While in the past continuous fetal monitoring and epidural techniques limited women’s mobility during labor and delivery, the most recent technologies no longer interfere with this, so they can no longer be seen as a reason to limit women’s movements.
The two major questions raised in the last few decades concerning mobility during labor are:
- Should women in labor be encouraged and assisted to adopt upright and mobile positions during labor?
- Should women be encouraged to deliver in an upright position?
Regarding the first question, there is evidence from randomised controlled trials that mobility and upright positions reduce the duration of the first stage of labor by an average of 1h22, reduce the incidence of cesarean delivery by 29%, and reduce the use of epidural by 19%.
Regarding the second question, there is evidence from randomised controlled trials that the upright position is associated with a 54% decrease in abnormal fetal heart rate patterns, a 22% reduction in instrumental vaginal deliveries, a 21% reduction in episiotomies, but a 35% increase in second degree perineal tears and a 65% increase in blood loss over 500 ml. It therefore seems that delivering in the upright position has both advantages and disadvantages.
In conclusion, there appear to be many advantages of encouraging and assisting women to adopt upright and mobile positions during the first stage of labor, although the majority may prefer to lie down once they have reached 5-6 cm. Delivering in the upright position appears to have both advantages and disadvantages, so it preferable to allow women to choose their position for delivery, or alternatively encourage them to adopt a semi-recumbent position, where healthcare professionals retain the control of perineal support during delivery of the fetal head.
Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(8):CD003934.
Gupta JK, Hofmeyr GJ, Shehmar M. Position in the second stage of labour for women without epidural anesthesia. Cochrane Database Syst. Rev. 2012, (5): CD005073