{"id":"https://openalex.org/W7212145229","doi":"https://doi.org/10.3418/jjam.jjam-2026-0002","title":"Effects of the hands-and-knees position on occiput posterior position during the first stage of labour: A systematic review and meta-analysis","display_name":"Effects of the hands-and-knees position on occiput posterior position during the first stage of labour: A systematic review and meta-analysis","publication_year":2026,"publication_date":"2026-01-01","ids":{"openalex":"https://openalex.org/W7212145229","doi":"https://doi.org/10.3418/jjam.jjam-2026-0002"},"language":"en","primary_location":{"id":"doi:10.3418/jjam.jjam-2026-0002","doi":"https://doi.org/10.3418/jjam.jjam-2026-0002","is_oa":true,"landing_page_url":"https://doi.org/10.3418/jjam.jjam-2026-0002","pdf_url":"https://www.jstage.jst.go.jp/article/jjam/advpub/0/advpub_JJAM-2026-0002/_pdf","source":{"id":"https://openalex.org/S135287143","display_name":"Journal of Japan Academy of Midwifery","issn_l":"0917-6357","issn":["0917-6357","1882-4307"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Japan Academy of Midwifery","raw_type":"journal-article"},"volume":null,"type":"review","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://www.jstage.jst.go.jp/article/jjam/advpub/0/advpub_JJAM-2026-0002/_pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5006348162","display_name":"Mai Takeshita","orcid":"https://orcid.org/0000-0003-1850-6301","observed_orcids":["https://orcid.org/0000-0003-1850-6301"]},"institutions":[{"id":"https://openalex.org/I22299242","display_name":"Kyoto University","ror":"https://ror.org/02kpeqv85","country_code":"JP","type":"education","lineage":["https://openalex.org/I22299242"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Mai TAKESHITA","raw_affiliation_strings":["Department of Implementation Science in Public Health, Kyoto University School of Public Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Implementation Science in Public Health, Kyoto University School of Public Health","institution_ids":["https://openalex.org/I22299242"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5117809474","display_name":"Yoriko KOTOKU","orcid":"https://orcid.org/0009-0008-4691-4568","observed_orcids":["https://orcid.org/0009-0008-4691-4568"]},"institutions":[{"id":"https://openalex.org/I43777268","display_name":"Nagasaki University","ror":"https://ror.org/058h74p94","country_code":"JP","type":"education","lineage":["https://openalex.org/I43777268"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Yoriko KOTOKU","raw_affiliation_strings":["Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University","institution_ids":["https://openalex.org/I43777268"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5054461502","display_name":"Yuko Masuzawa","orcid":"https://orcid.org/0000-0003-4629-2371","observed_orcids":["https://orcid.org/0000-0003-4629-2371"]},"institutions":[{"id":"https://openalex.org/I32132236","display_name":"Niigata College of Nursing","ror":"https://ror.org/03yta1g89","country_code":"JP","type":"education","lineage":["https://openalex.org/I32132236"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Yuko MASUZAWA","raw_affiliation_strings":["Faculty of Nursing, Niigata College of Nursing"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Faculty of Nursing, Niigata College of Nursing","institution_ids":["https://openalex.org/I32132236"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5102839847","display_name":"Kayo Ueda","orcid":"https://orcid.org/0000-0002-7986-2441","observed_orcids":["https://orcid.org/0000-0002-7986-2441"]},"institutions":[{"id":"https://openalex.org/I43777268","display_name":"Nagasaki University","ror":"https://ror.org/058h74p94","country_code":"JP","type":"education","lineage":["https://openalex.org/I43777268"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Kayo UEDA","raw_affiliation_strings":["Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University","institution_ids":["https://openalex.org/I43777268"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5056406079","display_name":"Rie Toyomoto","orcid":"https://orcid.org/0000-0003-1125-3145","observed_orcids":["https://orcid.org/0000-0003-1125-3145"]},"institutions":[{"id":"https://openalex.org/I22299242","display_name":"Kyoto University","ror":"https://ror.org/02kpeqv85","country_code":"JP","type":"education","lineage":["https://openalex.org/I22299242"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Rie TOYOMOTO","raw_affiliation_strings":["Department