Evaluation of the effectiveness of maternal Forward-Leaning Positions during labor on rotation of posterior fetal occipital position and Maternal and Neonatal Outcomes
Evaluation of the effectiveness of maternal Forward-Leaning Positions during labor on rotation of posterior fetal occipital position and Maternal and Neonatal Outcomes
Design
A randomized controlled clinical trial with parallel groups and a control group, no blinding, 208 participants, allocated to intervention and control groups using block randomization with a block size of four.
Settings and conduct
This study will be conducted in the maternity ward of Ganjavian Hospital, Dezful, Iran. Pregnant women with occiput posterior in active labor, after informed consent, will be randomly assigned to intervention (forward-leaning positions + routine care) or control (routine care) groups, and maternal and neonatal outcomes will be compared.
Participants/Inclusion and exclusion criteria
Inclusion criteria:
Pregnant women aged 18–40 years; term pregnancy (37–42 weeks); singleton cephalic gestation; spontaneous labor; estimated fetal weight 2500–4000 g; confirmed OP position; active phase of labor (cervical dilation ≥4 cm); parity 1–3; body mass index 18–30.
Exclusion criteria:
High-risk pregnancy (preeclampsia, gestational diabetes, cardiovascular or respiratory disease); previous cesarean section; severe vaginal bleeding; contraindication to maternal mobility during labor; development of indication for labor induction.
Intervention groups
For allocation concealment, a unique code was assigned to each participant and placed in an opaque envelope. In addition to routine midwifery care, the intervention group adopted forward-leaning positions for 15–20 minutes per hour during the active phase of labor. The control group received routine care only
Main outcome variables
Mean duration of active and second stage of labor; labor pain intensity; type of delivery; Apgar score; maternal satisfaction; number of episiotomies; third- and fourth-degree perineal tears; fetal head position at birth
General information
Reason for update
Acronym
OP- occiput posterior
IRCT registration information
IRCT registration number:IRCT20251229068486N1
Registration date:2026-02-15, 1404/11/26
Registration timing:prospective
Last update:2026-02-15, 1404/11/26
Update count:0
Registration date
2026-02-15, 1404/11/26
Registrant information
Name
Masome KHabazkhob
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 61 4224 4134
Email address
masomekhabaz2@gmail.com
Recruitment status
recruiting
Funding source
Expected recruitment start date
2026-04-04, 1405/01/15
Expected recruitment end date
2026-10-07, 1405/07/15
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
Evaluation of the effectiveness of maternal Forward-Leaning Positions during labor on rotation of posterior fetal occipital position and Maternal and Neonatal Outcomes
Public title
effectiveness of maternal Forward-Leaning Positions on rotation of posterior fetal occipital position and Maternal and Neonatal Outcomes
Purpose
Supportive
Inclusion/Exclusion criteria
Inclusion criteria:
Maternal age between 18 and 40 years.
Term pregnancy (37–42 weeks gestation).
Singleton pregnancy.
Cephalic presentation.
Spontaneous onset of labor.
Estimated fetal weight between 2500 and 4000 grams.
Fetus in occiput posterior (OP) position on initial examination or ultrasound.
Women in active phase of labor (cervical dilation ≥4 cm).
Women with parity 1 to 3.
Maternal body mass index (BMI) between 18 and 30.
Exclusion criteria:
High-risk pregnancies (preeclampsia, diabetes, maternal cardiac or respiratory disease).
History of previous cesarean delivery.
Presence of severe vaginal bleeding in the mother.
Maternal contraindication to movement during labor.
Indication for labor induction.
Age
From 18 years old to 40 years old
Gender
Female
Phase
N/A
Groups that have been masked
No information
Sample size
Target sample size:
208
Randomization (investigator's opinion)
Randomized
Randomization description
27 blocks will be used. In each block of 4, 2 people will be assigned to the intervention group and 3 people to the control group, which will be arranged randomly. Thus, at the end of each block, there will be two balancing groups.
Blinding (investigator's opinion)
Not blinded
Blinding description
Placebo
Not used
Assignment
Parallel
Other design features
The forward-leaning position involves the mother standing, on hands-and-knees, or leaning forward over a table, chair, or birthing ball, so that her body weight shifts forward and the pelvis is positioned to facilitate correction of the fetal head. The mother remains in this position during the active phase of labor, with free movement of arms and legs allowed.
