A Cochrane review [Abstract] 1 included 3 studies with a total of 2 794 women. The hands and knees posture, with the women kneeling forwards on her hands and knees, has been suggested as a method of promoting a favourable position for the baby. In one trial, four different variations of the hands and knees posture (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 (RR 0.26, 95% CI 0.18 to 0.38; 1 study, n=100). In a second trial, advice to assume the hands and knees posture for 10 minutes twice daily in the last weeks of pregnancy had no effect on the baby's position at delivery or any of the other pregnancy outcomes measured (n=2547). The third trial studied the use of hands and knees position in labour for a period of at least 30 minutes and involved 147 labouring women at 37 or more weeks gestation. Occipito-posterior position of the baby was confirmed by ultrasound. The reduction in occipito-posterior or -transverse positions at delivery (RR 0.76, 95% CI 0.47 to 1.21) and operative deliveries (RR 0.78, 95% CI 0.46 to 1.32; 1 study, n=147) were not statistically significant. There was a significant reduction in back pain.
Commet: The quality of evidence is downgraded by inconsistency (variability in results across studies and heterogeneity in outcomes) and by imprecise results (limited study size for each comparison).
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