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Repeated hands-and-knees positioning during labour: a randomized pilot study
Ellen D Hodnett1, Robyn Stremler, Stephen H Halpern
1Lawrence S. Bloomberg Faculty of Nursing , University of Toronto , Toronto , Canada.
Peerj
|May 3, 2013
Summary
This pilot study found low compliance with the hands-and-knees position during labor, making a large trial of this intervention for reducing caesarean births not justifiable. Further research requires modified criteria and settings.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Clinical Trial Design
Background:
- Rising caesarean birth rates in North America lack maternal and infant benefit.
- Recumbent labor positions may contribute to increased caesarean rates.
- Lack of evidence hinders adoption of alternative labor positions like hands-and-knees.
Purpose of the Study:
- Assess feasibility and acceptability of a labor position trial protocol.
- Obtain preliminary estimates of treatment effects on birth method and back pain.
- Determine if a large-scale trial on spontaneous vaginal birth is warranted.
Main Methods:
- Pilot randomized controlled trial in two North American hospitals.
- 30 nulliparous women in labor allocated to usual care or hourly 15-min hands-and-knees position.
- Data collected on compliance, acceptability, pain, interventions, and satisfaction.
Main Results:
- Low compliance with hands-and-knees position (9/16 used >2 times).
- Similar rates of spontaneous vaginal birth between groups (11/16 vs. 14/14).
- Higher caesarean rate in hands-and-knees group (4/16 vs. 0/14); variable back pain reported.
Conclusions:
- A definitive trial is not justified due to low compliance and inconclusive results.
- Feasibility of a future trial depends on modified eligibility and setting selection.
- Further research needed to explore benefits and barriers of hands-and-knees labor position.
