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Maternal positions reduce occiput posterior malposition and improve vaginal birth: a systematic review and
Meilin Yang1, Cheng Zhao2, Shaojun Lin3
1Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China (Yang, Zhao, Guo, J. Yang, Ni, and Y. Zhao); National Obstetric Healthcare Quality Management Center, Beijing, China (Yang and Y. Zhao); Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China (Yang).
Objective:
To evaluate the effect of changing maternal position in late pregnancy and the first stage of labor on rotation from occiput posterior (OP) to occiput anterior (OA) and subsequent maternal-fetal outcomes.
Data Sources:
We systematically searched randomized controlled trials (RCTs) from the databases including PubMed, Embase, and Cochrane Library without language restriction, spanning from their inception to May 11, 2025. Registration PROSPERO (CRD420251050400).
Study Eligibility Criteria:
The following PICOS criteria were included:(1) Population (P): singleton pregnancies in late pregnancy (≥37 weeks of gestation) or the first stage of labor. (2) Intervention (I): maternal positions. (3) Comparison (C): non-intervention position or unrestricted maternal activities. (4) Outcomes (O): number of participants who attained OA. (5) Study design (S):RCTs.
Study Appraisal And Synthesis Methods:
Separate meta-analyses were conducted for all RCTs and for trustworthy RCTs identified using the OBGYN Editors' Integrity Group criteria. Pooled relative risks (RR) and standard mean differences (SMD) with 95% CIs were calculated. Publication bias was assessed.
Results:
A meta-analysis of four trustworthy RCTs (n=922) from the first stage of labor demonstrated that positional intervention significantly increased OP to OA rotation (pooled RR=1.68, 95% CI=1.09-2.60; I²=66.3%). Moreover, when initiated at 3-5 cm dilation with a prolonged protocol (targeted hourly or continuous duration), the intervention yielded even greater benefits for rotation (pooled RR=2.45, 95% CI=1.63-3.67; I²=0.0%), and also significantly increased rates of both vaginal delivery (pooled RR=1.22, 95% CI=1.06-1.41; I²=0.0%) and spontaneous vaginal delivery (SVD) (pooled RR=1.39, 95% CI=1.05-1.84; I²=0.0%). Consistent benefits persisted in an analysis of all ten RCTs, remaining significant after adjustment for publication bias. Subgroup analyses of these ten RCTs indicated that the lateral position with upper thigh flexed benefited SVD. Additionally, two late-pregnancy studies (n=2647) assessed maternal position for OP fetuses, but methodological differences precluded meta-analysis.
Conclusions:
Intrapartum maternal position can promote OP to OA rotation and vaginal delivery, but antenatal evidence remains inconclusive and lacking. El resumen está disponible en Español al final del artículo.
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