Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of the hands and knees position during the first stage of labour to facilitate the rotation of the fetal head to the occiput anterior position. DESIGN: Randomised controlled trial. SETTING: Geneva University Hospitals, Switzerland. POPULATION: A total of 439 women with a fetus in the occiput posterior position during the first stage of labour. METHODS: The women in the intervention group were invited to take a hands and knees position for at least for 10 minutes. Women allocated to the control group received the usual care. For both groups, 15 minutes after randomisation, women completed a short questionnaire to report their perceived pain and the comfort of their position. MAIN OUTCOME MEASURES: The rotation of the fetal head in occiput anterior position confirmed by ultrasonography 1 hour after randomisation. RESULTS: One hour after the randomisation, 35 of 203 (17%) fetuses were diagnosed as being in the occiput anterior position in the intervention group compared with 24 of 209 (12%) in the control group. This difference was not statistically significant (relative risk 1.50; 95% CI 0.93-2.43; P = 0.13). The change in the evaluation of comfort between the randomisation and 15 minutes after showed an improvement in 70 and 39 women, no change in 82 and 78 women and a decrease in 56 and 86 women in the intervention and control groups, respectively (P = 0.02). CONCLUSIONS: This study could not demonstrate a benefit of the hands and knees position to correct the occiput posterior position of the fetus during the first stage of labour, but the women reported an increase in their comfort level. TWEETABLE ABSTRACT: Hands and knees position does not facilitate rotation into occiput anterior but increases the comfort level of women.

Fathers' anxiety levels during early postpartum: A comparison study between first-time and multi-child fathers.

BACKGROUND: The postnatal period is considered the most challenging period in the adjustment to fatherhood. This study aimed to assess anxiety levels among fathers during this period. METHODS: A comparative study assessing the anxiety levels of first-time and multi-child fathers before the mother and child returned home (0-7 days after birth) was conducted. We used the French validation of the State-Trait Anxiety Inventory (STAI). RESULTS: Among 235 fathers who were met at the maternity ward, 182 (77 %) responded to the questionnaire. For most fathers in both groups, anxiety levels were low or very low for trait anxiety (166/182, 91.21 %) and state anxiety (177/182, 97.25 %). Levels of state anxiety were statistically higher for first-time fathers compared to multi-child fathers but were mainly at a low or very low level (70/83 [84 %] versus 71/99 [71 %], respectively, p = 0.029). The multiple linear regression showed that "feeling prepared at birth time" was the only significantly (p < 0.001) associated factor with state anxiety among first-time fathers only. LIMITATIONS: The validity and reliability of the STAI have been widely proven for the general population but not specifically for men during the postpartum period. CONCLUSIONS: Most fathers had low to very low anxiety levels during the early postpartum period, suggesting that developing new specific support interventions is not needed during early postnatal care. Further research focusing on when the family is back home is warranted.

[Occiput posterior presentation at delivery: Materno-foetal outcomes and predictive factors of rotation]. / Accouchement en variété occipito-postérieure : issues materno-fœtales et facteurs prédictifs de la rotation.

OBJECTIVES: To describe the maternal and foetal outcomes of an occiput posterior foetal position at delivery; to evaluate predictive factors of anterior rotation during labour. METHODS: Descriptive retrospective analysis of a cohort of 439 women with foetuses in occiput posterior position during labour. Logistic regression analysis to quantify the effect of factors that may favour anterior rotation. RESULTS: Most of foetuses (64%) do an anterior rotation during labour and 13% during the expulsive phase. The consequences of a persistent foetal occiput posterior position during delivery are a significantly increased average time of second stage labour compared to others positions (65.19minutes vs. 43.29, P=0.001, respectively); a higher percentage of caesarean sections (72.0% versus 4.7%, P<0.001) and instrumental delivery (among low-birth deliveries, 60.7% versus 25.2%, P<0.001); more frequent third-degree perineal tears (14.3% vs. 0.6%, P<0.001) and more abundant blood loss (560mL versus 344mL, P<0.001). In a multi-variable model including nulliparity, station of the presenting part and degree of flexion of the foetal head at complete dilatation, the only predictive factor independent of rotation at delivery is a good flexion of the foetal head at complete dilatation, which multiplies the anterior rotation probability by six. CONCLUSION: A good flexion of the foetal head is significantly associated with anterior rotation. Other studies exploring ways to increase anterior rotation during labour are needed to reduce the very high risk of caesarean section and instrumentation associated with the foetal occiput posterior position.

