Medical References relating to Optimial Foetal Positioning
Hands/knees posture in late pregnancy or labour for fetal
malposition (lateral or posterior).
Hofmeyr GJ, Kulier R. Cochrane Database Syst Rev. 2000;(2):CD001063.
Review. Hands/knees posture in late pregnancy or labour for
fetal malposition (lateral or posterior). Hofmeyr GJ, Kulier
R. Department of Obstetrics and Gynaecology, Coronation Hospital
and University of the Witwatersrand, 7 York Road, Parktown
2193, Johannesburg, South Africa. 091just@chiron.wits.ac.za
BACKGROUND: Lateral and posterior position of the fetal presenting
parts may be associated with more painful, prolonged or obstructed
labour and difficult delivery. It is possible that maternal
posture may influence fetal position.
OBJECTIVES: The objective of this review is to assess the
effects of adopting a hands and knees maternal posture in
late pregnancy when the presenting part of the fetus is in
a lateral or posterior position.
SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth
Group trials register and the Cochrane Controlled Trials Register.
Date of last search: February 1999.
SELECTION CRITERIA: Randomised trials of hands and knees
maternal posture compared to other postures.
DATA COLLECTION AND ANALYSIS: Both reviewers assessed trial
eligibility and quality.
MAIN RESULTS: One trial involving 100 women was included.
Four different postures (four groups of 20 women) were combined
for the comparison with the control group of 20 women. 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 (relative
risk 0.25, 95% confidence interval 0.17 to 0.37).
REVIEWER'S CONCLUSIONS: Hands and knees maternal posture
for lateral or posterior fetal presentation appears to result
in short term effects ion fetal position. No other perinatal
or maternal outcomes were reported. There is not enough evidence
to evaluate the effectiveness of a hands and knees maternal
posture when the fetal presenting part is lateral or posterior,
on clinically important outcomes.
As you probably know, Jean Sutton is the queen of OFP -
and yes it is anecdotal in that she has reflected on her own
practice. However, she has very dramatic figures to quote
having been appointed to Principal Midwife in her unit in
NZ and introduced her OFP ideas she reduced her transfer (to
consultant unit) from 30% to 5% and the forceps rate from
3 or monthly to 2 or 3 annually. Now anything that even touches
those figures is worth considering.
Here are some other references I've picked up along the
way:
Nolan M (1997). Jean Sutton and optimal fetal positioning.
Modern Midwife, vol 7 no 1 pp 15- 17 Sutton J & Scott P (1994).
Optimal fetal positioning: a midwifery approach to increasing
the number of normal births. MIDIRS vol 4, no 3 pp 283 - 286
Sutton J (1996).
A midwife's observations of how the birth process is influenced
by the relationship of the maternal pelvis and the foetal
head. Journal of the Assoc. of Chartered Physiotherapists
in Women's Health, No 79, pp 31 -33 Walmsley K (2000).
Managing the OP labour. MIDIRS vol 10, No 1 pp 61 - 62 Denmark
R (2000).
Posterior Babies - Mothers can trust their instincts. AIMS
Journal, Summer Vol 12 No 2 Franco S (2001).
Optimal Foetal Positioning: Rocking your way to a straightforward
birth.
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