Research and references

Research and references

Is posture efficient? Desbriere 2013

  • Friday, 25 January 2013 02:47

 

Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial
 
Doi : 10.1016/j.ajog.2012.10.882 

Raoul Desbriere a  , Julie Blanc b, Renaud Le Dû b c d, Jean-Paul Renner f, Xavier Carcopino b c, Anderson Loundou e, Claude d'Ercole b c

 

Desbriere R, Blanc J, Le Dû R, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. Am J Obstet Gynecol 2013;208:60.e1-8.

From the AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY

Résumé

Objective

We sought to evaluate the efficacy of maternal posturing during labor on the prevention of persistent occiput posterior (OP) position.

Study Design

We conducted a randomized trial including 220 patients in labor with a single fetus in documented OP position. Main outcome was the proportion of anterior rotation from OP position.

Results

The rates of anterior rotation were, respectively, 78.2% and 76.4% in the intervention group and the control group without significant difference (P = .748). Rates of instrumental and cesarean section deliveries were not significantly different between intervention and control groups (18.2% vs 19.1%, P = .89, and 19.1% vs 17.3%, P = .73, respectively). In intervention and control groups, persistent OP position rates were significantly higher among women who had cesarean section (71.4% and 89.5%, respectively) and an instrumental delivery (25% and 33.3%, respectively) than among women who achieved spontaneous vaginal birth (5.8% and 2.8%, respectively). In multivariable analysis, body mass index and parity were found to have significant and independent impact on the probability of fetal head rotation.

Conclusion

Our study failed to demonstrate any maternal or neonatal benefit to a policy of maternal posturing for the management of OP position during labor.


Key words : fetal malposition, persistent occiput posterior position, posture

 

 

Please, someone, research Balance before Gravity and see if this improves outcomes! Though these are pretty low cesarean rates for today's University practices, they are still higher than the World Health Organization recommendation.

The first principle of Spinning Babies is to make the point that body balance is often necessary. The workshop instructs how to match technqiues for the station of descent. In other words, certain techniques are specific for the inlet, certain ones for the midpelvis, and others for the outlet. While changing position is useful and good, it is not specific to opening the diameters of the pelvis. Yet, the research sticks to repeating this point.

It is deceptive to say researching fetal positioning within the parameters of what isn't working  shows that "nothing" works.

Maternal posture is helpful for comfort, pain relief, and moving between postures may have added benefits and should be studied.

See The Three Principles, Balance, Gravity and Movement.

 

Bibliography for Asynclitism

  • Thursday, 01 December 2011 04:27

Bibliography for Asynclitism 

[Created for "The Tipping Point; Helping the Asynclitic Baby"]

2011

Read more: Bibliography for Asynclitism

Bibliography for Spinning Babies OP

  • Wednesday, 12 January 2011 21:56

 

Bibliography for Spinning Babies 2013

The books and articles on fetal positioning and maternal positioning. Send your favorites to gail at Spinning Babies dot comm

Read more: Bibliography for Spinning Babies OP

Ultrasound before a vacuum or manual rotation Martino 2007

  • Sunday, 01 August 2010 16:22

Its hard to tell baby's head position from a simple vaginal exam. The baby's skull is made up of portions of the skull that move and overlap somewhat. These are called "plates" and they have names. The borders between them are mobile and are called "sutures." Sutures lines are supposed to reveal fetal head position. Is it worth an ultrasound in a difficult labor?

OP by Martino

Who stays OP? Gardberg 1998

  • Sunday, 01 August 2010 16:04

These studies help show which babies may stay occiput posterior using modern university labor and delivery practices.

Finish researcher Gardberg has helped us understand the rates of occiput posterior and how often they rotate. We'll start with a 1998 Gardberg study here and I'll refer you over to the 2005 Lieberman study which finds similar rates, though reports it as new information. Both show that about 1/3 of babies that start OP stay OP. Again, we miss the rates of left occiput transverse (lateral) and right occiput transverse (lateral) and the route of rotation for these babies. 

