Walking May Shorten Labor and Reduce Need for Epidurals
By Peggy Peck, Executive Editor, MedPage Today
Published: April 14, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.
CLEVELAND, April 14 -- Women who walk off early labor pains are rewarded with shorter labors than women who lie in bed through the first stage of labor, according to a Cochrane review.
The first stage of labor was about an hour shorter for women who maintained upright positions -- sitting, standing, walking, kneeling, squatting, or on hands and knees -- compared with those who were recombinant, wrote Annemarie Lawrence, M.D., of the Institute of Women's and Children's Health at the Townsend Hospital in Douglas, Australia, and colleagues.
And women who maintained an upright position were also 17% less likely to require epidural analgesia (RR 0.83, 95% CI 0.72 to 0.96), the investigators reported in the review published online April 15 by the Cochrane Collaboration.
But aside from a shorter labor and less use of epidurals, there were no significant differences in labor outcome, including mode of delivery or length of second stage labor.
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Action Points
* Explain to interested patients that this study suggests that an upright position may be an effective way to shorten the first stage of labor, but the authors note that a woman may seek several different positions as labor progresses.
The review included 21 studies that enrolled a total of 3,706 women who were randomly assigned to upright or recumbent (semirecumbent, lateral, or supine) positions during the first stage of labor.
The findings that an upright position shortened the first stage of labor emerged from a pooled analysis that included data from nulliparous and multiparous women.
But, when the data were considered on the basis of parity, among nulliparous women "the length of first stage labor was not significantly different between groups; for multiparous women, the duration of first stage was approximately half an hour shorter for those randomized to upright positions."
Five trials included only women who had epidurals and for the 1,176 women in those trials, walking did not reduce the duration of first stage labor compared with recumbent positions.
The authors cautioned that the studies used in the review had a number of limitations, including the obvious one -- an inability to blind patients or clinicians to the intervention.
Also there was a wide variation in the way in which the upright or mobile intervention was practiced -- some centers asked women who were in bed for more than 30 minutes to get up and walk, while others gave only gentle reminders about the need to be upright, and some encouraged walking only during daytime hours.
The studies were also conducted over a long -- and disparate -- period, with the first done in the 1960s and the last done in 2007.
The authors concluded that women "should be encouraged to take up whatever position they find most comfortable while avoiding long periods supine."
Moreover, they said that a woman's preference may change during the course of labor, and they encouraged clinicians to support the woman's preference.
Dr. Lawrence made no financial disclosures.
Primary source: Cochrane Database of Systematic Reviews
Source reference:
Lawrence A "Maternal positions and mobility during first stage labour" Cochrane Database of Systematic Reviews 2009; 2.
