Are birth seats beneficial?

A study of more than ten and a half thousand women has looked at what happens when healthy women who have not previously had a caesarean give birth on a birth seat.

Birth seats have been in use for many years but we do not have conclusive evidence about whether and how they affect different outcomes for birthing woman. We know that there are benefits to active labour (where the woman isn’t on a bed) and to upright positions in labour, but we are less certain about whether and how birth seats affect the chance of a tear.

The recent study by Thies-Lagergren et al (2019) was “An observational cohort study based on birth information collected prospectively. In total 10 629 live, singleton, non-instrumental births in cephalic presentation were studied.”

The results showed that:

“Fewer women who gave birth on a birth seat experienced an overall intact genital tract compared to women who gave birth in any other position. Women who gave birth on a birth seat were less likely to have an episiotomy performed. Women who gave birth vaginally on a birth seat after a previous caesarean section may have an increased risk for sustaining a sphincter tear.” (Thies-Lagergren et al 2019)

I do want to suggest that anyone interested in this area goes to read the paper in full, in order to ensure a good understanding of the issues. For instance, the authors note a few important points about education and the use and avoidance of other good practice points while women used the birth seat:

“…a few years before the data for this study were collected, midwives were offered continuing education on voluntary basis. The education included introduction to the “BirthRite©” birth seat through an instructive film made by the producer of the birth seat, a hands on workshop with lectures on correct positioning on the birth seat, avoidance of strong pushing techniques and recommendations related to encouraging the women to stand up at least every 20 min to avoid edema. Systematic certification of the birth seat was not obtained as supporting women giving birth on the birth seat is considered a basic skill for midwives. At the study hospital, women are encouraged to give birth in the position they prefer. Midwives may in case of slow progress suggest an upright birth position including use of the birth seat. There were no restrictions concerning the use of the birth seat among included women; indication for use was not reported.” (Thies-Lagergren et al 2019)

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The study was published in Women and Birth and can be found here.

The Research

Background: Birth positions may influence the risk of tears in the genital tract during birth. Birth positions are widely studied yet knowledge on genital tract tears following birth on a birth seat is inconclusive.

Aim: The objective of this study was to describe the proportion of genital tract tears in women who gave birth on a birth seat compared to women who did not.

Method: An observational cohort study based on birth information collected prospectively. In total 10 629 live, singleton, non-instrumental births in cephalic presentation were studied.

Results: Fewer women who gave birth on a birth seat experienced an overall intact genital tract compared to women who gave birth in any other position. Women who gave birth on a birth seat were less likely to have an episiotomy performed. Women who gave birth vaginally on a birth seat after a previous caesarean section may have an increased risk for sustaining a sphincter tear.

Discussion: It is important to be aware of the decreased chance of an overall intact genital tract area when giving birth on a birth seat. Furthermore, there is a possibly increased risk of sphincter tear in women having a vaginal birth after caesarean. It is required and of importance to provide pregnant women with evidence-based information on factors associated with genital tract tears including birth positions.