of Health Promotion and Behavioral Sciences, Kyoto University Graduate School of Medicine/School of Public Health"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Promotion and Behavioral Sciences, Kyoto University Graduate School of Medicine/School of Public Health","institution_ids":["https://openalex.org/I22299242"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5063702838","display_name":"Kumiko Adachi","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I69740276","display_name":"Tokyo Metropolitan University","ror":"https://ror.org/00ws30h19","country_code":"JP","type":"education","lineage":["https://openalex.org/I69740276"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Kumiko ADACHI","raw_affiliation_strings":["School of Nursing, Department of Health Sciences, Tokyo Metropolitan University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Nursing, Department of Health Sciences, Tokyo Metropolitan University","institution_ids":["https://openalex.org/I69740276"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5148656101","display_name":"Hiromi ETO","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I43777268","display_name":"Nagasaki University","ror":"https://ror.org/058h74p94","country_code":"JP","type":"education","lineage":["https://openalex.org/I43777268"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Hiromi ETO","raw_affiliation_strings":["Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Reproductive Health, Institute of Biomedical Sciences, Nagasaki University","institution_ids":["https://openalex.org/I43777268"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5063514396","display_name":"Yuriko Usui","orcid":"https://orcid.org/0000-0002-6224-5391","observed_orcids":["https://orcid.org/0000-0002-6224-5391"]},"institutions":[{"id":"https://openalex.org/I74801974","display_name":"The University of Tokyo","ror":"https://ror.org/057zh3y96","country_code":"JP","type":"education","lineage":["https://openalex.org/I74801974"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Yuriko USUI","raw_affiliation_strings":["Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo","institution_ids":["https://openalex.org/I74801974"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5147122666","display_name":"Rieko Fukuzawa","orcid":"https://orcid.org/0000-0003-2805-7562","observed_orcids":["https://orcid.org/0000-0003-2805-7562"]},"institutions":[{"id":"https://openalex.org/I228363734","display_name":"Nagano College of Nursing","ror":"https://ror.org/03dpjp116","country_code":"JP","type":"education","lineage":["https://openalex.org/I228363734"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Rieko FUKUZAWA","raw_affiliation_strings":["Maternal Nursing & Midwifery, Nagano College of Nursing"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Maternal Nursing & Midwifery, Nagano College of Nursing","institution_ids":["https://openalex.org/I228363734"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5023782852","display_name":"Tomoko Nishino","orcid":"https://orcid.org/0000-0003-2958-0080","observed_orcids":["https://orcid.org/0000-0003-2958-0080"]},"institutions":[{"id":"https://openalex.org/I74801974","display_name":"The University of Tokyo","ror":"https://ror.org/057zh3y96","country_code":"JP","type":"education","lineage":["https://openalex.org/I74801974"]}],"countries":["JP"],"is_corresponding":false,"raw_author_name":"Tomoko NISHINO","raw_affiliation_strings":["School of Public Health, Graduate School of Medicine, The University of Tokyo"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"School of Public Health, Graduate School of Medicine, The University of Tokyo","institution_ids":["https://openalex.org/I74801974"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":6,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10453","display_name":"Maternal and Perinatal Health Interventions","score":0.9980000257492065,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10453","display_name":"Maternal and Perinatal Health Interventions","score":0.9980000257492065,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12715","display_name":"Pregnancy-related medical research","score":0.0006000000284984708,"subfield":{"id":"https://openalex.org/subfields/2729","display_name":"Obstetrics and Gynecology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11389","display_name":"Maternal and fetal healthcare","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2735","display_name":"Pediatrics, Perinatology