor due to its negative impact on uterine function and its limitation of the effects of gravity. A prolonged second stage is significantly associated with adverse maternal and neonatal outcomes, such as postpartum hemorrhage, assisted delivery, cesarean section, third- and fourth-degree perineal lacerations, and low Apgar scores. These negative outcomes can lead women to perceive their birthing experience negatively, making them more likely to develop birth anxiety in future pregnancies, prefer cesarean delivery, or avoid future childbirth altogether.
Although evidence definitively evaluating the absolute benefits and risks of various upright positions remains limited, studies suggest that positions that do not restrict sacral flexibility during labor have the potential to support superior maternal and neonatal outcomes. Upright positions that maintain sacral flexibility are considered more favorable for promoting natural childbirth because they allow for pelvic outlet expansion. Based on this literature, an ideal birthing position should positively contribute to delivery outcomes by preserving sacral flexibility, allowing full mobility of the bony pelvis to expand pelvic dimensions, and maximizing the utilization of gravity. Accordingly, the squatting position, which falls into both the upright and flexible sacrum categories, may uniquely contribute to improving outcomes in spontaneous vaginal deliveries. However, further structured research is emphasized to better define and comprehensively evaluate the specific clinical effects of the squatting position during delivery.
Hip flexion during squatting significantly alters the pelvic axis, cervical, and pelvic floor angles along which the fetal head progresses. This mechanical advantage creates additional space for the fetal rotations required during descent through the birth canal. Furthermore, it allows the fetus to benefit maximally from gravity, facilitating a faster and smoother descent while stretching the perineum gradually. By relaxing the woman's diaphragm and chest cavity, the squatting position also optimizes respiration and generates better intra-abdominal pressure. This enables more effective use of maternal abdominal muscles with less physical effort, thereby contributing to improved delivery outcomes, fewer medical interventions, and a reduced rate of intrapartum emergency cesarean sections.
In Turkey, the Ministry of Health actively promotes the expansion of "Mother-Friendly Hospital" practices. However, although the modern birthing beds used in single-patient delivery rooms within these frameworks offer women the opportunity to assume diverse positions, standard deliveries routinely continue to be performed in the conventional lithotomy position, mirroring the limitations of previously used gynecological exam tables. Consequently, research on the effects of the squatting position on the anatomy and physiology of labor, and how it alters intrapartum dynamics, is critical for guiding clinical practices in childbirth. Therefore, this study, entitled "The Effect of Squatting Position Application in the Second Stage of Labor on Birth Outcomes in Nulliparous Women: A Randomized Controlled Trial," aims to examine the effects of the squatting position during the second stage of labor in nulliparous women with low-risk pregnancies, comparing it to the widely used lithotomy position on modern birthing beds in Mother-Friendly Hospitals, on obstetric, maternal, and fetal-neonatal delivery outcomes.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Routine Care | Active comparator | Other: Routin Care (Lithotomy Position)For this group, following the hospital's routine clinical practices and standard intrapartum care, the upper section (head section) of the birthing bed is elevated to an angle of less than 45 degrees during delivery. The pregnant woman is placed in the lithotomy position by positioning her legs on the foot supports attached to the right and left sides of the birthing bed. The deliveries of the pregnant women included in this control group will be conducted in the lithotomy position by the researcher. |
| Squatting Position | Experimental | Other: Experimental (Squatting Position)After the fetal head crowns from the perineum, the upper section (head section) of the birthing bed will be elevated to an angle between 45 and 60 degrees. The pregnant woman will lean against the backrest of the birthing bed and position her buttocks on the seating area. She will be assisted to place her legs in flexion at the knees, with the soles of her feet pressing firmly onto the edges of the seating area. While the pregnant woman is maintained in this position, the delivery of the fetus will be conducted by the researcher. |
Who may qualify
- Ages
- 18 to 45 years
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (6 listed)
- Pregnant women who have read, understood, and voluntarily accepted the informed consent form both verbally and in writing,
- Individuals aged 18 years and older,
- Nulliparous pregnant women who will give birth for the first time,
- Gestational age between 37+0 and 41+6 weeks,
- Having a singleton, live fetus in vertex presentation,
Key exclusion criteria (11 listed)
- Having a diagnosis of high-risk pregnancy either previously or during hospital admission for normal delivery,
- Having a body mass index (BMI) of 30 kg/m² or above,
- Having a fetus with a detected congenital anomaly,
- Having any chronic disease (such as hypertension or diabetes),
- Having a mental or cognitive illness,
