Hands and knees posture in late pregnancy or labour for fetal malposition (lateral or posterior)

  • Review
  • Intervention

Authors

  • GJ Hofmeyr,

  • R Kulier


Prof G Justus Hofmeyr, Director/Hon. Professor, Effective Care Research Unit, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, 5200, SOUTH AFRICA. gjh@global.co.za.

Abstract

Background

Lateral and posterior position of the baby's head (the back of the baby's head facing to the side or the mother's back) may be associated with more painful, prolonged or obstructed labour and difficult delivery. It is possible that certain positions adopted by the mother may influence the baby's position.

Objectives

The objective of this review is to assess the effects of adopting a hands and knees maternal posture in late pregnancy or during labour when the presenting part of the fetus is in a lateral or posterior position, compared with no intervention.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2004) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2004).

Selection criteria

Randomised trials of hands and knees maternal posture compared to other postures or controls.

Data collection and analysis

Both review authors assessed trial eligibility and quality.

Main results

Two trials of hands and knees posture during pregnancy were included. In one trial involving 100 women, four different postures (four groups of 20 women) were combined for the comparison with the control group of 20 women. Lateral or posterior position of the presenting part of the fetus was less likely to persist following 10 minutes in the hands and knees position compared to a sitting position (one trial, 100 women, relative risk (RR) 0.25, 95% confidence interval (CI) 0.17 to 0.37). In a second trial including 2547 women, advice to assume the hands and knees posture for 10 minutes twice daily in the last weeks of pregnancy had no effect on the baby's position at delivery or any of the other pregnancy outcomes measured. No trials of hands and knees posture during labour were included.

Authors' conclusions

Use of hands and knees position for 10 minutes twice daily to correct occipitoposterior position of the fetus in late pregnancy cannot be recommended as an intervention. This is not to suggest that women should not adopt this position if they find it comfortable. The use of this position during labour has not been addressed in this review. In view of the promising short-term effects of the technique and its simplicity, further trials are justified to determine whether encouraging the use of hands and knees posture during rather than before labour, has any effect on substantive outcomes.

Plain language summary

Plain language summary

Assuming the hands and knees posture in late pregnancy does not improve pregnancy outcomes but use in labour is worth investigating

The best position for babies during birth is head down, with the back of their head facing forward. When babies lie with the back of their head towards the mothers' side (lateral) or towards the mothers' back (posterior), the labour may be longer and more painful. The review found that assuming the hands-knees position for ten minutes helped the baby to modify position at the time, but suggesting women assume the hands-knees position for ten minutes twice daily during late pregnancy had no effect on longer-term outcomes in labour. Using this position during labour is worth investigation.