and Child Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/occiput-posterior-position","display_name":"occiput posterior position","score":0.9670000076293945},{"id":"https://openalex.org/keywords/first-stage-of-labor","display_name":"first stage of labor","score":0.7990000247955322},{"id":"https://openalex.org/keywords/occiput-anterior-position","display_name":"occiput anterior position","score":0.8870000243186951},{"id":"https://openalex.org/keywords/labour-duration","display_name":"labour duration","score":0.9660000205039978},{"id":"https://openalex.org/keywords/maternal-position","display_name":"maternal position","score":0.40700000524520874},{"id":"https://openalex.org/keywords/obstetric-surgery","display_name":"obstetric surgery","score":0.7540000081062317},{"id":"https://openalex.org/keywords/prolonged-labour","display_name":"prolonged labour","score":0.7279999852180481},{"id":"https://openalex.org/keywords/neonatal-outcomes","display_name":"neonatal outcomes","score":0.6579999923706055}],"concepts":[{"id":"https://openalex.org/C198082294","wikidata":"https://www.wikidata.org/wiki/Q3399648","display_name":"Position (finance)","level":2,"score":0.7817999720573425},{"id":"https://openalex.org/C2778172420","wikidata":"https://www.wikidata.org/wiki/Q16317","display_name":"Occiput","level":2,"score":0.7548999786376953},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6815999746322632},{"id":"https://openalex.org/C146357865","wikidata":"https://www.wikidata.org/wiki/Q1123245","display_name":"Stage (stratigraphy)","level":2,"score":0.6632000207901001},{"id":"https://openalex.org/C105702510","wikidata":"https://www.wikidata.org/wiki/Q514","display_name":"Anatomy","level":1,"score":0.4564000070095062},{"id":"https://openalex.org/C29694066","wikidata":"https://www.wikidata.org/wiki/Q118301","display_name":"Orthodontics","level":1,"score":0.3296000063419342},{"id":"https://openalex.org/C3018151503","wikidata":"https://www.wikidata.org/wiki/Q608487","display_name":"Hand position","level":2,"score":0.304500013589859},{"id":"https://openalex.org/C163100246","wikidata":"https://www.wikidata.org/wiki/Q1064483","display_name":"Prone position","level":2,"score":0.2596000134944916},{"id":"https://openalex.org/C125567185","wikidata":"https://www.wikidata.org/wiki/Q3267428","display_name":"Supine position","level":2,"score":0.2290000021457672},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.19550000131130219}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.3418/jjam.jjam-2026-0002","doi":"https://doi.org/10.3418/jjam.jjam-2026-0002","is_oa":true,"landing_page_url":"https://doi.org/10.3418/jjam.jjam-2026-0002","pdf_url":"https://www.jstage.jst.go.jp/article/jjam/advpub/0/advpub_JJAM-2026-0002/_pdf","source":{"id":"https://openalex.org/S135287143","display_name":"Journal of Japan Academy of Midwifery","issn_l":"0917-6357","issn":["0917-6357","1882-4307"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Japan Academy of Midwifery","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.3418/jjam.jjam-2026-0002","doi":"https://doi.org/10.3418/jjam.jjam-2026-0002","is_oa":true,"landing_page_url":"https://doi.org/10.3418/jjam.jjam-2026-0002","pdf_url":"https://www.jstage.jst.go.jp/article/jjam/advpub/0/advpub_JJAM-2026-0002/_pdf","source":{"id":"https://openalex.org/S135287143","display_name":"Journal of Japan Academy of Midwifery","issn_l":"0917-6357","issn":["0917-6357","1882-4307"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core"],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Japan Academy of Midwifery","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.98580002784729,"id":"https://metadata.un.org/sdg/3"}],"study_designs":[{"display_name":"Systematic Review","id":"https://openalex.org/study-designs/systematic-review"},{"display_name":"Meta-Analysis","id":"https://openalex.org/study-designs/meta-analysis"}],"awards":[],"funders":[{"id":"https://openalex.org/F4320323434","display_name":"Nara Medical