Walking during the first stage of labor is believed to enhance progression and decrease the pain of labor. However, little research has been performed to evaluate the effects of the woman's position during labor. Bloom and colleagues performed a randomized study to determine if walking during the first stage of labor has any impact on the duration of labor or obstetric outcome.
The study included 536 women who were assigned to a walking group and 531 women who were assigned to a usual-care group (labor in bed). The two groups were similar with respect to race, age, nulliparity and cervical dilatation at baseline. All of the patients had spontaneous onset of labor at 36 to 41 weeks' gestation. Uterine contractions were regularly occurring and the cervix was dilated 3 to 5 cm when patients entered the study. Fetal membranes could be intact or ruptured, and both multiparous and nulliparous patients were included. Women who had breech presentations or any known complications were excluded from the study.
The women in the walking group were allowed to walk as they desired; 116 (21.6 percent) of the 536 women in this group did not walk during the first stage of labor. Patients who walked returned to their beds if they needed analgesia or when the second stage of labor began.
Routine electronic fetal monitoring was not used in either group, although intermittent surveillance was used when clinically indicated. Ineffective labor was suspected if the cervix did not dilate progressively in the first two hours after admission. If the fetal membranes were intact, amniotomy was performed, and the progress of labor was evaluated two hours later. Augmentation with intravenous oxytocin was instituted if no further cervical dilatation occurred in two to three hours and hypotonic uterine contractions were documented by an internal pressure catheter.
A nurse attended each walking woman, recording the number of minutes spent walking. In addition, women from both groups wore a pedometer that recorded the number of steps taken during the first stage of labor.
The walking time was 56 ± 46 minutes and the number of steps taken was 553 ± 801 in the patients who walked during the first stage of labor. The 116 patients who were assigned to the walking group but chose not to walk had a significantly shorter first stage of labor than those who walked. The duration of the first stage of labor was 5.5 ± 3.6 hours in the group that chose not to walk, compared with a duration of 6.2 ± 3.5 hours in the group that walked. In the women assigned to the usual-care group, the duration of the first stage of labor was 6.1 ± 3.5 hours.
No significant differences between the walking and usual-care groups were found in any characteristic of labor, including the need for oxytocin, duration of the first and second stages of labor, need for analgesia or development of chorioamnionitis. There were also no differences in the frequency of episiotomy, use of forceps or need for cesarean section. Infant outcomes were similar in both groups.
The authors conclude that walking during the first stage of labor neither enhances nor impedes the normal progress of labor during the first stage. Because their study provides no objective evidence for or against walking during the first stage of labor, they believe it is reasonable to allow the patient to decide what she prefers to do.
editor's note: The findings from this study should not discourage physicians from encouraging patients to walk during the first stage of labor. Rather, the findings suggest that walking during labor is not medically superior or inferior to labor in bed. In an accompanying editorial, Cefalo and Bowes note that since walking provides no measurable benefit but also causes no obvious harm, physicians should allow patients to have the last word as to whether they walk or stay in bed during the first stage of labor. The authors further note that the only intrapartum intervention truly shown to reduce the rate of cesarean section is the presence of one-on-one support, such as that given by a nurse, nurse-midwife or doula.—j.k.