Background The benefits of upright birth positions are wellestablished in the literature, yet women are persistently challenged to assume the lithotomy or supine birth positions. This study aimed to explore what is known about women s capacity to assume upright birth positions in hospital environments, and its effect on physiological birth. Methods A structured five-step approach was employed to conduct an integrative review of the literature. The Cumulative Index to Nursing and Allied Health Literature and MEDLINE were searched for articles on women s position during labour and birth in hospital settings. Four articles were selected for inclusion and subjected to thematic analysis to elicit themes and subthemes. Results Three core themes emerged from this review: the biomedical model of care and workplace culture impact the positions women adopt during labour and birth , midwives philosophy and views support physiological birth and clinical settings are not conducive to physiological birth . Conclusions Midwives are losing the skills and confidence to support women into upright birth positions. Improved education and training around upright birthing may see a rise in women adopting these positions in hospital environments.