Upright positions and walking beneficial in first stage of labour

Clinical question: 
Are upright positions and walking beneficial in the first stage of labour?
Bottom line: 
Upright positions and walking are associated with a reduction in the length of the first stage of labour (by approximately one hour), and women randomised to upright positions may be less likely to have epidural analgesia (NNT* 19 [11 to 97]). There was little evidence of differences for other outcomes, including length of the second stage of labour, mode of delivery, use of opioid analgesia or mothers' and babies' wellbeing. *NNT = number needed to treat to benefit 1 individual (95% confidence intervals)
Caveat: 
Little information on maternal satisfaction or outcomes for babies was collected, and none of the studies compared different upright or recumbent positions.
Context: 
It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested, if women lie on their backs during labour, this may have adverse effects on uterine contractions and impede progress in labour.
Review CD#: 
CD003934
PEARLS No: 
183
Date: 
July, 2009
Authored by: 
Brian R McAvoy