CompletedInterventional

A trial of manual versus instrumental rotation of malpositioned babies at birth

During labour, some babies end up in an awkward position, such as facing sideways or 'back-to-back' against the mother's spine. This can make pushing the baby out difficult. In the NHS, doctors usually turn the baby’s head to help them arrive safely. They can do this gently by hand (manual rotation) or by using instruments like forceps or a small suction cup called a ventouse. Both techniques are common and considered standard care across the UK. However, doctors do not yet know which technique is better at preventing tears to the mother and avoiding emergency caesareans. The ROTATE study randomly places birthing mothers into one of the two groups. Researchers will track recovery, perineal tears, baby safety, and overall birth experiences to help make childbirth safer for future families.

At a glance

Status

Completed

Sponsor

University College London

Enrolment target

5,200

Start

11 Sep 2022

Estimated completion

31 Oct 2024

Fetal head in malposition at birth

What is this study about?

Around one in 25 births in the UK involves a baby whose head is positioned awkwardly in the birth canal. Often, the baby's head is facing the mother's front or turned sideways, rather than facing her back. When this happens during the pushing stage, labour can slow down or stall. Doctors and midwives often step in to help turn the baby into an easier position so birth can continue safely.

At present, NHS doctors use two safe, routine methods to turn a baby. In one method, the doctor uses their hands to gently guide the baby's head around. In the other method, they use specialised birthing tools, such as forceps or a ventouse suction cup. Both methods are widely used, but there is not enough evidence to say which one is gentler on the mother's body or safer for the baby.

Assisted births can sometimes cause tears to the perineum (the skin between the vagina and the back passage) or require an emergency caesarean. By directly comparing hand rotation with instrument rotation, this trial aims to discover which technique leads to fewer injuries, easier healing, and a more positive birth experience.

Key takeaways

Compares two standard NHS ways to turn a baby during labour: by hand or using instruments.
Aims to discover which method causes fewer tears and leads to safer, more comfortable recoveries.
Open to pregnant women aged 16+ carrying one baby at 36 weeks or more whose baby is in an awkward position.
Both techniques are already used across the NHS and will be carried out by fully qualified doctors.
No extra hospital visits are required beyond your normal post-birth care.

Who may be eligible?

This trial is open to pregnant women and birthing people aged 16 or over who are carrying a single baby at 36 weeks of pregnancy or more. You may be invited to take part if you are in active labour, your baby is head-down, and your doctor finds that the baby’s head is facing sideways or back-to-back and needs to be turned.

You will not be able to take part if your baby is already facing the ideal way for birth, if the baby is coming down brow-first, or if there are medical reasons why using forceps or a suction cup would not be safe for you or your baby.

Could this study suit you?

Answer these quick questions to see if you may be eligible. This is a guide only — the research team makes the final call.

I am at least 16 years old.
I am pregnant with one baby and at 36 weeks of pregnancy or more.
My baby is head-down but facing sideways or 'back-to-back'.
My maternity team has confirmed that my baby needs to be turned to help with birth.
There are no medical reasons preventing an assisted vaginal birth.

Answer every question to see your result.

What does participation involve?

If you decide to join the study and your doctor confirms your baby needs turning, a secure computer system will randomly assign you to either hand rotation or instrument rotation. Both techniques are performed by experienced doctors who are fully trained in standard NHS birth practices. Your normal labour care and pain relief options will continue as planned. After your baby is born, the research team will check on your recovery and your baby’s health while you are in hospital. You may also be invited to answer short questions or do an interview about how you felt about your birth, how you are recovering, and how feeding is going. Taking part does not require any extra hospital visits beyond your usual maternity care.

Potential risks and benefits

Because both methods of turning a baby are already standard NHS practice, taking part does not expose you to experimental or untested procedures. While you may not personally benefit from being in the study, your participation provides vital evidence to help improve care and reduce birth injuries for thousands of mothers in the future. You are always in control of your care; you can choose to leave the study at any time without giving a reason, and your medical team will continue to provide you with the best possible treatment.

Locations (13)

University College London Hospitals
City only
London, England
Leeds General Infirmary
Approximate
Leeds, England
Sunderland Royal Hospital
Approximate
Sunderland, England
Liverpool Women's Hospital
Approximate
Liverpool, England
University Hospital Coventry
Approximate
Coventry, England
Rosie Maternity Hospital
Unverified
Cambridge, England
St Thomas' Hospital
Unverified
London, England
James Cook University Hospital
Unverified
Middlesbrough, England
Nottingham University Hospitals NHS Trust - City Campus
Unverified
Nottingham, England
The Whittington Hospital
Unverified
London, England
Royal United Hospital
Unverified
Bath, England
University Hospital of North Tees
Unverified
Stockton-on-tees, England

Common questions

Are both methods of turning my baby safe?

Yes. Both hand rotation and using instruments like forceps or a ventouse are standard, well-established NHS procedures used safely every day.

Will taking part affect my pain relief during labour?

No. Taking part in the trial will not change the pain relief options available to you, including gas and air or an epidural.

How is it decided which method I will receive?

A computer programme chooses at random, like flipping a coin. This ensures the comparison between both methods is fair and accurate.

What happens if the assigned method does not work?

Your doctor will use their clinical judgment to switch techniques or recommend another safe option, such as a caesarean birth, to ensure you and your baby remain safe.

Can I change my mind after agreeing to join?

Yes. You can withdraw your consent at any point, and your healthcare team will support you fully without your care being affected.

How to find out more

Laura Butler

rotate@trials.bham.ac.uk +44 (0)7500007709 Official trial record

Always speak to your GP or specialist before deciding to take part in a study.