Friday, April 10, 2015

Clinical Inquiry Series

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice.  Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care.  Here is another in our series entitled "Clinical Inquiry". 

Q: What laboring positions are most effective in turning a posterior baby anterior?  We currently use far left or lateral, upper LE on over bed table, and "frog" position.  I have also seen hands on knees used.

A: What does the evidence say?
There are many beliefs regarding the best way to position a laboring woman to turn an OP baby to the occiput anterior (OA) position.  A review of the literature notes conflicting evidence for the hands and knees position (Kariminia et al., 2004) (Stremler et al., 2005).  There is not enough evidence at this time to confirm if all other positions (left lateral, right lateral or frog position) assist with rotating the baby from OP to OA position (Simkin, 2010).  The evidence does show that the hands and knees position reduces back pain during labor (Hunter et al., 2007).  None of the aforementioned positions have been shown to be harmful.  At this time, the evidence in conflicting or there is not enough evidence to say one position is better than another to rotate an OP baby.


1: Desbriere R, Blanc J, Le Dû R, Renner JP, Carcopino X, Loundou A, d'Ercole C.
Is maternal posturing during labor efficient in preventing persistent occiput
posterior position? A randomized controlled trial. Am J Obstet Gynecol. 2013
Jan;208(1):60.e1-8. doi: 10.1016/j.ajog.2012.10.882. Epub 2012 Oct 26. PubMed
PMID: 23107610.

2: Simkin P. The fetal occiput posterior position: state of the science and a new
perspective. Birth. 2010 Mar;37(1):61-71. doi: 10.1111/j.1523-536X.2009.00380.x.
Review. PubMed PMID: 20402724.

3: Stremler R, Halpern S, Weston J, Yee J, Hodnett E. Hands-and-knees positioning
during labor with epidural analgesia. J Obstet Gynecol Neonatal Nurs. 2009
Jul-Aug;38(4):391-8. doi: 10.1111/j.1552-6909.2009.01038.x. PubMed PMID:

4: Hunter S, Hofmeyr GJ, Kulier R. Hands and knees posture in late pregnancy or
labour for fetal malposition (lateral or posterior). Cochrane Database Syst Rev.
2007 Oct 17;(4):CD001063. Review. PubMed PMID: 17943750.

5: Hart J, Walker A. Management of occiput posterior position. J Midwifery Womens
Health. 2007 Sep-Oct;52(5):508-13. Review. PubMed PMID: 17826716.

6: Stremler R, Hodnett E, Petryshen P, Stevens B, Weston J, Willan AR. Randomized
controlled trial of hands-and-knees positioning for occipitoposterior position in
labor. Birth. 2005 Dec;32(4):243-51. PubMed PMID: 16336365.

7: Kariminia A, Chamberlain ME, Keogh J, Shea A. Randomised controlled trial of
effect of hands and knees posturing on incidence of occiput posterior position at
birth. BMJ. 2004 Feb 28;328(7438):490. Epub 2004 Jan 26. PubMed PMID: 14744821;
PubMed Central PMCID: PMC351839.