Key messages
We found no evidence for guiding practice with respect to the best positions for the mother to adopt in late pregnancy to change the position of the baby.
What is the issue?
The ideal position for the baby during labour and birth is with the baby's well-flexed head downwards, and the back of the head facing forwards (occipito-anterior). When the back of the baby's head faces backwards or to the side, labour may be more difficult. Various positions adopted by the mother, such as hands-knees or lying on a particular side, have been considered as possible ways to promote rotation of the baby to the forward position. This review assesses the use of such positions in late pregnancy, compared with alternative positions or no specific positioning.
What did we want to find out?
We wanted to find out whether adopting certain positions promotes rotation of the baby to a more favourable position, as this would provide women with a simple method of potentially improving labour outcomes. On the other hand, evidence that these positions are unhelpful would allow women to avoid investing time and effort unnecessarily.
What did we do?
We searched the literature for studies assessing the effectiveness of various postures adopted by the mother in late pregnancy for improving the position of the baby and birth outcomes. We assessed the quality of the research, and where necessary attempted to contact study authors for clarification of the methods they used.
What did we find?
We identified two trials that might have been eligible for the review. However, we were unable to contact the primary authors to resolve queries about how women were allocated to the different groups, possibly because the trials were conducted a long time ago (1983 and 2004). There was insufficient information in the two study reports to assess the methodological quality, and further information is needed.
Main results
We are unsure whether adopting specific positions in late pregnancy promotes rotation of the baby from a backward or sideways position to a forward position for the back of the head. More research is needed, particularly focussing on positions adopted in late pregnancy and repeated until the onset of labour.
What are the limitations of the evidence?
We included no studies in this review.
How up to date is this evidence?
The evidence is up to date to 24 October 2022.
We did not identify evidence for guiding practice with respect to positional interventions for fetal malposition in late pregnancy. More studies are needed to understand the effect of positional interventions in late pregnancy.
Future research on positional interventions for fetal malposition in late pregnancy should include follow-up to determine whether short-term correction of fetal position translates to improved pregnancy outcomes. This might include interventions commenced in late pregnancy and repeated as needed until the onset of labour. The latter would be included in the review on maternal positions during labour.
The optimal relationship of the fetus to the mother's birth canal is when the fetus is in the longitudinal lie, cephalic presentation with well-flexed head (vertex presentation), and in the occipito-anterior position. Fetal malposition is described as occipito-posterior (OP) when the back of the fetal head lies posteriorly in the mother’s pelvis, and occipito-transverse (OT) when the back of the fetal head lies transversely in the mother’s pelvis. The fetal head will often be deflexed and may extend further to a mento-anterior or mento-transverse position, where the chin is anterior or transverse to the maternal pelvis.
Fetal malposition is associated with both maternal and fetal complications, including prolonged labour, fetal distress, maternal exhaustion, need for caesarean section, operative vaginal birth, and increased risk of perineal trauma and anal sphincter injuries.
This review considered positional interventions in late pregnancy to correct fetal malposition. A separate Cochrane review addresses maternal postural position for fetal malposition during labour.
To assess the effects of maternal posture for fetal malposition in women in late pregnancy.
We searched Cochrane Pregnancy and Childbirth’s Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (24 October 2022), and reference lists of retrieved studies.
Our selection criteria were randomised controlled trials and cluster-randomised controlled trials that included women in late pregnancy with a malposition of the fetus including OP and OT, mento-anterior and mento-transverse, or with uncertain fetal position, randomly allocated to use of specified maternal positioning in late pregnancy, compared with usual care.
Two review authors independently assessed potential studies for inclusion in the review. We used standardised methodology for assessment of risk of bias and trustworthiness developed by the Cochrane Pregnancy and Childbirth Group.
We reviewed three full-text reports; we excluded one due to lack of a comparison group and listed two as awaiting classification.
We needed further information from the report authors for both potentially suitable studies to account for substantial imbalances between the numbers allocated to each group in one, or identical numbers for all groups in the other. The failure to resolve these issues may have been due to the long interval since publication of the studies (2004 and 1983).