University","ror":"https://ror.org/045ysha14"}],"has_content":{"pdf":true,"grobid_xml":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7212145229.pdf","grobid_xml":"https://content.openalex.org/works/W7212145229.grobid-xml"},"referenced_works_count":21,"referenced_works":["https://openalex.org/W1983023533","https://openalex.org/W1985817012","https://openalex.org/W2002720633","https://openalex.org/W2045891078","https://openalex.org/W2047658778","https://openalex.org/W2073108970","https://openalex.org/W2080355826","https://openalex.org/W2098923148","https://openalex.org/W2107077060","https://openalex.org/W2123085815","https://openalex.org/W2165010366","https://openalex.org/W2165610272","https://openalex.org/W2273047852","https://openalex.org/W2560438049","https://openalex.org/W3123893780","https://openalex.org/W3133614988","https://openalex.org/W3153617835","https://openalex.org/W3184540533","https://openalex.org/W4293741021","https://openalex.org/W4380268424","https://openalex.org/W4404216314"],"related_works":["https://openalex.org/W3127883017","https://openalex.org/W3133614988","https://openalex.org/W2019059869","https://openalex.org/W2273047852","https://openalex.org/W4242521012","https://openalex.org/W2297901065","https://openalex.org/W2010437932","https://openalex.org/W3152345396","https://openalex.org/W2107077060","https://openalex.org/W2620263846"],"abstract_inverted_index":{"PurposeOcciput":[0],"posterior":[1],"(OP)":[2],"foetal":[3,25,62,76,151],"position":[4,43,54,135,249,272],"in":[5,85,94,145,170,281],"labour":[6,11,60,144],"is":[7,17],"associated":[8],"with":[9,39,72,87,129,147,220,256,299],"prolonged":[10],"and":[12,64,67,83,119,164,183,194,213,254],"increased":[13],"obstetric":[14],"interventions.Hands-and-knees":[15],"positioning":[16,128],"a":[18,40,73,80,148],"simple,":[19],"non-invasive":[20],"strategy":[21],"used":[22],"to":[23,48,161],"encourage":[24],"rotation;":[26],"however,":[27],"its":[28],"effects":[29],"on":[30,102,245],"clinically":[31],"important":[32],"outcomes":[33,69,205],"remain":[34],"uncertain,":[35],"particularly":[36],"among":[37,70],"women":[38,71,146],"confirmed":[41,74,149],"OP":[42,75,150],"during":[44,55,139],"labour.This":[45],"review":[46,82,174],"aimed":[47],"evaluate":[49],"whether":[50],"adopting":[51],"the":[52,56,88,95,111,140,171,201,229,240,243,270,282],"hands-and-knees":[53,127,138,283,300],"first":[57,141],"stage":[58,142],"of":[59,115,143,186,196],"improves":[61],"rotation":[63],"related":[65],"maternal":[66,134],"neonatal":[68],"position.":[77],"MethodsWe":[78],"conducted":[79],"systematic":[81],"meta-analysis":[84],"accordance":[86],"Cochrane":[89,112,192],"Handbook.The":[90],"protocol":[91],"was":[92,188,198,226,252,278,296],"registered":[93],"Open":[96],"Science":[97],"Framework":[98],"before":[99],"data":[100,212],"collection":[101],"24":[103],"December":[104,162],"2024":[105],"(https://osf.io/":[106],"tn8ue).We":[107],"searched":[108],"MEDLINE":[109],"(PubMed),":[110],"Central":[113],"Register":[114],"Controlled":[116],"Trials":[117],"(CENTRAL),":[118],"Ichushi-Web":[120],"for":[121,175,210,217],"randomised":[122],"controlled":[123],"trials":[124],"(RCTs)":[125],"comparing":[126],"usual":[130],"care":[131],"or":[132],"any":[133],"other":[136],"than":[137],"position.We":[152],"included":[153,169],"English-and":[154],"Japanese-language":[155],"reports":[156],"published":[157],"from":[158],"February":[159],"2018":[160],"2024,":[163],"carried":[165],"forward":[166],"two":[167],"RCTs":[168,234],"2020":[172],"guideline":[173],"reassessment.Two":[176],"reviewers":[177],"independently":[178],"screened":[179],"records,":[180],"assessed":[181,189],"eligibility,":[182],"extracted":[184],"data.Risk":[185],"bias":[187],"using":[190,200,206,228],"standard":[191],"methods,":[193],"certainty":[195],"evidence":[197],"appraised":[199],"GRADE":[202],"approach.We":[203],"synthesised":[204],"risk":[207],"ratios":[208],"(RRs)":[209],"dichotomous":[211],"mean":[214],"differences":[215],"(MDs)":[216],"continuous":[218],"data,":[219],"95%":[221,261,287],"confidence":[222],"intervals":[223],"(CIs).Statistical":[224],"heterogeneity":[225,258],"evaluated":[227],"I":[230],"2":[231,264,290],"statistic.":[232],"ResultsThree":[233],"(n":[235],"=":[236,265,291],"766":[237],"women)":[238],"met":[239],"inclusion":[241],"criteria.Overall,":[242],"effect":[244],"occiput":[246],"anterior":[247],"(OA)":[248],"at":[250,273],"birth":[251],"inconsistent":[253],"imprecise,":[255],"substantial":[257],"(RR":[259,285],"1.12;":[260],"CI":[262,288],"0.64-1.94;I":[263],"73%;":[266],"low":[267],"certainty).In":[268],"contrast,":[269],"OA":[271],"1":[274],"h":[275],"after":[276],"randomisation":[277],"more":[279],"frequent":[280],"group":[284],"1.66;":[286],"1.07-2.55;I":[289],"0%;":[292],"moderate":[293],"certainty).Labour":[294],"duration":[295],"modestly":[297],"shorter":[298],"position-":[301]},"counts_by_year":[],"updated_date":"2026-11-10T11:39:43.021295","created_date":"2026-09-11T00:00:00"}
