Investigating which methods for rotating the baby at birth (hand or instrument) have the best outcomes.

Operational birth

An assisted vaginal birth often happens when the baby is awkwardly positioned in the birth canal, for example when the baby's spine is resting against the pregnant woman or pregnant person's spine. This makes it much harder to push the baby out. Around 30,000 births per year in the UK (one in 25) are affected.

This research project is investigating which methods for rotating the baby at birth (hand or instrument) have the best outcomes, both straight after the birth and in the longer term.

Assisted birth is when doctors (obstetricians) will try to turn the baby into a better position, using either instruments (forceps or ventouse) or a manual technique with their hands.  It is thought that the manual hand technique may result in less trauma for women and babies but we do not yet have the information needed to make a robust recommendation about this.

We know that births complicated by assisted birth can cause long term health problems for birthing women and birthing people which can affect their physical and emotional health, relationships and careers. It can also have serious consequences for the baby.

Some 5,200 women and people will be asked to take part in the trial. We won't know who is eligible to take part until they are in the advanced stages of labour.

The ROTATE trial will collect data to find out whether manual rotation is less likely to cause trauma to the anus (back passage) and the perineum (skin between vagina and anus) without increasing the risk of caesarean birth. This is because caesarean section in the later stages of labour can be risky and result in considerable trauma to the woman, person, and baby, as well as bad outcomes in future pregnancies including very preterm birth. We will also ask women about their birth experience and other important outcomes such as injury to the baby and impact on breastfeeding.

This study developed a list of outcomes after talking to parents, parenting organisations and charities, obstetricians and midwives. Two charities that support parents, NCT and the Birth Trauma Association, are part of the research team. 

If you are eligible you may be invited to take part whilst in labour.