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Experimental (Squatting Position)Also: second stage of labor, maternal position, birth position, squatting positionUntil the second stage of labor (until cervical dilation reaches 10 cm), routine clinical care will continue to be provided. During the second stage of labor, in the active phase when the pregnant woman begins to feel spontaneous urges to push, she will be supported to assume a squatting position on the birthing bed. The woman will adopt the squatting position during uterine contractions and will be allowed to rest in any position she desires on the bed between contractions. Delivery Phase: After the fetal head crowns, the upper section (head section) of the birthing bed will be elevated to an angle between 45 and 60 degrees. The pregnant woman will lean against the backrest, position her buttocks on the seating area, and place her legs in flexion at the knees, pressing her feet onto the edges of the bed. While the pregnant woman is held in this position, the delivery of the fetus will be performed by Meryem Özdemir, a specialist midwife who is part of the research team. | Other | Squatting Position |
| Routin Care (Lithotomy Position)Also: second stage of labor, birth position, maternal position, lithotomy positionNulliparous pregnant women included in this control group will receive routine clinical care, and no experimental intervention will be performed until the crowning stage (when the fetal scalp becomes visible at the perineum). For this group, following standard intrapartum protocols, the upper section (head section) of the birthing bed is elevated to an angle of less than 45 degrees during delivery. The pregnant woman is placed in the conventional lithotomy position by positioning her legs on the foot supports attached to the right and left sides of the birthing bed. The deliveries of the pregnant women included in this control group will be conducted in the lithotomy position by the researcher, Expert Midwife Meryem Ozdemir. | Other | Routine Care |
Primary outcome
Duration of the second stage of labor
Time frame: From the exact moment of full cervical dilation (10 cm) until the complete delivery of the fetus (measured in minutes)
The time elapsed from the completion of cervical dilation (full dilation - 10 cm) to the birth of the baby will be recorded.
Need for operative or obstetric interventions during delivery
Time frame: From the onset of labor (and after the crowning of the fetal head) until the complete delivery of the infant's entire body (measured in minutes).
The occurrence of any obstetric or operative interventions (such as episiotomy incision, vacuum extraction/Kiwi device use, or fundal pressure/Kristeller maneuver) will be recorded as a binary outcome (yes or no).
12 secondary outcomes
Perineal Laceration Degree and Episiotomy Status
Time frame: Immediately following the delivery of the placenta.
Maternal Pain Level at the Onset of the Second Stage of Labor
Time frame: Immediately after the procedure/intervention (During the interval between uterine contractions following the onset of the second stage)
Maternal Pain Level at the Crowning Stage of the Fetal Head
Time frame: At crowning of the fetal head, during the second stage of labor
Maternal Fatigue Level at the Onset of the Second Stage of Labor
Time frame: At the onset of the second stage of labor (full cervical dilation)
Maternal Fatigue Level at the Crowning Stage of the Fetal Head
Time frame: At crowning of the fetal head, during the second stage of labor
Maternal Childbirth Experience
Time frame: Within the first 24 hours postpartum, prior to hospital discharge
Newborn 1st Minute APGAR Score
Time frame: At 1 minute after birth
Newborn 5th Minute APGAR Score
Time frame: At 5 minutes after birth
Umbilical Cord Blood Gas Parameters
Time frame: Immediately after the delivery of the baby and prior to placental separation
Requirement for Neonatal Resuscitation
Time frame: During the immediate stabilization period within the first minutes after birth
Status of Being Placed in Maternal Skin-to-Skin Contact Without Intervention
Time frame: Immediately following the delivery of the baby
Newborn Clinical Status and Physical Examination Findings
Time frame: Within the first hour after birth
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Nov 2026.
- Background: PubMed 37998488Fu L, Huang J, Li D, Wang H, Xing L, Wei T, Hou R, Lu H. Effects of Using Sitting Position versus Lithotomy Position during the Second Stage of Labour on Maternal and Neonatal Outcomes and the Childbirth Experience of Chinese Women: A Prospective Cohort Study. Healthcare (Basel). 2023 Nov 20;11(22):2996. doi: 10.3390/healthcare11222996.
- Background: PubMed 30070803WHO recommendations: Intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. Available from http://www.ncbi.nlm.nih.gov/books/NBK513809/
- Background: PubMed 31324160Desseauve D, Fradet L, Lacouture P, Pierre F. Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. BMC Pregnancy Childbirth. 2019 Jul 19;19(1):251. doi: 10.1186/s12884-019-2408-2.
- Background: PubMed 28539008Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017 May 25;5(5):CD002006. doi: 10.1002/14651858.CD002006.pub4.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
İbrahim Karaca, Prof. study director
Çiğli Training and Research Hospital
Esin Ceber Turfan, Prof. study chair
Ege University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Experimental (Squatting Position) and Routin Care (Lithotomy Position) in people with Nulliparity and Labor Stage, Second, run by Ege University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 5 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Meryem Ozdemir, PhD Candidate (+905451787789, meryem.4214@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Duration of the second stage of labor (time frame: From the exact moment of full cervical dilation (10 cm) until the complete delivery of the fetus (measured in minutes)). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07918872, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Nov 2026.