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Ahvaz Jundishapur University of Medical Sciences
Street address
Farvardin Street, Golestan
City
Ahvaz
Province
Khouzestan
Postal code
6135715794
Approval date
2026-01-10, 1404/10/20
Ethics committee reference number
IR.AJUMS.REC.1404.553
Health conditions studied
1
Description of health condition studied
Normal Delivery Manangment
ICD-10 code
O80
ICD-10 code description
Vaginal delivery
Primary outcomes
1
Description
Rotation of the fetal head from posterior occiput position
Timepoint
At delivery
Method of measurement
Observation and record in check list
2
Description
Type of delivery
Timepoint
After delivery
Method of measurement
Observation and record in check list
Secondary outcomes
1
Description
Duration of active phase and second stage of labor
Timepoint
Cervix dilatation from 4 centimeter to 10 centimeter for active phase of labor and cervix dilatation from 10 centimeter to delivery of newborn for second stage of labor
Method of measurement
Clinical examination/ Measurement by digital chronometer / record in check list
2
Description
Apgar score
Timepoint
At 1 and 5 minutes after birth
Method of measurement
Observation and examination
3
Description
Mother satisfaction from delivery
Timepoint
After delivery
Method of measurement
Asking the mother and record in check list
4
Description
Frequency use of episiotomy
Timepoint
After delivery
Method of measurement
Observation and record in check list
5
Description
Labor Pain intensity
Timepoint
Measurement severity of pain for dilatation of 4; 6; 8 and 10 centimeter and second stage
Method of measurement
By visual analog scale
Intervention groups
1
Description
Intervention group: The intervention group, in addition to routine midwifery care (examination, vital signs, and fetal heart rate monitoring), will assume forward-leaning positions alternately for 15–20 minutes per hour during the active phase of labor. Forward-leaning includes standing, hands-and-knees, or leaning over a table, chair, or birthing ball to shift weight forward and align the pelvis for fetal head correction, with free movement of arms and legs.
Category
Other
2
Description
The control group will receive routine care.
Category
Other
Recruitment centers
1
Recruitment center
Name of recruitment center
Ganjavian Hospital Dezful
Full name of responsible person
Masoumeh Khabazkhoub
Street address
Opposite the 292nd Armored Brigade of the Army, Dezful-Andimeshk road
City
Dezful
Province
Khouzestan
Postal code
6461643981
Phone
+98 61 4242 2040
Email
masomekhabaz2@gmail.com
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Ahvaz University of Medical Sciences
Full name of responsible person
Abdollah Rafiei
Street address
School of Nursing and Midwifery, Jundishapur University of Medical Sciences, Ahvaz University City, Khouzestan Ahvaz
City
Ahvaz
Province
Khouzestan
Postal code
6135715794
Phone
+98 61 3336 2414
Email
itc@ajums.ac.ir
Web page address
http://vchresearch.ajums.ac.ir
Grant name
RHPRC-0410
Grant code / Reference number
RHPRC-0410
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Ahvaz University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic
Person responsible for general inquiries
Contact
Name of organization / entity
Ahvaz University of Medical Sciences
Full name of responsible person
Masoumeh Khabazkhoub
Position
MS midwifery student
Latest degree
Master
Other areas of specialty/work
Midwifery
Street address
Farvardin Street, Golestan
City
Ahvaz
Province
Khouzestan
Postal code
6135715794
Phone
+98 61 4224 4134
Email
masomekhabaz2@gmail.com
Person responsible for scientific inquiries
Contact
Name of organization / entity
Ahvaz University of Medical Sciences
Full name of responsible person
Dr. Mina Iravani
Position
Ph.D of Midwifery
Latest degree
Ph.D.
Other areas of specialty/work
Midwifery
Street address
Farvardin Street, Golestan
City
Ahvaz
Province
Khouzestan
Postal code
6135715794
Phone
+98 61 3373 8538
Email
minairavani2004@yahoo.com
Web page address
http://ajums.ac.ir/
Person responsible for updating data
Contact
Name of organization / entity
Ahvaz University of Medical Sciences
Full name of responsible person
Dr.Mina Iravani
Position
Ph.D of Midwifery
Latest degree
Ph.D.
Other areas of specialty/work
Midwifery
Street address
School of Nursing and Midwifery, Jundishapur University of Medical Sciences, Ahvaz University City, Khouzestan Ahvaz Ahvaz Khuuzestan , Islamic Republic Of Iran
City
Ahvaz
Province
Khouzestan
Postal code
6135715794
Phone
+98 61 3373 8538
Email
minairavani2004@yahoo.com
Web page address
http://ajums.ac.ir/
Sharing plan
Deidentified Individual Participant Data Set (IPD)
No - There is not a plan to make this available
Justification/reason for indecision/not sharing IPD
There are currently no plans to publish it.
Study Protocol
Undecided - It is not yet known if there will be a plan to make this available
Statistical Analysis Plan
Undecided - It is not yet known if there will be a plan to make this available
Informed Consent Form
No - There is not a plan to make this available
Clinical Study Report
Undecided - It is not yet known if there will be a plan to make this available