Maternal posture for fetal malposition to improve labour and birth outcomes for mothers and their infants
type: CreativeWork
description: Aim: To assess current evidence-based practice for fetal malposition in labour; to investigate the incidence and outcomes of fetal malposition in New Zealand; and to assess the feasibility of a randomised controlled trial (RCT) of maternal posture for fetal malposition to improve maternal and infant health outcomes. Methods: A Cochrane systematic review of maternal posture for fetal malposition assessed its efficacy on health outcomes. A retrospective cohort study reviewed records and compared outcomes of occiput-posterior/transverse and occiput-anterior fetal position in labouring women at Auckland Hospital in 2018. A mixed method study using web-based surveys and focus groups (midwives) assessed pregnant women and midwives’ knowledge and views on fetal malposition and the acceptability of a future RCT of maternal posture. Findings: Hands and knees and lateral postures had little/no effect on operative birth, serious neonatal morbidity and other outcomes in the systematic review. However, the evidence was judged of low/very-low certainty due to risk of bias, heterogeneity and/or imprecision. Two-thirds of the retrospective cohort of women had fetal malposition and a quarter persisted till birth. Malposition was associated with body mass index ≥30, right-sided fetus, oxytocin augmentation, epidural-use, longer mean first-stage labour, reduced normal birth and increased caesarean section. Surveyed midwives mostly (80%) thought posture affects fetal position, utilise postural changes during labour, would recommend posture if caesareans reduced, and would collaborate with a trial. Focus-group participants (n=19) linked participation to relevance, practice flexibility and knowledge/skill development. One-quarter thought the Sims posture difficult for fetal monitoring. Of 206 surveyed pregnant women, 76% knew of malposition but only 28% were aware of postural approaches to care. 37% would participate in an RCT but half were unsure primarily related to comfort concerns, a…
abstract: Aim: To assess current evidence-based practice for fetal malposition in labour; to investigate the incidence and outcomes of fetal malposition in New Zealand; and to assess the feasibility of a randomised controlled trial (RCT) of maternal posture for fetal malposition to improve maternal and infant health outcomes. Methods: A Cochrane systematic review of maternal posture for fetal malposition assessed its efficacy on health outcomes. A retrospective cohort study reviewed records and compared outcomes of occiput-posterior/transverse and occiput-anterior fetal position in labouring women at Auckland Hospital in 2018. A mixed method study using web-based surveys and focus groups (midwives) assessed pregnant women and midwives’ knowledge and views on fetal malposition and the acceptability of a future RCT of maternal posture. Findings: Hands and knees and lateral postures had little/no effect on operative birth, serious neonatal morbidity and other outcomes in the systematic review. However, the evidence was judged of low/very-low certainty due to risk of bias, heterogeneity and/or imprecision. Two-thirds of the retrospective cohort of women had fetal malposition and a quarter persisted till birth. Malposition was associated with body mass index ≥30, right-sided fetus, oxytocin augmentation, epidural-use, longer mean first-stage labour, reduced normal birth and increased caesarean section. Surveyed midwives mostly (80%) thought posture affects fetal position, utilise postural changes during labour, would recommend posture if caesareans reduced, and would collaborate with a trial. Focus-group participants (n=19) linked participation to relevance, practice flexibility and knowledge/skill development. One-quarter thought the Sims posture difficult for fetal monitoring. Of 206 surveyed pregnant women, 76% knew of malposition but only 28% were aware of postural approaches to care. 37% would participate in an RCT but half were unsure primarily related to comfort concerns, a…
author: Barrowclough, Jennifer Andrée
license: https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm
date published: 2022
date modified: 2026-07-24T01:05:11Z
provider: University of Auckland
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: ResearchSpace@Auckland

PropertyValue
property ID: Handle
value: https://hdl.handle.net/2292/61816