Intervention Review

You have free access to this content

Maternal positions and mobility during first stage labour

  1. Annemarie Lawrence1,*,
  2. Lucy Lewis2,
  3. G Justus Hofmeyr3,
  4. Cathy Styles4

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 9 OCT 2013

Assessed as up-to-date: 18 APR 2013

DOI: 10.1002/14651858.CD003934.pub4


How to Cite

Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub4.

Author Information

  1. 1

    The Townsville Hospital and Health Service, Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, Douglas, Queensland, Australia

  2. 2

    Department of Nursing and Midwifery Education Research, King Edward Memorial Hospital, School of Nursing and Midwifery, Curtin University, Perth, Australia

  3. 3

    University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Department of Obstetrics and Gynaecology, East London Hospital Complex, East London, Eastern Cape, South Africa

  4. 4

    Sunshine Coast Health Service District, Women's and Family Service Group, Nambour, Queensland, Australia

*Annemarie Lawrence, Health & Well Being Service Group and Tropical Health Research Unit for Nursing and Midwifery Practice, The Townsville Hospital and Health Service, Douglas, Queensland, 4810, Australia. annemarie_lawrence@health.qld.gov.au. maternalpositions@hotmail.com.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 9 OCT 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Andrews 1990 {published data only}
  • Andrews CM, Chrzanowski M. Maternal position, labour and comfort. Applied Nursing Research 1990;3(1):7-13.
Ben Regaya 2010 {published data only}
  • Ben Regaya L, Fatnassi R, Khlifi A, Fekih M, Kebaili S, Soltan K, et al. Role of deambulation during labour: a prospective randomized study [Interet de la deambulation au cours du travail obstetrical: etude prospective randomisee de 200 cas]. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 2010;39(8):656-62.
Bloom 1998 {published data only}
  • Bloom SL, Kelly MA, Beimer H, Garcia M, Burpo B, McIntire DD, et al. A randomized trial of the effects of ambulation on active labor. American Journal of Obstetrics and Gynecology 1998;178(1 Pt 2):S98.
  • Bloom SL, McIntire DD, Kelly MA, Beimer HL, Burpo RH, Garcia MA, et al. Lack of effect of walking on labor and delivery. New England Journal of Medicine 1998;339(2):76-9.
  • Goer H. Does walking enhance labor progress?. Birth 1999;26(2):127-9.
Boyle 2002 {published data only}
  • Boyle S, Entwistle F, Hamilton C, Kulinska E. A randomised controlled trial examining the effect of ambulation on labour outcome in women who choose a Combined Spinal Epidural for pain relief in labour. International Confederation of Midwives. Midwives and women working together for the family of the world: ICM Proceedings; 2002; Vienna, Austria. 2002.
Bundsen 1982 {published data only}
  • Bundsen P, Lundberg J, Peterson LE. Telemetric versus conventional fetal monitoring in labour - a prospective randomized study [abstract]. Proceedings of 8th European Congress of Perinatal Medicine; 1982 Sept 7-10; Brussels, Belgium. 1982:Abstract no: 256.
Calvert 1982 {published data only}
Chan 1963 {published data only}
  • Chan DPC. Positions during labour. British Medical Journal 1963;1:100-2.
Chen 1987 {published data only}
Collis 1999 {published data only}
  • Collis R, Harding S, Davies L, Moore C, Baxendall M, Morgan B. Ambulation in labour with an epidural: the effect on analgesic requirements, outcome of labour and maternal satisfaction [abstract]. International Journal of Obstetric Anesthesia 1994;3:109.
  • Collis RE, Harding SA, Morgan BM. Effect of maternal ambulation on labour with low-dose combined spinal-epidural analgesia. Anaesthesia 1999;54(6):535-9.
Fernando 1994 {published data only}
  • Fernando R, Bonello E, Gill P, Urquhart J, Morgan B, Reynolds F. Placental and maternal plasma concentrations of fentanyl and bupivacaine after ambulatory combined spinal epidural (CSE) analgesia during labour. International Journal of Obstetric Anesthesia 1995;4:178-89.
