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

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