Maternal Positioning for Fetal Occiput Posterior Position

Overseen By Emma Brenner, MD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Northwell Health

Disqualifiers: Under 18, Unable to consent, Others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

Duration: Until 10 cm cervical dilation

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores whether certain maternal positions can help babies in the occiput posterior (OP) position, where the baby faces up, to turn into the occiput anterior (OA) position, where the baby faces down. Babies in the OA position are often easier to deliver vaginally, while those in the OP position can lead to more complications during birth. Participants may be assigned to one of three groups: staying in any position they choose, lying on the side where they feel the baby's movements, or lying on the opposite side. This trial is open to women who are full-term, have a single baby in the OP position, and are in the early stages of labor. As an unphased trial, this study offers participants the opportunity to contribute to valuable research that could improve childbirth experiences for many.

Do I have to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.

What prior data suggests that this maternal positioning technique is safe for labor and delivery?

Research shows that certain positions during labor might help turn babies from a less favorable position, called occiput posterior (OP), to a better position, called occiput anterior (OA). This is important because babies in the OP position can make delivery harder and might increase the chances of needing a cesarean section or other medical help.

Studies on how a mother's position affects this have shown mixed results. One study found that 17% of babies in the group using specific positions moved to the OA position after an hour, compared to 12% in the group that did not. This suggests that using certain positions might help turn the baby, but the results can vary.

Importantly, there are no known safety risks with the positions being tested. Since these positions involve how a mother lies or sits during labor, they are generally safe for both mother and baby. The focus is on comfort and natural movement, making it a low-risk approach. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores maternal positioning as a non-invasive method to address fetal occiput posterior position, which can complicate labor. Unlike standard practices such as manual rotation or instrumental delivery, this approach focuses on using the mother's position to potentially encourage the baby to rotate naturally. The trial investigates whether specific positioning based on fetal movement can effectively facilitate this rotation, which could lead to a more comfortable and less intervention-heavy birthing experience. If successful, this method could offer a simple and safer alternative to current practices, reducing the need for more invasive procedures.

What evidence suggests that maternal positioning is effective for correcting fetal occiput posterior position?

This trial will compare different maternal positioning strategies to determine their effectiveness in turning a baby from the occiput posterior (OP) position to the occiput anterior (OA) position during labor. Research suggests that a mother's position might affect the baby's position. Some studies have investigated whether changing the mother's position aids this transition, which benefits vaginal delivery. However, results have been mixed. Some research found no significant improvement with certain positions, while other studies showed slight improvements. These findings were neither consistent nor strong enough to be conclusive. While there is some hope that changing positions might help, stronger evidence is needed to confirm its effectiveness. Participants in this trial will assume different positions to assess their impact on fetal positioning. ^{4 5 6 7 8}

Who Is on the Research Team?

Valerie Schulz, MD

Principal Investigator

Northwell Health

Sarah Pachtman, MD

Principal Investigator

Northwell Health

Are You a Good Fit for This Trial?

This trial is for women over 18 years old, at full term (37+ weeks pregnant) with a single baby in head-down position facing up ('sunny side up') when admitted for labor. They must be less than 10cm dilated and have mild pain (score of ≤3/10). Excluded are those under 18, unable to consent, in advanced labor (>10cm), wanting cesarean delivery or with complications like fetal growth restriction or abnormal presentations.

Inclusion Criteria

I am admitted to LIJ or NSUH for labor.

>/=37 weeks gestation (full term) with a viable singleton intrauterine pregnancy noted to be cephalic presentation in the OP position at the time of admission as noted on bedside ultrasound

I am a woman aged 18 or older.

Exclusion Criteria

I am unable to give consent by myself.

all women with pregnancies noted to have IUGR, fetal anomalies, malpresentation (i.e. breech), multiple gestations or fetuses not in the OP position at time of admission will be excluded.

I am not in advanced labor, do not have a nonviable pregnancy, and my pain is manageable.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

Upon admission

1 visit (in-person)

Treatment

Participants are assigned to different maternal positioning strategies during the first stage of labor to correct fetal OP to OA position

Until 10 cm cervical dilation

Continuous monitoring during labor

Follow-up

Participants are monitored for delivery outcomes and any complications

From delivery to discharge

In-person monitoring

What Are the Treatments Tested in This Trial?

Interventions

• Maternal Positioning

Trial Overview The study tests if certain maternal positions during the first stage of labor can turn babies from a 'sunny side up' position to a more favorable one for vaginal birth. Women will be randomly placed into three groups: control group choosing any position, and two experimental groups using specific positioning strategies based on fetal movement.

How Is the Trial Designed?

Group I: C Experimental Treatment 1 Intervention

Group C, will be placed in the same position but opposite that of which fetal kicks are felt.

Group II: B Experimental Treatment 1 Intervention

Group B will be placed in a dorsal recumbent, modified sims position on the side of fetal movement.

Group III: A Active Control 1 Intervention

Who Is Running the Clinical Trial?

Northwell Health

Lead Sponsor

Trials

481

Recruited

470,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10397531/

The Impact of Maternal Position in Labor on Occiput ... This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes.

2. bmcpregnancychildbirth.biomedcentral.com bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-83

Maternal positioning to correct occipito-posterior fetal position ... Our objective is to evaluate the efficacy of maternal position in the management of OP position during the first stage of labour.

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0266613821000875

Maternal positioning with flexed thighs to correct foetal ... This systematic review reports no significant correlation between maternal positioning with flexed thighs and foetal rotation from occipito-posterior to ...

4. obgyn.onlinelibrary.wiley.com obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.13855

Maternal positioning to correct occiput posterior fetal position ... In the intervention group, there were 10 of 60 (16.7%) fetuses in OA position when women were kept in the hands and knees position for 0–15 ...

5. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT05307393

Maternal Positioning to Correct Fetal Occiput Posterior | ... This data will include: maternal age, BMI, race, maternal medical complications, delivery type, laceration, fetal position at delivery, dilation on admission ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7154761/

Babies in occiput posterior position are significantly more ... Babies in occiput posterior position are significantly more likely to require an emergency cesarean birth compared with babies in occiput transverse position.

7. sciencedirect.com sciencedirect.com/science/article/pii/S2666577822000296

Labor and delivery outcomes by delivery method in term ... Deliveries in occiput posterior position have been shown to have higher rates of adverse short-term maternal and neonatal outcomes compared with deliveries in ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5132127/

Maternal positioning to correct occiput posterior fetal ... One hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of ...