  • Fernando R, Gill P, Urquhart J, Morgan BM. Neurobehavioural changes in neonates after ambulatory combined spinal epidural (CSE) analgesia during labour. International Journal of Obstetric Anesthesia 1994;3:174.
Flynn 1978 {published data only}
  • Broadhurst A, Flynn AM, Kelly J, Lynch PF. The effect of ambulation in labour on maternal satisfaction, analgesia and lactation. Proceedings of 5th International Congress on Psychosomatic Medicine in Obstetrics and Gynaecology, "Emotion and Reproduction";1977 Nov 13-19; Rome, Italy. 1979:943-6.
  • Flynn AM, Hollins G, Kelly J, Lynch PF. The effect of ambulation in labour on uterine action, analgesia and fetal well-being. Proceedings of 6th European Congress of Perinatal Medicine; 1978 Aug 29-Sept 1; Vienna, Austria. 1978:Abstract no: 344.
  • Flynn AM, Kelly J, Hollins G, Lynch PF. Ambulation in labour. British Medical Journal 1978;2:591-3.
Frenea 2004 {published data only}
Gau 2011 {published data only}
  • Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery 2011;27(6):e293-300.
Haukkama 1982 {published data only}
Karraz 2003 {published data only}
MacLennan 1994 {published data only}
  • MacLennan AH, Crowther C, Derham R. Does the option to ambulate during spontaneous labour confer any advantage or disadvantage?. Journal of Maternal-Fetal Medicine 1994;3:43-8.
Mathew 2012 {published data only}
  • Mathew A, Nayak S, Vandana K. A comparative study on effect of ambulation and birthing ball on maternal and newborn outcome among primigravida mothers in selected hospitals in Mangalore. Nitte University Journal of Health Science 2012;2(2):2-5.
McManus 1978 {published data only}
Miquelutti 2007 {published data only}
Mitre 1974 {published data only}
  • Mitre IN. The influence of maternal position on duration of the active phase of labor. International Journal of Gynecology & Obstetrics 1974;12(5):181-3.
Nageotte 1997 {published data only}
  • Nageotte M, Larson D, Rumney P, Sidhu M, Hollenback K. A prospective randomized study of intrapartum epidural vs combination intrathecal/epidural anesthesia with or without ambulation. American Journal of Obstetrics and Gynecology 1997;176(1 Pt 2):S22.
  • Nageotte MP, Larson D, Rumney PJ, Sidhu M, Hollenbach K. Epidural analgesia compared with combined spinal-epidural analgesia during labor in nulliparous women. New England Journal of Medicine 1997;337(24):1715-9.
Phumdoung 2007 {published data only}
  • Phumdoung S, Youngvanichsate S, Jongpaiboonpatana W, Leetanaporn R. The effects of the PSU Cat position and music on length of time in the active phase of labor and labor pain. Thai Journal of Nursing Research 2007;11(2):96-105.
Taavoni 2011 {published data only}
  • Taavoni S, Abdolahian S, Haghani H. Effect of birth ball on active phase of physiologic labor: randomized control trial study [Abstract]. International Journal of Medicine 2010;40(Suppl 1):171.
  • Taavoni S, Abdolahian S, Haghani H, Neisani L. Effect of pelvic tilt by using birth ball on active phase of physiologic labor: A randomized control trial study. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S496.
  • Taavoni S, Abdolahian S, Haghani H, Neysani L. Effect of birth ball usage on pain in the active phase of labor: a randomized controlled trial. Journal of Midwifery & Women's Health 2011;56(2):137-40.
Vallejo 2001 {published data only}
  • Vallejo M, Firestone L, Mandell G, Jaime F, Makishima S, Ramanathan S. The effect of sitting and ambulating on labor duration and maternal outcome [abstract]. Anesthesiology 2001;94(1A):Abstract no: A7.
  • Vallejo M, Mandell G, Jaime F, Ramanathan S. Ropivacaine for walking epidural analgesia during labor. Regional Anesthesia and Pain Medicine 1999;24(3 Suppl):74.
  • Vallejo MC, Firestone LL, Mandell GL, Jaime F, Makishima S, Ramanathan S. Effect of epidural analgesia with ambulation on labor duration. Anesthesiology 2001;95(4):857-61.
  • Vallejo MC, Mandell GL, Jaime F, Makishima S, Ramanathan S. Walking epidural analgesia: the effect of ambulation on labor duration and maternal outcome [abstract]. Anesthesiology 2000;93(3A):Abstract no: A1069.
Williams 1980 {published data only}

