'This is like tradition, lie on your back, hold your leg, and push': understanding midwives' perspectives on their choice of labour positions in a Ugandan hospital.

Introduction: Despite the well-documented benefits of upright positions and mobility during labour and childbirth, the adoption of these remains limited. Offering women choices in labour positions is essential for respectful maternity care. Since midwives play a pivotal role in guiding women through labour, their perspectives are crucial to the effective integration of these practices.

Aim: The study aimed to understand midwives' perspectives and reasoning behind their choice of labour positions.

Methods: This qualitative study was conducted in a regional referral hospital in eastern Uganda. Twelve midwives were recruited purposively at two different time points in December 2020 and February 2024. A data-driven reflexive thematic analysis was conducted.

Results: Midwives' choice of labour positions was based on their understanding of the advantages and disadvantages for mothers and babies. Midwives were only open to changing their practices when they were confident in their knowledge and skills. The availability of resources influenced their perspectives on which positions were most feasible and effective in different situations. The midwives prioritised assessment of the mother's clinical condition rather than her preferences when choosing birth positions.

Conclusion: This study highlighted midwives' willingness to support different and, to them, new labour positions when confident in their efficacy and safety. Addressing misconceptions about risks and equipment needs is therefore crucial. The prevailing provider-centric norms in hospitals may shape midwives' approach to care, highlighting the need for supportive environments to foster midwives' confidence in new practices.