“Aspects to consider for the application of birthing stools to assist women giving birth to their children”
Abridged, with permission, from original article by Kate Tuohy-Main, Physiotherapist, Manual Handling Specialist


This paper looks at the aspect of occupational health and safety in the workplace, including tasks performed by health care workers on or near to the ground; the comfort, safety and dignity of the client and health care workers; the potential hazards of giving birth on a bed as well as aspects of using a birthing stool. The aim of the paper is to give an overview of different factors that need to be considered to prevent the birthing stool being ruled out as a successful option, or used inappropriately, to assist mothers delivering their children. The content of the paper also aims to encourage reflection and discussion of current work practices.

Birthing stools

As in all people-handling issues, it is necessary to consider the comfort, dignity and safety of both the carer and the client. A mother may feel that the most appropriate position to labour and deliver her baby is on a bed, but it could be hanging from a wall bar, in a bath or shower, sitting on a toilet, on hands and knees on the floor, or on a birthing stool. It is important that she feels safe and in as much control as possible, with her needs of comfort, safety and dignity being met in a situation where she has to work very hard, sometimes in extreme pain, in an unknown situation, in an unfamiliar environment and in many cases with people she has never met before. During labour, if the mother is independently positioning herself — as guided by what her body is telling her — verbal guidance from the midwife may be all that is necessary to give birth to her child.

If sitting or squatting is the most natural position for the woman, a birthing stool can take her weight and allow access to the perineum and the baby, which would not be possible if the woman was sitting on the toilet. It also gives the woman the chance to relax her legs, rather than if squatting, and conserve energy for concentrating on giving birth. The woman can lean back on another person or a bed and hold onto the birth stool to remain empowered throughout her birthing experience.

The midwife getting down on the floor to assist needs to be aware of back care principles, wear unrestricting clothing, and have available padded foam or a floormat on which mother and midwife can kneel. The midwife should be able to position herself safely in kneeling, half-kneeling or sitting on a low stool in front of the mother.

Personal experience

A good example of such a birth stool is the BirthRite Birthing Seat which is receiving support from mothers and medical staff in Australia.

The BirthRite Seat enabled me to have my daughter, Lilian, without requiring any pain relief. I was able to watch her being born in a mirror and pick her up and hold her straight away. This may seem undignified to those who look upon delivering babies as a clinical experience, with drapes to cover naked flesh and the mother passive on her back, even with her legs in stirrups in the air. But for many families who have had the opportunity to use the Birthing Seat, this can be a marvellous, unforgettable experience. It is unfortunate that cinema often portrays the drama of women lying down screaming in agony while giving birth to their babies. Although lying on a bed may be the preferred option for some mothers, or a necessity for medical intervention, lying down was the last position I personally wanted to be in when my daughter was being born. Semi-squatting or sitting on the Birthing Seat seemed the most natural position for me.

Hazard factors to consider in assisting a mother giving birth lying on a bed

Although the use of the Birthing Seat involves the accoucheur working near the floor, it is important to compare the woman’s perspective about her position as well as the health care worker’s. It is also important to look at the alternative arrangements that may be offered to the woman and to explore the safety aspects of these other approaches.

One alternative, as mentioned above, is to have the woman on a bed, either sitting up or lying on her back, with or without her legs in the air. It may be more convenient for health care workers to stand with the bed pumped up to the correct height for easy access to the woman’s vagina, but stooping and side flexing will be required to look at what is going on. From this angle, it is quite difficult to keep the woman’s face and her perineum in view at the same time.

From my experience of working with staff in labour wards, there is a range of hazards for health care workers that are associated with assisting mothers to have their babies on beds. These include:–

Some of these issues are discussed in A Manual of Handling People — Implementing a No-lift Approach (2nd edition, Chapter 4).

What is most appropriate for birthing women?

Research is underway to establish which birthing positions are most acceptable for the women themselves as well as the medical benefits and risks with different birthing positions. These also need to be taken into account when discussing different position options with prospective mothers, prior to and during the birthing process.


I have worked with a wide range of labour ward staff. Apart from staff at times commenting that it is not always easy working with women on the floor, I have not had reports that staff or patients are being injured from working on the floor or when using a birthing stool. This could mean that not many women have been allowed to use, or have not been been offered, or have not requested the use of, a birthing stool. Or, staff have not reported injuries or injuries are not occurring.

Birthing seats are an attractive option for many women. With this in mind obstetricians and midwives will need to continue with research, trials, and the assessment of different birthing options. Education on the benefits and potential hazards from different birthing processes for babies, mothers, midwives and medical staff needs to be ongoing. Birthing seats need to be included in part of this research and education process.

— Kate Tuohy-Main
Physiotherapist, Manual Handling Specialist
Author of A Manual of Handling People — Implementing a No-lift Approach
Newcastle, NSW, Australia

Last altered: 2013-06-07 [ISO 8601] Copyright © 2006–2013 BirthRite. All rights reserved.