Lack of Effect of Walking on Labor and Delivery
ABSTRACT & COMMENTARY
Synopsis: Walking had no effect on intrapartum outcome.
Source: Bloom SL, et al. N Engl J Med 1998;339: 76-79.
All women who were admitted to parkland Memorial Hospital, Dallas, Texas, in spontaneous labor who met the inclusion criteria during a period of approximately 13 months were potential participants in this study. The purpose of this study was to determine whether walking during the first stage of labor resulted in different outcomes than bed rest during the same time period. Exclusionary criteria included pregnancies less than 36 or more than 41 weeks, dilatation less than 3 cm or greater than 5 cm, non-cephalic presentation, or known pregnancy complication. Women who agreed to this study were randomly assigned either to be confined to a labor bed (in the position of their choice) or walk as desired during the first stage of labor. Electronic fetal monitoring was not routinely used in either group. However, hand-held devices were used to evaluate fetal heart rates approximately every 30 minutes. Pelvic examinations occurred approximately every 120 minutes.
Five hundred thirty-six women were assigned to the walking group and 531 to the labor and bed group. Twenty-two percent of the walking group did not walk. The patient assigned to the walking group but who did not walk had significantly shorter labors, probably because they were rapidly progressing.
In those who participated in the assigned activity, no significant differences were noted for any labor or delivery outcome, and no differences were noted in neonatal outcomes. The Table lists nine of the variables for which no difference was noted. Most of the women (99%) who walked during the first stage of labor said that they would do so again in a subsequent labor, if permitted.
Bloom and associates compared their results with those found in other published articles. In the three large randomized trials (including the current trial), no difference in the duration of labor with walking was noted. Two small trials found a shorter duration of labor with walking.
Table
Walking vs. bed-No difference in any of the outcomes, including:
· 1st stage (hrs)
· 2nd stage (hrs)
· Oxytocin
· Forceps
· Epidural
· Episiotomy
· Cesarean delivery
· Infection
· Neonatal
COMMENT BY KENNETH NOLLER, MD
I absolutely love articles that look at any of our routine beliefs to determine whether they are true. Everywhere I have worked, women in early labor have been encouraged to get up and walk around because "you'll feel better and your labor will be shorter." Perhaps the first is true, but, based on this large randomized trial and two others, it does not appear that the second part of the statement is believable. I now hope someone will eventually try to study (and I emphasize the word "try") whether patients who walk feel better. Somehow, it seems that any distraction may help to attenuate the pain of labor. On the other hand, that also may be an old wives tale.
I am forever trying to convince OB-GYN residents who are searching for a topic for their research paper to pick a routine practice in either obstetrics or gynecology and determine whether it makes sense. Unfortunately, few choose such mundane topics-they prefer new, cutting-edge technology. I'd rather know, for example, whether vaginal douching should be recommended on a routine basis rather than discouraged. Or whether massaging the uterus immediately after delivery makes a difference in blood loss or transfusion. Is a plastic speculum more comfortable than a metal one? There must be a thousand similar studies that could be done. I congratulate the group at Texas Southwestern for proving to us that the patient should be allowed either to walk or to remain in bed, depending on her preference.
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