Does the Option to Ambulate During Spontaneous Labour Confer Any Advantage or Disadvantage?

The objective of this study was to determine if there is any advantage or disadvantage to giving the option to ambulate in labour compared with labour in a recumbent position in relation to length of labor, need for analgesia, mode of delivery, and maternal satisfaction. This study was designed as a prospective randomised controlled trial.One hundred ninety-six women in spontaneous established labour with a singleton fetus in a cephalic presentation between 37 and 42 weeks gestation who had the ability to ambulate in labour were randomised either to an ambulation as desired group or a recumbent group. Amniotomy was performed if the membranes were intact and fetal heart rate monitoring was achieved by radiotelemetry in the ambulant group and direct electronic monitoring in the recumbent group.The demographic characteristics of the two randomised treatment groups were similar. There were no significant differences in any of the maternal or neonatal outcomes between women in the intention-to-ambulate group and the recumbent group. The mean length of labour (SD) from trial entry was 5.0 (3.9) h and 4-9 (3.5) h, respectively. Only 37 of the 96 women (39%) allocated to the ambulation group were upright for half an hour or more. The mean length of labour (SD) for this ambulant group was 6.2 (4.1) h compared with 4.2 (3.5) h for those who reneged on the option to ambulate (N.S.). There was a trend for higher maternal satisfaction (N.S.) amongst those who had the option to ambulate with radiotelemetry with regards to their attitude to electronic fetal monitoring.No advantages or disadvantages accrued from being given the option to adopt an upright posture or ambulate in labour. Addition of this data to a meta-analysis of similar trials in the literature strengthens this conclusion and the opinion that women appreciate the chance to determine their own position in labour. The only significant advantage to ambulant labour in this new meta-analysis is a reduction in analgesic requirements. Delivery suite personnel should provide an environment that allows all options of labour positions, including fetal cardiotelemetry, and should not dictate any routine position in normal labour.