Pregnant Women’s Views on a Trial of Posture for Fetal Malposition

Authors: Jennifer A. Barrowclough, Caroline A. Crowther, Bridget Kool

Abstract:

Fetal malposition in labour is associated with adverse maternal and infant health outcomes. Evidence for effective interventions for fetal malposition is inconclusive. The feasibility and design of a randomized controlled trial (RCT) of maternal posture to improve maternal and infant outcomes of malposition should be considered, based on the hypothesis that gravity corrects malposition. The aim was to assess pregnant women’s views on the acceptability of a future trial of maternal posture for fetal malposition in labour, and the enablers and barriers of participation. Method: An online anonymous survey of pregnant women was conducted in Auckland during 2020. Descriptive summaries of quantitative data used chi-square to assess differences in proportions. The influence of maternal characteristics on women’s responses was assessed using cross-tabulation. Free text responses were analysed thematically. Results: Respondents (n=206) were mostly aged26-35 years (75%), of 29-38 weeks gestation (71%), of European (40%) or Asian (36%) ethnicity, were evenly nulliparous or multiparous. Most women (76%) had heard of fetal malposition in labour however only 28% were aware of the use of maternal posture to correct this. Most women (86%) were interested in labour research. Although 37% indicated they would participate in a future RCT of posture for fetal malposition, nearly half (47%) were unsure and a further quarter (15%) indicated they would not participate. Comfort was the predominant concern (22%). Almost half of the respondents (49%) indicated they would consult their partner before deciding on participation in an RCT. Conclusions: Participation in a trial of maternal posture in labour can be enabled through measures to enhance maternal comfort, increased awareness of malposition and the role of posture, and the involvement of partners during trial counselling and recruitment.

Keywords: pregnant women, labour, presentation, posture, randomized controlled trial, survey