Mobility strategies during labor significantly shorten stages and reduce cesarean rates in women receiving low-dose epidural analgesia
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Key Takeaway
Mobility strategies shorten labor stages and reduce cesarean rates, but upright activity alone may increase assisted vaginal birth risk.
This comprehensive meta-analysis examined the impact of mobility interventions on women receiving low-dose epidural analgesia. The study included 5,439 participants and evaluated outcomes related to labor progression and delivery methods. Results indicated that engaging in upright and bed activities significantly shortened the first stage of labor, with a standardized mean difference of -0.37. The second stage of labor also experienced a notable reduction in duration when these activities were employed.
Further analysis revealed that combining upright and bed activities further reduced the duration of the second stage of labor. Additionally, the intervention demonstrated a strong association with lower rates of cesarean sections. Specifically, the relative risk for cesarean delivery was 0.12, indicating a substantial decrease in surgical interventions. Assisted vaginal birth rates were also lowered when both activity types were utilized together.
However, the data suggests that upright activity intervention alone may increase the risk of assisted vaginal birth. This nuance warrants cautious interpretation and highlights the need for standardized protocols. Future research should clarify activity definitions and assess safety across diverse maternity settings to ensure optimal care for all patients.
View Original Abstract ↓
BACKGROUND: Epidural analgesia effectively relieves labour pain but may prolong labour and increase the risk of assisted vaginal birth. Mobility and positional changes during labour have been suggested to improve outcomes, yet evidence remains inconsistent.
AIM: To evaluate the effectiveness of upright and bed activities in accelerating labour progression among women receiving low-dose epidural analgesia.
METHODS: This systematic review and meta-analysis were conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and reported following the PRISMA 2020 statement. Seven databases were searched from inception to March 2025 for relevant randomised controlled trials. Methodological quality was assessed using the Cochrane Risk of Bias tool (RoB 2), and meta-analyses were performed using RevMan.
FINDINGS: Twelve studies (5439 women) were included. Bed activity significantly shortened the first (standardised mean difference [SMD] -0.37; 95% confidence interval [CI] -0.56 to -0.18; p < 0.001) and second stage (SMD -0.53; 95% CI -0.81 to -0.24; p < 0.001) of labour. Combined upright and bed activities further reduced second stage duration (SMD -0.75; 95% CI: -1.08 to -0.43; p < 0.001) and lowered caesarean (risk ratio [RR] 0.12; 95% CI 0.02 to 0.96; p = 0.05) and assisted vaginal birth (RR 0.59; 95% CI 0.36 to 0.97; p = 0.04). However, the risk of assisted vaginal birth increased by 8% in women receiving the upright activity intervention (RR 1.08; 95% CI 1.01 to 1.15; p = 0.02) than in those receiving no intervention.
CONCLUSION: Bed and upright activities may enhance labour progression and reduce interventions during labour and birth in women with low-dose epidural analgesia. These findings support the integration of mobility and postural strategies into intrapartum care. However, a potential increased risk of assisted vaginal birth associated with upright activity alone warrants cautious interpretation. Future research should aim to standardise intervention protocols, clarify activity definitions, and assess safety and effectiveness across diverse maternity settings to inform evidence-based clinical practice.
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