Dynamic birth position, awareness and practice by midwives in Ethiopia: a parallel mixed-methods study

Abstract

BACKGROUND: Respectful maternity care, as recommended by the World Health Organization, includes allowing women to give birth in the position of their choice. Dynamic birth positions, which enable women to adopt various positions during labor and delivery, are associated with improved obstetric outcomes. However, the extent of knowledge and practice regarding dynamic birth positions among Ethiopian midwives remains poorly understood. OBJECTIVE: To assess midwives' awareness and practice of dynamic birth positions and explore their perspectives and experiences. METHODS: A convergent parallel mixed-methods design was employed to evaluate midwives' knowledge, attitudes, and practices regarding dynamic birth positions. Quantitative data were analyzed using stepwise backward elimination logistic regression to identify key predictors, while qualitative data were examined through thematic analysis. RESULTS: The study included 483 midwives, with 473 participating in the quantitative survey and 10 in the qualitative interviews. Fewer than half of the midwives demonstrated good levels of knowledge (45%) and attitude (49.5%), while only 22.6% reported regular practice of dynamic birth positions. Participation in training emerged as the strongest predictor of knowledge, attitude, and practice. Thematic analysis revealed six key themes: routine practices, awareness, clinical implementation, barriers, facilitators, and user needs. CONCLUSION: Awareness and practice of dynamic birth positions among Ethiopian midwives are notably low. Key barriers include limited awareness and suboptimal working conditions, whereas targeted training significantly enhances all assessed domains. To promote the adoption of dynamic birth positions, efforts should focus on increasing awareness, modifying delivery equipment, and improving the clinical environment.