Maternal Positioning in the Second Stage of Labour and its Relationship with Perineal Trauma: A Systematic Review and Network Meta-Analysis

Overall, pooled RCT evidence shows no significant difference in perineal tears of any degree or episiotomy between upright and supine/lithotomy positions. Network estimates suggest potential differences between specific positions, but the evidence is limited and heterogeneous. Birthing position should primarily reflect women's preferences and comfort, while considering other key predictors of perineal trauma (e.g. parity, operative delivery, and episiotomy itself). In addition, the findings from this meta-analysis can be used to provide individualized counselling, taking into account each woman's specific risk factors. This approach may help inform and guide shared decision-making, supporting women in choosing the birthing position that best aligns with their circumstances, preferences, and clinical profile.