The effects of hands on and hands off/poised techniques on maternal outcomes: A systematic review and meta-analysis

Midwifery. 2020 Aug:87:102712. doi: 10.1016/j.midw.2020.102712. Epub 2020 May 1.


Background: Negative maternal outcomes such as perineal trauma and related perineal pain may cause both long-and short- term morbidities. Hands on and hands off/poised technique are two kinds of techniques to protect perineum during the second-stage of labor. Hands on technique has been the routine midwifery practice for a long time; nevertheless, the effects of hands on technique on protecting perineum has been doubted. Hands off/poised as a promising technique seems prevalent in clinical practice. However, there is no consensus on use of hands off/poised technique and hands on technique. The effects of these techniques on maternal outcomes have not been fully investigated.

Objective: To evaluate the effects of hands on hands off/poised technique on maternal outcomes during the second-stage of labor.

Design: Systematic review and meta-analysis of relevant quantitative studies.

Data sources: Seven databases: PubMed, EMBASE, The Cochrane Library, CINAHL, WanFang Data, China National Knowledge Infrastructure (CKNI), SinoMed were systematically searched from inception to July 23,2018 for relevant quantitative studies comparing the effects of hands on and hands off/poised technique on maternal outcomes.

Review methods: Quantitative studies were retrieved for relevant studies. Two reviewers independently screened the studies, evaluated the methodological quality using JBI appraisal checklist tools and extracted the data. The included studies were divided into two groups for analysis according to study types.

Results: Nine RCTs with a total of 7112 participants and eight non-RCTs with 37,786 participants were included for meta-analysis. Based on the results from RCTs, this study did not find difference between hands on and hands off/poised technique regarding the risk of 2nd perineal tears, 3rd /4th degree perineal tears, duration of second-stage labor and incidence of postpartum hemorrhage (PPH>500 ml). The results from 9 non-RCTs were similar with that of RCTs, except for showing less 2nd degree perineal tears in hands off/poised technique than in hands on technique.

Conclusion: Evidence in the present study indicated that hands off/poised technique may be a promising delivery technique to maintain intact perineum, and reduce perineal pain and episiotomy use among women with low-risk pregnancy undergoing vaginal delivery. In addition, hands off/poised technique might be safe to use as it did not increase the risk of severe perineal trauma, postpartum hemorrhage, and longer duration of second-stage labor when compared with hands on technique. More studies with stringent study design, especially large randomized controlled trial, should be conducted before strong recommendation of the hands off/poised technique.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Female
  • Humans
  • Midwifery / methods*
  • Midwifery / standards
  • Midwifery / trends
  • Obstetric Labor Complications / prevention & control
  • Outcome Assessment, Health Care / standards
  • Outcome Assessment, Health Care / trends*
  • Pregnancy
  • Procedures and Techniques Utilization / standards*
  • Procedures and Techniques Utilization / trends
  • Time Factors