At the National University of Lesotho (NUL), final-year nursing and midwifery student Mopenyaki Kolane has been asking a bold question: Why don’t more midwives let women give birth in positions that feel comfortable to them?
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You’d think in 2025, expectant mothers could squat, kneel, lie sideways, or even lean on a birthing stool if they wanted. But nope. The old-fashioned “lie-on-your-back” method, called the lithotomy position, is still the go-to at many hospitals in Lesotho, including St. Joseph’s Hospital, where Kolane did the research.

Kolane wanted to understand why.

Now, before we go any further, let’s talk about what this really means.

When a woman gives birth, her body is doing one of the hardest, most powerful things it can ever do. And believe it or not, how she positions herself can affect how safe, smooth, and comfortable the birth will be, for both her and the baby. That’s not just Kolane’s opinion. The World Health Organization and doctors all over the world say so too.

Kolane found that upright positions like squatting, sitting, or even getting on all fours can make labour shorter, reduce pain, and lower the chance of things like cuts and stitches. “It’s not just about comfort,” he says, “it’s about real health outcomes.”

But here’s the kicker! Midwives know this. They’ve read the research. And many of them actually want to support women who prefer alternative positions.

So, what’s stopping them?

Let’s break it down.

“We want to support women. But the system is working against us.”

That’s what one midwife told Kolane during his research. And that one sentence sums up a lot of what he found.

At St. Joseph’s Hospital, Kolane gave surveys to 49 midwives. He wanted to know what they thought about different birthing positions and why they don’t use them more often.

He found that:

• 77% of midwives said they’re familiar with alternative positions (like squatting or kneeling).

• But almost half said they never use them, and only 2% use them always.

• Most blamed a lack of training, equipment, and hospital support.

Kolane explains, “A lot of the midwives said they simply weren’t taught how to help women in those other positions. Or they felt the hospital layout didn’t make it easy. No birthing stools, no mats, no ropes, just a bed and stirrups.”

And even when midwives wanted to offer options, they didn’t feel supported.

One midwife told Kolane, “You can’t just try new methods when management doesn’t back you. If something goes wrong, you’ll be blamed.”

“We’re not robots. We’re human. We want what’s best for the mother.”

That’s another quote from one of the midwives. And it shows just how deeply this issue affects the people who are trying to help.

Kolane’s project also found that personal beliefs and cultural norms played a part. Many midwives admitted they had grown up believing the lithotomy position was the “proper” way to give birth. It’s what they were taught. It’s what they saw. And it’s what they do, partly out of habit, partly out of fear.

Still, nearly 89% said they were willing to try alternatives if they got the right support and tools. That’s huge!

“They’re not being stubborn,” Kolane says. “They’re being realistic. They want more training. They want clear hospital policies. They want to feel confident.”

“Birth is not just a procedure. It’s a shared experience.”

That line from Kolane’s research report says it all.

When midwives are stuck in outdated methods because the system won’t help them change, it’s not just bad for them. It’s bad for mothers and babies, too.

Kolane believes that improving maternity care in Lesotho starts with listening, to both mothers and midwives.

His study suggests simple but powerful solutions:

• Give midwives proper training on alternative birthing positions.

• Provide equipment like mats and birthing stools.

• Create hospital policies that protect midwives who support maternal choice.

• And above all, let women decide the position that works for them.
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