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Ahmed 1985 {published data only}
  • Ahmed LT, Bouchetara K. The influence of maternal position on duration of labor [abstract]. Archives of Gynecology 1985;237 Suppl:9.
Allahbadia 1992 {published data only}
Asselineau 1996 {published data only}
  • Asselineau D. Does ambulation under epidural analgesia during labour modify foetal extraction conditions? [La deambulation sous peridurale lors du travail modifie-t-elle les conditions d'extraction foetale?]. Contraception, Fertilité, Sexualité 1996;24(6):505-8.
Caldeyro-Barcia 1960 {published data only}
  • Caldeyro-Barcia R, Noriega-Guerra L, Cibils LA, Alvarez H, Poseiro JJ, Pose SV, et al. Effect of position changes on the intensity and frequency of uterine contractions during labor. American Journal of Obstetrics and Gynecology 1960;80(2):284-90.
Cobo 1968 {published data only}
  • Cobo E, De Bernal MM, Quintero CA, Cuadrado E. Neurohypophyseal hormone release in the human. III. Experimental study during labor. American Journal of Obstetrics and Gynecology 1968;101:479-89.
Cohen 2002 {published data only}
  • Cohen S, Ayers C, Zada Y, Trnovski S, Burley E, Maestrado P. A comparison of continuous epidural-PCA analgesia for labor pain with or without maternal ambulation [abstract]. Anesthesia & Analgesia 2002;94(2S):Abstract no: S195.
COMET 2001 {published data only}
  • COMET Study Group. The comparative obstetric mobile epidural trial (C.O.M.E.T.). Ambulatory epidural analgesia, delivery mode and pain relief: a randomized controlled trial. The C.O.M.E.T. Study Group. [abstract]. European Journal of Anaesthesiology 2000;17:782-3.
  • COMET Study Group. The comparative obstetric mobile epidural trial. Ambulatory epidural analgesia, delivery mode and pain relief: a randomised controlled trial [abstract]. Anesthesiology 2000;92 Suppl:Abstract no: A21.
  • COMET Study Group, Wilson MJ. A randomised controlled trial comparing traditional with two "mobile" epidural techniques: effect on urinary catheterisation in labor [abstract]. Anesthesiology 2002;96(Suppl 1):Abstract no: Z2.
  • Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Effect of low-dose mobile versus traditional epidural techniques on mode of delivery: a randomised controlled trial. Lancet 2001;358(9275):19-23.
  • Cooper GM, MacArthur C, Wilson MJ, Moore PA, Shennan A, on behalf of the COMET Study Group UK. Satisfaction, control and pain relief: short- and long-term assessments in a randomised controlled trial of low-dose and traditional epidurals and a non-epidural comparison group. International Journal of Obstetric Anesthesia 2010;19(1):31-7.
  • Duhig K, MacArthur C, Shennan AH, The COMET Study Group. The hypotensive and fetal heart rate response to low dose epidurals: analysis of an RCT data set [abstract]. Journal of Obstetrics and Gynaecology 2007;27(Suppl 1):S63-S64.
  • Elton C, Bharmal S, May AE, COMET Study Group. Does walking in labour with regional blockade affect the mode of delivery? [abstract]. International Journal of Obstetric Anesthesia 2002;11 Suppl:33.
  • Hussain for the COMET Study Group. Haemodynamic changes with 'mobile' epidurals in labour: is it safe for women to ambulate? [abstract]. Anesthesiology 2001;94(1A):Abstract no: A63.
  • Shennan AH, COMET Study Group. The effect of low-dose 'mobile' compared with traditional epidural techniques on mode of delivery: a randomised controlled trial [abstract]. Journal of Obstetrics and Gynaecology 2001;21 Suppl 1:S19.
  • Wilson MJ, COMET Study Group. The comparative obstetric mobile epidural trial (C.O.M.E.T.). A randomized controlled trial [abstract]. British Journal of Anaesthesia 2001;87(4):659P.
  • Wilson MJ, Cooper G, MacArthur C, Shennan A, Comparative Obstetric Mobile Epidural Trial (COMET) Study Group UK. Randomized controlled trial comparing traditional with two "mobile" epidural techniques: anesthetic and analgesic efficacy. Anesthesiology 2002;97(6):1567-75.
  • Wilson MJ, MacArthur C, Cooper GM, Bick D, Moore PA, Shennan A, et al. Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group. Anaesthesia 2010;65(2):145-53.
