A Systematic Review on the Impact of Maternal Positioning During the Third Stage of Labor on Obstetric Outcomes

Suman Dhaniya; Poonam Mahala; Virendra Kumar; Abhishek Sharma; Shatrughan Pareek

Authors

Suman Dhaniya Faculty of nursing, College of Nursing, Lady Hardinge Medical college, New Delhi
Poonam Mahala Nursing Officer, Department of Obstetrics and gynecology, AIIMS, Bathinda
Virendra Kumar Assistant Professor, Ganaganagar college of nursing, Tantia university, Sri Ganganagar, Rajastahan
Abhishek Sharma Nurse- A, Department of Onco surgery, Dr. BhubaneswerBorooah cancer institute, Guwahati
Shatrughan Pareek Senior Nursing Superintendent, Indian Railway health services, Bikaner, Rajasthan

Keywords:

Systematic review, Impact, Maternal Positioning, Third Stage of Labor, Obstetric Outcomes

Abstract

Background: The third stage of labor carries significant clinical risks, primarily Postpartum Hemorrhage (PPH)—a leading global cause of maternal mortality. While active management of the third stage of labor (AMTSL) is standard care, the specific biomechanical contribution of maternal posture (upright vs. recumbent) during placental separation and expulsion remains under-synthesized. The present systematic review was done to evaluate the effect of upright versus recumbent maternal positioning during the third stage of labor on the duration of third stage, estimated blood loss (EBL), incidence of PPH (≥500 mL and ≥1000 mL), rate of manual removal of placenta (MROP), and maternal comfort. Methodology: The present research was data was extracted from PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, and Web of Science were systematically searched from inception through August 2026. Data were extracted independently. Meta-analytical pooling using random-effects models was performed where appropriate, generating Mean Differences (MD) for continuous outcomes and Risk Ratios (RR) with 95% Confidence Intervals (CI). Study quality was appraised using Cochrane RoB 2.0 and ROBINS-I tools. Results: Twenty-two studies (N = 6,842 participants) met inclusion criteria. Upright maternal positioning was associated with a statistically significant reduction in the duration of the third stage of labor (MD = -3.42 minutes, 95% CI: -4.18 to -2.66 min; p < 0.001). Upright positioning significantly lowered the incidence of primary PPH (≥500 mL) (RR = 0.72, 95% CI: 0.58 to 0.89; p = 0.002) and decreased the necessity for manual removal of the placenta (RR = 0.54, 95% CI: 0.36 to 0.81; p = 0.003). Mean estimated blood loss was lower in upright cohorts (MD = -41.8 mL, 95% CI: -58.2 to -25.4 mL). Maternal comfort and satisfaction scores were higher in upright groups. Conclusion: Upright maternal positioning during the third stage of labor significantly accelerates placental delivery, reduces estimated blood loss, lowers PPH incidence, and decreases manual placental interventions without adverse maternal or neonatal effects. Freedom of maternal positioning should be routinely integrated into third-stage clinical practice guidelines.

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