Influence of Laboring People's Mobility and Positional Changes on Birth Outcomes in Low-Dose Epidural Analgesia Labor: A Systematic Review with Meta-Analysis.
Maite de Verastegui-Martín, Ana de Paz-Fresneda, José Antonio Jiménez-Barbero and 2 others
PMID 36504479WHAT IT FOUND
For people in labor with epidural analgesia, moving or changing positions did not change birth mode, labor length, or Apgar scores.
No harmful effects were found, so mobility can be supported as a safe choice rather than restricted.
Key findings
01Pooled analysis found no significant difference in vaginal birth versus cesarean birth between mobile and static groups (relative risk 1.00, 95% CI 0.87 to 1.14).
02Pooled analysis found no significant difference in neonates with Apgar score below 7 at 5 minutes (relative risk 0.86, 95% CI 0.39 to 1.93).
03Pooled analysis found no significant difference in labor duration (reported value 1.64, 95% CI -34.57 to 37.86), with high heterogeneity (I2 = 82%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 10 studies were included, and only 9 were usable for the meta-analysis, so the evidence base is small. Movement was defined very differently across studies, from walking to peanut ball to upright positions, and some interventions covered only one stage of labor. Labor duration results were highly inconsistent across studies (I2 = 82%), and excluding one study changed the estimate. Some included studies poorly monitored or documented positions, and some participants in mobile groups were not sufficiently mobilized. The review mixed spontaneous and induced labors, different parities, and different ages, which can affect birth outcomes. One very large study was much larger than the others; when it was excluded, the mode of birth result remained null but with less heterogeneity.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not conclude that mobility during labor with epidural analgesia improves birth outcomes. The pooled analyses found no significant differences in mode of birth, labor duration, or Apgar score, and the studies varied widely in how movement was defined.