Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth

doi:10.1136/bmj.37942.594456.44

BMJ 2004;328:490 (28 February), doi:10.1136/bmj.37942.594456.44 (published 26 January 2004)

Paper

Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth

Azar Kariminia, research officer¹, Marie E Chamberlain, professor of midwifery³, John Keogh, consultant obstetrician and gynaecologist², Agnes Shea, lecturer³

¹ Midwifery Research, Hornsby Hospital, Palmerston Road, Hornsby, NSW 2077, Australia, ² Department of Obstetrics and Gynaecology, Hornsby Hospital, ³ University of Sydney, Sydney, NSW 2006, Australia

Correspondence to: Azar Kariminia, Public Health Unit, Long Bay Complex, Anzac Parade, Malabar, PO Box 150, Matraville, NSW 2036, Australia karimia{at}chs.health.nsw.gov.au

Objective To evaluate the efficacy of hands and knees positionand pelvic rocking exercises on the incidence of fetal occiputposterior position at birth.

Design Multicentre randomised controlled trial.

Setting Seven maternity units in New South Wales, Australia,encompassing teaching hospitals and district general hospitals.

Participants 2547 pregnant women at 37 weeks' gestation; 1292randomised to the intervention group and 1255 to the controlgroup.

Intervention Hands and knees position and pelvic rocking exercisesfrom 37 weeks' gestation until the onset of labour.

Main outcome measure Incidence of fetal occiput posterior positionat birth.

Results 1046 women in the intervention group and 1209 womenin the control group remained in the study until they went intolabour. No significant difference existed between the groupsfor the incidence of occiput posterior position at birth: 105(8.1%) women in the intervention group and 98 (7.8%) in thecontrol group had a baby in a posterior position at delivery(difference in risk 0.3%, 95% confidence interval -1.8 to 2.4).The incidence of fetal transverse arrest was 3.4% (44 women)in the intervention group and 3.0% (38 women) in the controlgroup (difference in risk 0.4, -1 to 1.7). No differences occurredbetween intervention and control groups for induction of labour,use of epidural, duration of labour, mode of delivery, use ofepisiotomy, or Apgar score.

Conclusion Hands and knees exercise with pelvic rocking from37 weeks' gestation to the onset of labour did not reduce theincidence of persistent occiput posterior position at birth.

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This article has been cited by other articles:

Altman, D., Bland, J M. (2004). Confidence intervals illuminate absence of evidence. BMJ 328: 1016-1017 [Full text]
Alderson, P., Groves, T. (2004). What doesn't work and how to show it. BMJ 328: 473-473 [Full text]

Rapid Responses:

Read all Rapid Responses

interesting article: Susan Hughes
bmj.com, 12 Mar 2004 [Full text]
Validity is flawed - what about the laws of gravity and bouyancy?: Sara S Webb, et al.
bmj.com, 8 Apr 2004 [Full text]
We need more trials like this, but: Karen Leitzel
bmj.com, 21 Oct 2004 [Full text]
Help for the posterior baby: Esther Marilus
bmj.com, 9 Mar 2007 [Full text]