  • Wilson MJ, MacArthur C, Cooper GM, Shennan A, for the COMET Study Group UK. Ambulation in labour and delivery mode: a randomised controlled trial of high-dose vs mobile epidural analgesia. Anaesthesia 2009;  64(3):266-72.
  • Wilson MJ, Macarthur C, Shennan A, on behalf of the COMET Study Group (UK). Urinary catheterization in labour with high-dose vs mobile epidural analgesia: a randomized controlled trial. British Journal of Anaesthesia 2009;102(1):97-103.
Danilenko-Dixon 1996 {published data only}
  • Danilenko-Dixon DR, Tefft L, Cohen RA, Haydon B, Carpenter MW. Positional effects on maternal cardiac output during labor with epidural analgesia. American Journal of Obstetrics and Gynecology 1996;175:867-72.
Delgado-Garcia 2012 {published data only}
  • Delgado-Garcia BE, Orts-Cortes MI, Poveda-Bernabeu A, Caballero-Perez P. [Randomised controlled clinical trial to determine the effects of the use of birth balls during labour]. [Spanish]. Enfermeria Clinica 2012;22(1):35-40.
Diaz 1980 {published data only}
  • Diaz AG, Schwarcz R, Fescina R, Caldeyro-Barcia R. Vertical position during the first stage of the course of labor, and neonatal outcome. European Journal of Obstetrics & Gynecology and Reproductive Biology 1980;11(1):1-7.
Divon 1985 {published data only}
  • Divon MY, Mushkat Y, Sarna Z, Zimmer EZ, Vilensky A, Paldi E. The association between fetal heart rate patterns and maternal posture during labor. Archives of Gynecology 1985;237(Suppl 1):89.
Ducloy-Bouthors 2006 {published data only}
  • Ducloy-Bouthors AS, De Gasquet B, Davette M, Cuisse M. Maternal postures and epidural analgesia during labour [Postures maternelles pendant le travail: description et interference avec l'analgesie peridurale]. Annales Françaises d'Anesthesie et de Reanimation 2006;25(6):605-8.
Hemminki 1983 {published data only}
Hemminki 1985 {published data only}
  • Hemminki E, Lenck M, Saarikoski S, Henriksson L. Ambulation versus oxytocin in protracted labour: a pilot study. European Journal of Obstetrics & Gynecology and Reproductive Biology 1985;20:199-208.
Hodnett 1982 {published data only}
Li 2010 {published data only}
  • Li J, Ma QL, Chen RX, Li HN, Zhang HY. Effect of different pre-labor positions for premature rupture of membranes with vertex and engaged presentation on the maternal and neonatal outcomes. Chinese Journal of Evidence-Based Medicine 2010;10(12):1415-8.
Liu 1989 {published data only}
McCormick 2007 {published data only}
  • McCormick C. A randomised controlled trial of the effect of ambulation in the first stage of labour in terms of duration of labour of women with a previous caesarean section. controlled-trials.com (accessed 21 June 2007).
Melzack 1991 {published data only}
Molina 1997 {published data only}
Radkey 1991 {published data only}
  • Radkey AL, Liston RM, Scott KE, Young C. Squatting: preventive medicine in childbirth?. Proceedings of Annual Meeting of Society of Obstetricians and Gynaecologists of Canada; 1991; Toronto, Ontario, Canada. 1991:76.
Read 1981 {published data only}
  • Read JA, Miller FC, Paul RH. Randomized trial of ambulation vs oxytocin for labor enhancement: a preliminary report. American Journal of Obstetrics and Gynecology 1981;139:669-72.
Roberts 1984 {published data only}
  • Roberts JE, Mendez-Bauer C, Blackwell J, Carpenter ME, Marchese T. Effects of lateral recumbency and sitting on the first stage of labor. Journal of Reproductive Medicine 1984;29(7):477-81.
Schmidt 2001 {published data only}
  • Schmidt S, Sierra F, Hess C, Neubauer S, Kuhnert M, Heller G. Effect of modified labor posture on oxygenation of the fetus--a pulse oximetry study. Zeitschrift fur Geburtshilfe und Neonatologie 2001;205:49-53.
Schneider-Affeld 1982 {published data only}
Selby 2012 {published data only}
  • Selby C, Valencia S, Garcia L, Keep D, Overcash J, Jackson J. Activity level during a one-hour labor check evaluation: walking versus bed rest. MCN, American Journal of Maternal Child Nursing 2012;37(2):101-7.
Solano 1982 {published data only}
  • Solano F, Gallo M, Llamas C, Requena F, Arbues J. Perinatal effects of the maternal vertical position during dilatation period of the delivery. Effects on the mother-child couple [Efectos perinatales de la posición vertical materna durante el período de dilatación de parto. Efectos sobre el binomio madre-hijo]. Acta Obstétrica y Ginecológica Hispano-Lusitana 1982;30:81-104.
