Will a mother going into a hands and knees position during late pregnancy help rotate her posterior baby? Many mothers advise each other to spend time on hands and knees each day. Pelvic rocking helps relieve a sore lower back. But will it help the posterior baby rotate before labor starts? Gail comments afterwards with her Spinning Babies point of view.

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

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

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

Design Multicentre randomised controlled trial.

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

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

Main outcome measure Incidence of fetal occiput posterior position at birth.

Results 1046 women in the intervention group and 1209 women in the control group remained in the study until they went into labour. No significant difference existed between the groups for the incidence of occiput posterior position at birth: 105 (8.1%) women in the intervention group and 98 (7.8%) in the control 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 control group (difference in risk 0.4, -1 to 1.7). No differences occurred between intervention and control groups for induction of labour, use of epidural, duration of labour, mode of delivery, use of episiotomy, or Apgar score.

Conclusion Hands and knees exercise with pelvic rocking from 37 weeks' gestation to the onset of labour did not reduce the incidence of persistent occiput posterior position at birth.

Gail's comments:

I don't know how well controlled this "Randomized Controll Study" really was, because upon reading the full article it seems that about 11% of women did the pelvic rocking in the manner recommended from week 37 through week 40 or later. The rest did not complete three weeks or did not do the pelvic rocking daily.

 But more importantly to my readers, starting to attend to fetal position at 37 weeks is quite late in the pregnancy. 

Again, here is yet another study that does not put balance before gravity.

If we did a random control study of just one variable, I would suggest the Forward-leaning Inversion. Mothers would agree to do at least one a day starting anywhere from week 12 to week 37 and doing so through the remaining pregnancy. The mother's head would be flexed and not resting on the floor nor her hands or arms.  Her lower back (lumbar) is slightly, so slightly, flattened; but her back isn't curved. The position is held for 30 seconds (or 3 deep breaths). This position effects cervical ligaments and the alignment of the pelvis. Over time and repeated use it may well be helpful.

From anecdotal observations I vote for the Forward-leaning Inversion.