Effect of Maternal Ambulation on Labour With Low-Dose Combined Spinal-Epidural Analgesia

Abstract

Some believe that confining women to bed will prolong labor and make it more painful, but other studies have failed to show any effect of maternal ambulation. This trial examined the effects of walking on the duration of labor, amount of anesthesia used, mode of delivery, and the infant’s condition. The study enrolled 229 nulliparous women who requested regional analgesia in the form of a low-dose combined spinal-epidural block. The initial subarachnoid injection contained 25 μg of fentanyl and 2.5 mg of bupivacaine. When the spinal block began to wear off, 15 ml of 0.1 percent bupivacaine containing 2 μg fentanyl/ml was injected through the epidural catheter. Subsequent doses of 10 to 15 ml of the epidural mixture were given as needed. A group of 110 women were allowed to get out of bed, and the remaining 110 stayed in bed. All participants had a singleton pregnancy at 36 to 42 weeks’ gestation and a cephalic presentation. About one-third of the women had labor induced. Some of the control women left bed for short periods, and fewer than half of the ambulatory group spent 30 percent or more of their block time out of bed. In some cases, motor block was responsible, but the most common reason was fatigue. Whether women were assigned to the walking group made no difference in the duration of labor or analgesic requirements, and there was no difference in modes of delivery between the two groups. Very few neonates had low 5-minute Apgar scores, and infants in both groups had similar blood gas values. More than 90 percent of women in both groups were totally satisfied with their analgesia. Several women had generalized backache or tenderness at the injection site. Two parturients had to be catheterized because of urinary retention. No definite benefit of ambulation during labor emerged from this study, but there also were no apparent disadvantages. Mothers do welcome the freedom afforded by combined spinal-epidural analgesia. Conceivably, a study looking at the duration and timing of ambulation would demonstrate effects not noted in the present trial. Anaesthesia 1999;54:535–539