Active Birth: concept, physiology, clinical benefits and evidence-based indications

The term “active birth” refers to an approach to labour management that emphasizes the physiology of both the mother and the fetus. It is a model that promotes maternal mobility, the adoption of free positions (vertical or semi-vertical), the conscious use of gravity, and self-directed pushing during the second stage of labour.
This approach is grounded in an understanding of the physiological mechanisms regulating labour and in respect for the woman’s innate ability to spontaneously modulate her contractions and pushing efforts, thereby optimizing labour progression and reducing unnecessary and inappropriate medical intervention.

The implementation of active birth is strongly supported by the guidelines of the World Health Organization (WHO), the recommendations of the American College of Obstetricians and Gynecologists (ACOG), and the position statements of the International Federation of Gynecology and Obstetrics (FIGO).

From a physiological perspective, active labour management facilitates optimal fetal alignment with the birth canal and effective rotation of the fetal head, which are key determinants of a safer and faster vaginal birth.
Maternal mobility enhances the effectiveness of uterine contractions through stimulation of neuromuscular receptors and optimization of uteroplacental perfusion, thereby improving fetal oxygenation.

The adoption of vertical positions reduces compression of the major maternal blood vessels, improves venous return, and increases fetal pressure on the cervix, facilitating cervical dilation and labour progression. Furthermore, spontaneous pushing directed by the birthing woman allows coordinated activation of the abdominal muscles and pelvic floor, limiting the risk of perineal trauma and reducing the need for instrumental obstetric interventions.

Maternal clinical benefits

Numerous clinical studies demonstrate that, for the mother, active birth is associated with:

• a significant reduction in the overall duration of labour, particularly the active phase
• a decreased incidence of operative vaginal birth and caesarean section
• a reduced risk of severe perineal trauma
• increased maternal satisfaction, related to a greater sense of control and active participation

Neonatal clinical benefits

For the newborn, active birth is associated with:

• higher Apgar scores at one and five minutes
• reduced need for immediate neonatal interventions
• decreased variability in fetal heart rate associated with maternal stress
• improved postnatal respiratory and metabolic adaptation

Supporting scientific evidence

Scientific evidence supports these benefits. WHO guidelines (2018) recommend maternal mobility and upright positions during low-risk labour, highlighting their role in reducing labour duration and the need for obstetric interventions.

The ACOG Practice Bulletin No. 218 (2020) emphasizes the importance of freedom of movement, spontaneous pushing, and continuous support as key factors in improving maternal and fetal outcomes.

The Cochrane review by Gupta and colleagues (2021) confirms that active birth significantly reduces the duration of the active phase of labour, the need for epidural analgesia, the use of obstetric instruments, and caesarean section rates, with positive effects on maternal satisfaction.

Active birth represents an evidence-based approach that integrates physiology, maternal autonomy, and obstetric safety. By minimizing iatrogenic interventions and optimizing outcomes for both mother and newborn, the routine adoption of this strategy in low-risk labour supports a birth experience that is physiologically respectful, safe, participatory, and woman-centred, in alignment with the most up-to-date international recommendations and the strongest available scientific evidence.