Read more: Who stays OP? Gardberg 1998

Women's Position in Labor studies

  • Saturday, 31 July 2010 22:03

These are some of the studies on what women can do in labor to effect labor progress and outcome. More are needed. Please send the names and links of studies which you find important. Together we can make this a better article.

 

Maternal position during the first stage of labor: a systematic review

From João P Souza and his research team in Brazil.

This review and randomization analysis found walking and being upright to be safe. Two of the studies looked at really long labors and perhaps that is why, overall, the report doesn't show moving around shortened labor compared with laying around. Interventions in labor were common, so this isn't a study to show anything about natural labor per se. 

 

Mobility and maternal position during childbirth in Tanzania: an exploratory study at four government hospitals

Helen Lugina

 

2nd Stage or Pushing Stage

MidwifeInfo.com website has this to say about a study on vertical positions in the 2nd Stage:

Fewer abnormal fetal heart rate patterns 1 trial - OR 0.31, 95% CI 0.11 - 0.91).

(Citation: Gupta JK , Nikodem VC. Woman's position during second stage. Cochrane Library)

Nancy from MidwifeInfo says, "I find this evidence too compelling to be ignored by those of us involved in the care of laboring women. There have been varied hypotheses about the reasons for the advantages of non-recumbent positions, such as stronger and more effective uterine contractions (Caldeyro-Barcia 1960), and improved alignment of the fetus for passage through the pelvis (Gold 1950); and also lessened risk of aorto-caval compression and improved acid-base outcomes in the newborn (Ang 1969, Humphrey 1974, Scott 1963). Until recently in the history of childbearing, women would try to avoid the dorsal position and would change position during labor when and as she wished (Engelmann 1882). Different upright positions were achieved using posts, hammocks, furniture, ropes or knotted pieces of cloth, kneeling, crouching or squatting using bricks, stones, a pile of sand, or a birth stool (Englemann 1881). Today, most women deliver in a dorsal, semi-recumbent or lithotomy position. We all know that it is easier for the midwife to monitor the baby and see what is happening if the woman is in a dorsal or semi-recumbent position (yes, the ubiquitous semi-Fowler's position), and we know that this is the position modern Western women expect to assume to birth their babies (or, all too often, to be delivered of them). After all, the TV screen in the labor room is positioned so that the view is best from the semi-recumbent position in the bed, so women just naturally get into bed and slide down into that position. Then they stay there.

Nancy continues, "I would like to propose that we, as midwives, using the best available evidence, make a non-recumbent position the default position for second stage of labor, and use a recumbent position only for specific situations. Why don't we do this now? I would hazard that the reasons have more to do with habit, hospital protocols, fatigue or overwork (I am frequently too tired or too busy to try something different, even if it occurs to me that it might help) than with a conviction that the semi-Fowler's position is better. Even with an epidural, most women can sit in a chair, on a commode, or on a birthing ball next to the bed; or they can stand next to the bed and lean over it, with support from another person. Remembering the significant advantages of an upright position, I would like to challenge all of us to use this evidence to encourage our patients to sit, squat, kneel, or stand to push their babies out."

Thank you, Nancy. I'm sure the readers of SpinningBabies.com agree!  Visit MidwifeInfo.com

 
Researcher Gupta also had this report published:

Woman's position during second stage of labour.

Gupta JK, Nikodem VC.

Which is better, being upright or lying down to push out a baby? This review of the Cochrane articles "suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500ml. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies."

I wonder about increased blood loss. I think we should look at how much comes with the placental gush and then how much over the postpartum period before we decide. Sometimes when women lose more at birth they lose less in the days and weeks following birth. Watching blood loss within the next hour or two and making a comparison of blood loss would show us if this initial increased blood loss is significant. 

