Work

Effects of the hands-and-knees position on occiput posterior position during the first stage of labour: A systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: PurposeOcciput posterior (OP) foetal position in labour is associated with prolonged labour and increased obstetric interventions.Hands-and-knees positioning is a simple, non-invasive strategy used to encourage foetal rotation; however, its effects on clinically important outcomes remain uncertain, particularly among women with a confirmed OP position during labour.This review aimed to evaluate whether adopting the hands-and-knees position during the first stage of labour improves foetal rotation and related maternal and neonatal outcomes among women with a confirmed OP foetal position. MethodsWe conducted a systematic review and meta-analysis in accordance with the Cochrane Handbook.The protocol was registered in the Open Science Framework before data collection on 24 December 2024 (https://osf.io/ tn8ue).We searched MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), and Ichushi-Web for randomised controlled trials (RCTs) comparing hands-and-knees positioning with usual care or any maternal position other than hands-and-knees during the first stage of labour in women with a confirmed OP foetal position.We included English-and Japanese-language reports published from February 2018 to December 2024, and carried forward two RCTs included in the 2020 guideline review for reassessment.Two reviewers independently screened records, assessed eligibility, and extracted data.Risk of bias was assessed using standard Cochrane methods, and certainty of evidence was appraised using the GRADE approach.We synthesised outcomes using risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, with 95% confidence intervals (CIs).Statistical heterogeneity was evaluated using the I 2 statistic. ResultsThree RCTs (n = 766 women) met the inclusion criteria.Overall, the effect on occiput anterior (OA) position at birth was inconsistent and imprecise, with substantial heterogeneity (RR 1.12; 95% CI 0.64-1.94;I 2 = 73%; low certainty).In contrast, the OA position at 1 h after randomisation was more frequent in the hands-and-knees group (RR 1.66; 95% CI 1.07-2.55;I 2 = 0%; moderate certainty).Labour duration was modestly shorter with hands-and-knees position-

Source: Journal of Japan Academy of Midwifery

DOI: 10.3418/jjam.jjam-2026-0002