Management of Occiput Posterior Position in the Second Stage of Labor: A Survey of Midwifery Practice in Australia

Authors

  • Hala Phipps RM, BSc, MPH, ,

    Research Midwife and PhD Candidate, Corresponding author
    1. RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
    2. Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
    3. Faculty of Nursing and Midwifery, University of Sydney, Sydney, Australia
    • Address correspondence to Hala Phipps, PhD Candidate/Research Midwife, RPA Women and Babies, Royal Prince Alfred Hospital, Sydney 2050, Australia.

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  • Brad de Vries BSc(Med), MBBS, MM, FRANZCOG, MM(Clin epi),

    Staff Specialist
    1. RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
    2. Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
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  • Ujvala Jagadish MBSS,

    1. Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, Australia
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  • Jon Hyett MBBS, MD, MCROG, FRANZCOG

    Clinical Professor
    1. RPA Women and Babies, Royal Prince Alfred Hospital, Sydney, Australia
    2. Faculty of Nursing and Midwifery, University of Sydney, Sydney, Australia
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Abstract

Background

The management of the occiput posterior (OP) position has been controversial for many years. Manual rotation can be performed by midwives and could reduce cesarean sections and instrumental births. We aimed to determine current midwifery views, knowledge, and practice of manual rotation.

Method

A de-identified, self-reported questionnaire was e-mailed to all Australian College of Midwives full members (n = 3,997).

Results

Of 3,182 surveyed, 57 percent (1,817) responded, of whom 51 percent (920) were currently practicing midwifery. Seventy-seven percent of midwives thought that manual rotation at full dilatation was a valid intervention. Sixty-four percent stated the procedure was acceptable before instrumental delivery, but 30 percent were unsure. Most practicing midwives (93%) had heard of manual rotation, but only 18 percent had performed one in the last year. Midwives would support the routine performance of manual rotation for OP position if it reduced operative births from 68 to 50 percent and would support manual rotation for occiput transverse (OT) position if it reduced operative births from 39 to 25 percent.

Conclusion

This study indicates that manual rotation is considered acceptable by most midwives in Australia, yet is only performed by a minority. Midwives would be willing to perform prophylactic manual rotation if it was known to facilitate normal vaginal births suggesting a scope to introduce this procedure into widespread clinical practice.

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