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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.

 

The first study is

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

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

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, I would warn that waiting to start attending to fetal position at 37 weeks is quite late in the pregnancy. Maybe not too late if you use a comprehensive approach. This article shows that doing a few pelvic tilts for a few weeks is too little, too late. Pelvic tilts address a few of the pelvic muscles and joints in only one direction. Women with a persistent posterior lie in pregnancy need to address the WHOLE pelvis with all its soft tissues. That takes a series of activities for anywhere from 20 to 45 minutes a day. Some of these women will need professional body work.

 

 

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

 

Here is another hands and knees study. Hands and knees position is studied because nurses, doulas, midwives, mothers and doctors notice that there are benefits to hands and knees. So we all want to learn more about how to understand the cause and effect of positional benefits. The limits of studies is that they study one thing at a time in a set way, a way that might not be how we use it in practice. This is a pretty good try, though:

The second study is a review of articles in the Cochrane data base:

Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001063.

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

Hunter S, Hofmeyr GJ, Kulier R

Abstract

BACKGROUND: Lateral [Gail: Lateral means to the side, so in this case, baby is facing a hip, but these papers don't define WHICH hip] and posterior position of the baby's head (the back of the baby's head facing to the mother's side or 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: 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.

MAIN RESULTS: Three reports involving 2794 women showed that 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.

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.

Hands and knees position in labour for a period of at least 30 minutes, compared to no hands and knees positioning in labour, reduced occipito-posterior or -transverse positions at delivery. Operative deliveries were not statistically significant. There was a significant reduction in back pain.

AUTHORS' CONCLUSIONS: Use of hands and knees position for 10 minutes twice daily to correct occipito-posterior 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 position in labour was associated with reduced backache.

 

Gail's comments

Again, I suggest the 1st Principle before the 2nd - Balance the womb before trying to change baby's position through gravity-friendly positions for better effectiveness.

It might be useful to try crawling in late pregnancy and see if that works better than hands and knees alone. Pelvic tilts on hands and knees may work better after a forward-leaning inversion and especially when baby is actively trying to rotate as noted by a surge of contractions before fetal engagement.

Adding pelvic tilts and crawling utilizes the 3rd Principle of Spinning Babies, Movement.



 

Birth. 2005 Dec;32(4):243-51.

Randomized controlled trial of hands-and-knees positioning for occipitoposterior position in labor.

Stremler R, Hodnett E, Petryshen P, Stevens B, Weston J, Willan AR.

This study finds that hands and knees reduces back pain and may improve birth outcomes somewhat.

 

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