Comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position

Background: The supine position is the most common birth position adopted in China, but the World Health Organization recommends non-supine positions for delivery. The hands-and-knees position shows several advantages, such as wide pelvic diameter and easy fetal rotation during delivery. Small trials conducted in China in 2011 revealed that the hands-and-knees position resulted in improved maternal and neonate outcomes than those in the supine position. However, a comprehensive study must be conducted before the hands-and-knees position can be introduced into clinical practice. Hence, we conducted this multicenter trial to comprehensively examine the benefits of the hands-and-knees position over the supine position during delivery. Methods: Our clinical study was conducted in 11 hospitals in China from May to December 2012. A total of 446 pregnant women who gave birth in the hands-and-knees position were assigned into the experimental group, and 440 women who gave birth in the supine position were classified into the control group. Episiotomy rate was evaluated as the primary outcome, and perineum laceration degree was considered the secondary outcome. Results: Women in the experimental group achieved lower rates of episiotomy and higher rates of intact perineum and first-degree perineum lacerations compared with those in the control. Postpartum bleeding amount, neonatal asphyxia, and APGAR scores at 1 and 5 min were not significantly different between the two groups. Conclusions: This study proves that women who delivered in the hands-and-knees position achieved low rates of episiotomy and intact perineum. Moreover, the rates of neonatal asphyxia and postpartum bleeding did not increase. Pregnant patients who prefer to adopt the hands-and-knees position should be assisted in assuming such position during delivery.