Maternal posture, pelvic shape and fetal position,

The effects of five maternal postures on the position of the full term fetus in the uterus were investigated. Dystocia during labor due to posterior positions of the fetus is associated with the need for increased obstetrical intervention and decrease parental satisfaction. Particular maternal postures were found to effectively facilitate anterior fetal rotations, allowing for a more obstetrically normal and parentally satisfying labor experience. The effect of the shape of the maternal pelvis on the position changes of the full term fetus in the uterus resulting from the five maternal postures was also investigated. The posterior positions of the fetus associated with dystocia during labor also associated with the anthropoid and android pelves. The shape of these pelves appeared to prevent the maternal postures from facilitating anterior fetal rotations. The hypotheses suggested relationships between fetal rotations and each pair of pelvic types; and, between fetal returns to the posterior positions during labor and delivery and each pair of pelvic types. These hypotheses were based on facts gathered from the literature and previous studies on related topics. The sample for this study included 50 healthy, gravid women at full term gestation. Subjects who met the inclusion criteria and consented to participate, were randomly assigned to one of the five posture groups until each group included 10 subjects. The data was collected in a prenatal clinic before or after the subject's regular prenatal appointment. Leopold's Maneuvers were used to measure the dependent variable (fetal position). One member of the data collection team performed the Leopold's Maneuvers exclusively. The examiner recorded each determination of fetal position separately and hand no knowledge of the postures performed by the subjects, to eliminate possible bias. After the first determination of fetal position, subjects who had a transverse or posterior fetus performed their assigned posture for a 10 minute period. At the conclusion of the posture period the fetal position was determined by the examiner. If the fetus was found in one of the anterior positions, the subject was assigned to perform a side lying posture (Sims). If the fetus was found in a transverse of posterior position, the subject was reassigned to one of the five original posture groups for a second period of posturing. The second period of posture manipulation was followed by the third determination of fetal position. All subject whose fetuses were in one of the anterior positions at this time were followed up by a chart review, after their deliveries, for information concerning the fetal positions during labor and delivery. The nine hypothesis dealing with the relationships between the five maternal postures were each tested by a Fisher's Exact Test. None of the probabilities were less than the established alpha level.(.05), indicating no statistically significant differences between any pair of maternal postures with respect to producing fetal rotations. In is clinical significant, however, that a number of fetal rotations were produced by posturing. The gravid women could use these postures to increase her comfort in late pregnancy. The last six hypotheses, dealing with pelvic shape, were tested when possible be chi squares. There was no qualified subject to test the four final hypotheses. Statistical and clinical significance of the relationships was discussed. Chi square and one way analysis of variance were used to test for the homogeneity of posture group sheets and position change subsets. Limitation of the study was discussed. Recommendations for further study, based on the findings and limitation, were made.