 


 

Penny Simkin's 2010 article on OP position

  • Saturday, 31 July 2010 20:31

The Fetal Occiput Posterior Position...

PennySimkin, PT

From Birth Volume 37 Issue 1, Pages 61 - 71

The occiput posterior position challenges every aspect of labor care. Trying to prevent OP fetal position, diagnosing the OP position, correcting the OP position, supporting labor and making decisions about what to do for labor, and the delivery itself. Mothers and babies outcomes are often worse with both physical and psychological trauma being more common than with fetal occiput anterior positions. Here Penny Simkin highlights nine common beliefs and shows which are myths. Gail comments afterwards.

More Simkin

"What's your research?"

  • Friday, 04 June 2010 03:34

The Spinning Babies approach is active, holistic, anecdotal, and grassroots. Evidence-based medicine is a coat rack upon which convention hangs. The rack isn't what the Obstetrician wears. If US maternity were evidence-based, we'd have a cesarean rate below 15%, breech babies would be allowed to be born, and there would be a doula in every birthing suite. My arms are open and waiting for grad students who want to take on some of the successful techniques shared at Spinning Babies. I'm just not going to wait for convention to catch up with me. 

Research?

Breech References

  • Monday, 15 March 2010 15:14

Scroll down (Read More) to see the list of articles and books contributing to the Spinning Babies view on breech position and breech birth. Click on these underlined words to begin downloading the Bibliography for Breech pdf. [Adobe Acrobat PDF - 99.22 KB] You will download the Breech Bibliography pdf. that is at the bottom of this page. Use Acrobat Reader to view this pdf. file once it is on your desktop. You can download the Adobe Acrobat Reader for free onto your computer to see this and other pdf. files.

 


More Breech

Thyroid and OP Dutch 2009

  • Thursday, 24 December 2009 21:16

A study published in Clinical Endocrinology finds evidence that low levels of the thyroid hormone called thyroxine may be associated with more posterior positioned babies. While the 3 Principles are often effective in correcting malposition, there are occasional women whose babies do not respond, or respond in the amount of time the mother has after finding out her baby is posterior. This may be helpful information. In addition, it may be helpful to have your thyroid levels checked in pregnancy. The New England Journal of Medicine suggests a type of iodine supplementation in pregnancy.

Thyroid & OP

Hands and Knees studies

  • Saturday, 19 December 2009 20:27

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.

Kariminia

Which side should I lay on? what studies say

  • Saturday, 19 December 2009 19:02

There are reasons that laying on your left side is helpful in pregnancy. Most women (but not all) will have a lower blood pressure while lying on their left side compared to when lying on their right side. But with fetal positioning will lying on one's left help the baby's back to come over to the left, too? Two articles help answer the question of whether you should try and sleep on your left side to help your baby turn anterior.

Click to de side

Patience when labor stalls 2008 Caughey

  • Tuesday, 18 November 2008 15:22

Researcher Aaron Caughey finds giving more time will reduce 400,000 cesareans a year. See the Nov. 18, 2008 Orgyn.com article called Patience after stall in labor advised. Read the research itself. Obstetrics and Gynecology 2008; 112: 1109-15 Perinatal Outcomes in the setting of active phase arrest in labor.

Caughey

Review: 2005 Lieberman on Posterior and Epidurals

  • Monday, 06 October 2008 01:20

Ellice Lieberman’s 2005 research article on Fetal Position and Epidural Analgesia

Ellice Lieberman and her research colleagues looked at which came first, the posterior positioned baby or the epidural. In previous research studies it was somewhat unclear if women having epidural anesthesia (here called analgesia) were more likely to have a posterior baby or whether women with a posterior baby in labor were more likely to ask for an Epidural. While they tracked that question to an answer they observed multiple changes in fetal position at four times during labor. 

Research article title: Changes in Fetal Position During Labor and Their Association With Epidural Analgesia.

Lieberman

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