Sutton & Scott’s (1996) work is not research based but they have strong anecdotal evidence to support their claims. This is an area that needs researching but at present does not appear to have any disadvantages for suitable women.

Another method that has been proposed since the 1950s is for the woman to adopt an ‘all-fours’ position, using knees and hands for support, used in conjunction with pelvic rocking. This method has been recommended over the years and used by many women without being researched as to its effectiveness. Hunter et al (2007) following a systematic review of the studies evaluating this intervention conclude that whilst adopting this position for 10 minutes twice a day resulted in a change in the position of the baby at the time, it had no effect on the position of the fetus at term, and thus do not recommend the hands–knees position as an intervention; however, use of this position during labour reduced the incidence of backache. Kariminia et al’s (2004) small study compared this intervention (for 10 minutes twice daily) with a control group who had to undertake walking each day from 37 weeks. They concluded that although the hands–knees posture combined with pelvic rocking exercises is a practice commonly used within midwifery to encourage rotation from the posterior to the anterior position, their results did not support this practice and recommended that in the absence of any beneficial effects, the practice should be discontinued. Encouraging rotation of the occiput from a posterior to an anterior position remains an area for further research.