Effect of Squatting Position in the Second Stage of Labor on Birth Outcomes

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.

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.

• second stage of labor
• maternal position
• birth position
• nulliparous women
• lithotomy 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.

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.

• second stage of labor
• maternal position
• birth position
• squatting position
• nulliparous women

The time elapsed from the completion of cervical dilation (full dilation - 10 cm) to the birth of the baby will be recorded.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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)

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).

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).

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.