The goal of this randomized trial is to test if changing a person's position in labor can increase the chances of delivering their baby vaginally.
Specifically, it aims to answer the questions:
* In fetuses who are facing upwards (occiput posterior, OP) or sideways (occiput transverse, OT) during labor, does changing the patient's position during active labor to a side-lying posture with a peanut ball increase the chances of them having a successful, spontaneous vaginal delivery? * Does changing the patient's position in active labor affect the position of the baby at the time of delivery? * Do intentional position changes in labor impact patient-perceived autonomy during their labor and delivery experience?
Participants will:
* Receive an ultrasound during labor to determine the position of their baby * Be asked to adopt a specific position in labor (side-lying with peanut ball) if they are randomized to the study group * Receive additional ultrasounds during labor to assess their baby's position * Fill out a questionnaire about their labor experience following the delivery of their baby
Maternal age >18
Term gestation (>37 weeks)
Singleton pregnancy
Spontaneous or induced active labor (cervical dilation 6-9cm)
Multiple gestations
Unanesthetized labor
Known fetal anomalies
Known intrauterine fetal demise
Parallel
Maternal position change to side-lying lateral with peanut ball
BehavioralParticipants will be assisted into a position lying on their side, specifically the same side as the fetal spine diagnosed by ultrasound. An inflated peanut ball will be positioned between the legs to open the pelvis. They will be asked to maintain the position for 60 minutes.
Free maternal position
BehavioralParticipants will be asked to adopt any position of their choosing and to maintain it for 60 minutes. They will be asked to not use a peanut ball during the 60 minute study period.
Operative Delivery Rate
The combined rate of cesarean and instrumental vaginal deliveries in each study group
Rotation at Complete Dilation
The percent of fetuses that rotate to facing downwards (occiput anterior) at the time of complete cervical dilation (10cm) in each study group
Rotation at Delivery
The percent of fetuses that rotate to facing downwards (occiput anterior, OA) at the time of delivery in each study group
Duration of Active Second Stage
The mean amount of time spent pushing during the second stage of labor in each group (measured in minutes)
Estimated Blood Loss
The mean amount of blood loss incurred at delivery in each study group (measured in mL)
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