Stewart 1983 {published data only}
  • Hillan EM. The birthing chair trial. Research and the Midwife Conference; 1984; Manchester, UK. 1984:22-37.
  • Stewart P, Hillan E, Calder A. A study of the benefits of maternal ambulation during labour and the use of a birth chair for delivery. Proceedings of 8th European Congress of Perinatal Medicine; 1982 Sept 7-10; Brussels, Belgium. 1982:113.
  • Stewart P, Hillan E, Calder AA. A randomised trial to evaluate the use of a birth chair for delivery. Lancet 1983; Vol. 1:1296-8.
Tussey 2011 {published data only}
Weiniger 2009 {published data only}
Wilson 2011 {published data only}
Wu 2001 {published data only}
  • Wu X, Fan L, Wang Q. Correction of occipito-posterior by maternal postures during the process of labor. [Chinese]. Chung-Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics & Gynecology] 2001;36(8):468-9.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Abitbol 1985
Albers 1997
Anim-Somuah 2011
Boyle 2000
  • Boyle M. Childbirth in bed: the historical perspective. Practising Midwife 2000;3(11):21-4.
Broadhurst 1979
  • Broadhurst A, Flynn AM, Kelly J, Lynch PF. The effect of ambulation in labour on maternal satisfaction, analgesia and lactation. Proceedings of 5th International Congress on Psychosomatic Medicine in Obstetrics and Gynaecology, "Emotion and Reproduction";1977 Nov 13-19; Rome, Italy. 1979:943-6.
Carlson 1986
  • Carlson JM, Diehl JA, Sachtleben-Murray M, McRae M, Fenwick L, Friedman EA. Maternal position during parturition in normal labor. Obstetrics & Gynecology 1986;68(4):443-7.
Cluett 2009
Cyna 2006
Fenwick 1987
Gates 2005
  • Gates S. Methodological Guidelines. In: The Editorial Team. Pregnancy and Childbirth Group. About the Cochrane Collaboration (Collaborative Review Groups (CRGs)) 2005, Issue 2.
Goer 1999
Gupta 2000
Gupta 2012
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Hodnett 2012
Hollins Martin 2013
  • Hollins Martin CJ, Martin CR. A narrative review of maternal physical activity during labour and its effects upon length of first stage. Complementary Therapies in Clinical Practice 2013;19:44-9.
Hunter 2007
Huovinen 1979
Jones 2012
Kemp 2013
Lupe 1986
Marx 1982
McNabb 1989
  • McNabb M. The science of Labour?. Nursing Times 1989;85(9):58-9.
Mendez-Bauer 1980
  • Mendez-Bauer C, Arroyo J, Freese U, Garcia-Ramos C, Hundsdorfer P, Izquierdo F, et al. The dynamics of labor in different positions. 7th European Congress Perinatal Medicine; 1980 Sept 14-17; Barcelona, Spain. 1980.
RevMan 2008 [Computer program]
  • The Cochrane Collaboration. Review Manager (RevMan). Version 5.0. Copenhagen, The Nordic Cochrane Centre: The Cochrane Collaboration, 2008.
RevMan 2012 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Roberts 1980
Roberts 1983
Roberts 1989
  • Roberts J. Maternal position during the first stage of labour. In: Chalmers I, Enkin M, Keirse MJN editor(s). Effective Care in Pregnancy and Childbirth. Vol. 2, Oxford: Oxford University Press, 1989:883-92.
Rooks 1999
  • Rooks JP. Evidence-based practice and its application to childbirth care for low-risk women. Journal of Nurse Midwifery 1999;44(4):355-69.
Simkin 1989
  • Simkin P. Non-pharmacological methods of pain relief during labour. In: Chalmers I, Enkin M, Keirse MJN editor(s). Effective Care in Pregnancy and Childbirth. Vol. 2, Oxford: Oxford University Press, 1989:893-911.
Simkin 2002
  • Simkin P, Hara M. Nonpharmacological relief of pain during labor: systematic reviews of five methods. American Journal of Obstetrics and Gynecology 2002;186(5):5131-59.
Simmons 2012
Stacey 2011
  • Stacey T, Thompson JMD, Mitchell EA, Ekeroma AJ, Zuccollo JM, McCowan LME. Association between maternal sleep practices and risk of late stillbirth: a case-control study. BMJ 2011;342:d3403.
Stewart 1989
Ueland 1969
Walsh 2000
  • Walsh D. Part five: why we should reject the 'bed birth' myth. British Journal of Midwifery 2000;8(9):554-8.

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Lawrence 2009
Lewis 2002
  • Lewis L, Webster J, Carter A, McVeigh CCM, Devenish-Meares PPDM. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD003934]