[Translation and validation in French of the First-Time Father Questionnaire]. / Vécu de l'accouchement par les pères : traduction et validation transculturelle du First-Time Father Questionnaire sur un échantillon francophone.

OBJECTIVES: For fathers, being present at a birth for the first time is not an insignificant event. Witnessing suffering can cause feelings of loneliness and powerlessness, which may be associated with postnatal problems such as depression. However, without a confirmed French-language tool concerning the experience of childbirth for fathers, we are limited in our ability to develop our understanding of their experiences and establish links between these experiences and their distress (anxiety, depression, etc.), or to develop appropriate methods of support. Our objective has been to translate and validate the Swedish "First-Time Father Questionnaire" with a French-speaking sample. METHODS: The tool was translated using a translation/backtranslation process (using two independent agencies, with a pre-test on 30 new fathers as well as exchanges with the Swedish authors). The French version was then tested with 154 new fathers at 1 month post-partum. Factorial analysis followed by multi-trait analysis and variance analyses were conducted, with subgroups contrasted according to the mode of delivery. RESULTS: The factorial structure is satisfactory, retaining 19 items and reproducing 54.12% of variance. Professional support, worry, and prenatal preparation constitute the 3 dimensions of this. Internal consistency, homogeneity, and the discriminating capacity of the questionnaire are good. CONCLUSION: Validation of the questionnaire shows good metrological qualities. It can therefore be used in the perinatal field to evaluate the childbirth experience for first-time fathers.

[External cephalic version in case of persisting breech presentation at term: motivations and women's experience of the intervention]. / Version céphalique externe en cas de siège persistant à terme : motivations et vécu de l'intervention par les femmes.

OBJECTIVES: To evaluate the efficacy and acceptability of external cephalic version (ECV). MATERIALS AND METHOD: From 2004 to 2008, 212 pregnant women between 34-37 weeks of gestation with fetus in breech presentation were included in a randomized clinical trial and 125 externals cephalic versions were studied. RESULTS: A success rate of 37.6%t was recorded. At 34 weeks of gestation, 80.6% of women were considering an ECV in the event of persistent breech position at 37 weeks. These women expressed the desire to give birth vaginally (52% versus 24.4%, P<0.001). In contrast, others women preferred an elective cesarean section to avoid the risk of a breech vaginal delivery. Women felt pain during the ECV and scored 60 on average using the analogical visual scale. Women rated on a verbal rating scale the ECV as severely painful to unbearable (68%), and as stressful (70%). Despite this, the majority of women would recommend ECV to their friends or would be willing to repeat it for themselves. DISCUSSION AND CONCLUSION: ECV remains a scary and painful medical procedure. More research is needed to reduce the impact. The use of analgesic medication for this indication is controversial. Hypnosis could be an alternative to evaluate.

[Correcting occiput posterior position during labor: the role of maternal positions]. / Correction des variétés occipito-postérieures durant la phase de dilatation de l'accouchement: intérêt des postures maternelles.

Occipito-posterior presentation represents 10 to 34% of cephalic presentations in early labor. Spontaneous rotation during labor to occipito-anterior mode occurs in most cases, but 5 to 8% of fetuses will persist in posterior position for the expulsive phase of delivery. Previous research has shown that this presentation carries an increased risk of unusually long labor, maternal and fetal exhaustion, instrument-assisted delivery, severe perineal injury, and cesarean section. The diagnosis of posterior variety is usually made quite late at the end of dilation. Several researchers have reported the benefits of determining presentation during labor by transabdominal ultrasonography. Some obstetrical techniques to correct these presentations at complete dilation have also been described. In the case of diagnosis of posterior variety, the usual attitude is expectant management. Postural techniques to promote physiological labor and delivery have been documented in the literature. De Gasquet has described a very precise technique to facilitate fetal rotation, but its effectiveness has never been assessed scientifically. A Cochrane review on the topic has shown that similar positions are well accepted by women and reduce back pain. On the other hand, the sample size of included studies appeared inadequate to assess their interest for use in childbirth, in general, and for adverse outcomes associated with posterior presentation varieties in particular. Attempts to correct the fetal malposition during the expansion phase would allow to reduce adverse outcomes during the expulsive phase of delivery. Further research is necessary to assess the efficacity of specific maternal positions during labor for the correction of fetal posterior presentation.