Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Simkin & O’Hara, 200286Systematic review1−N=2773 women14 RCTs involving women in labourUpright position during first stage of labourHorizontal position during first stage of labourImmediate PN periodPain: maternal perceptions and observer ratings.
Uterine contractions: intensity, frequency, efficiency.
Women’s preferences
One consistent finding across studies: none report higher degree of comfort in the supine position.Not statedThe included trials are of variable quality and include different outcome measures. Hence the low EL grading and the inability to pool data.
Bloom et al, 199887RCT1+N=1067 womenWomen with uncomplicated pregnancies in active labour between 36 and 41 weeks gestation.Walking during the first stage of labourNo walking (usual care)Duration of established labourLength of labour (first stage and first+second stage)
Labour augmentation with IV oxytocin
Shoulder dystocia
Mode of birth: spontaneous, forceps, caesarean section

Apgar scores (1 and 5 min)
Umbilical artery pH
Intubation in delivery room
Neonatal seizures
No significant differences between groups for any of the studies maternal or infant outcomes.Not statedCountry: US
MacLennan et al, 199488RCT1+N=196 womenWomen in established labour following an uncomplicated pregnancy, with a single fetus between 37 and 42 weeks gestationWalking during the first stage of labourRecumbent position during labourDuration of established labourLength of labour (total duration)
Labour augmentation with IV oxytocin
Epidural analgesia
Narcotic analgesia
Abnormal CTG
Apgar scores (1 and 5 min)
Mode of birth
No significant differences found between groups.The Queen Victoria Hospital Research Foundation
Hewlett Packard ltd.
Cadbury Schweppes Pty Ltd.
Only 37 of the 96 women allocated to the ambulant group (39%) actually chose to ambulate for 30 mins. or longer.

Country: Australia
Flynn et al, 1978 89RCT1−N=68 womenWomen in established labour who had expressed antenatally a desire to be ambulant during labourWalking during the first stage of labourLateral position in bedDuration of established labourFetal heart rate patterns: accelerations, decelerations, beat- to-beat variation
Length of first stage of labour
Uterine contractions: strength, frequency
Need for augmentation: IV oxytocin, IV prostaglandin, oral prostaglandin
Epidural analgesia
Narcotic analgesia
Mode of birth: spontaneous, assisted breech, forceps, caesarean section
Third stage blood loss
Apgar scores (1 and 5 min)
Fetal heart rate: More women in ambulant group had fetal heart rate accelerations (10 vs. 1, p<0.01) and fewer decelerations 4 vs. 17, p<0.005)

First stage of labour significantly shorter (4.1 vs. 6.7 hours, p<0.001)

Contractions were less frequent in the ambulant group (8.53 vs. 10.13 in 30 min, p<0.05) but stronger (55.53 vs. 46.54 mmHg, p<0.005)
Significantly more ambulant women used no analgesia during labour (20 vs. 0, p<0.001)
The overall dose of pethidine administered to ambulant women was signif. lower (103 vs. 153 mg, p<0.001)
Apgar scores were significantly better for babies born to women in the ambulant group (1 min: 8.8 vs. 7.5, p<0.001; 5 min: 9.9 vs. 9.4, p<0.05
Not statedCountry: UK
Molina et al, 199790RCT1+100 women acting as their own controls (ie. alternating between positions)Women in established labourVertical position during first stage of labourHorizontal position during first stage of labourEstablished labour until to end of first stage of labourPain (maternal perception)As labour progressed women reported less pain in the horizontal position compared with the vertical position:
For continuous abdominal pain: 4–5 cm p<0.05
8–9 cm p<0.05
For continuous lumbar pain: 6–7 cm p<0.05
8–9 cm p<0.05
Abdominal pain during contractions: 6–7 cm p<0.01
8–9cm p< 0.05
Lumbar pain during contractions: 4–5 cm p<0.05
6–7 cm p< 0.01
8–9 cm p<0.05
Argentine Foundation Against PainCountry: Argentina
Andrews & Chrzanowski, 199091RCT1+N=40 womenPrimiparous women in spontaneous labour at 38–42 weeks’ gestation following an uncomplicated pregnancy with a single fetus presenting head first in an anterior position.Upright position for first stage of labourRecumbent position for first stage of labourStudy period: 4–9 cm cervical dilationLength of most active phase of labour (4–9 cm cervical dilation)
Maternal comfort (as measured by observer)
Women in upright group had signif. shorter active phase of labour (mean difference 90.25 minutes, p=0.003).

No signif. difference was found re women’s comfort in labour
Not statedCountry:US

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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