A Study of the Benefits and Acceptability of Ambulation in Spontaneous Labour

Williams, Roger M.; Thom, Margaret H.; Studd, John

doi:10.1111/j.1471-0528.1980.tb04504.x

Cited by 51 publications

(42 citation statements)

References 7 publications

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“…Purported advantages of ambulation in labor include 1) increased intensity of contractions, 2) decreased frequency of contractions, 3) increased uterine activity, 4) decreased pain, 5) shorter first stage of labor, 6) less frequent fetal heart rate abnormalities, 7) improved Apgar scores, 8) less need for augmentation, 9) fewer forceps-assisted deliveries, and 10) patients enjoy being able to ambulate (10)(11)(12)(13)(14)(15). Several studies have failed to demonstrate advantages of ambulation (17)(18)(19). Several studies have failed to demonstrate advantages of ambulation (17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Epidural Anesthesia for Labor in an Ambulatory Patient

Breen

Shapiro

Glass

et al. 1993

Anesthesia & Analgesia

230

136

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The effectiveness of two epidural analgesic regimens on the ability to ambulate was compared in women in labor by a prospective, randomized, double-blind design. One group of patients received epidural fentanyl, a 75-micrograms bolus and an infusion of fentanyl 2.5 micrograms/mL at 15 mL/h (FENT, n = 53). A second group received ultra low-dose bupivacaine (0.04%), epinephrine (1.7 micrograms/mL), and fentanyl (1.7 micrograms/mL) (BEF, n = 77), a 15-mL bolus followed by an infusion at 15 mL/h. Adequate analgesia was rapidly obtained in 90.6% of patients in the FENT group and 92.2% of patients in the BEF group (P = 0.89). Seventy percent of patients in the FENT group ambulated versus 68% in the other group. The BEF mixture provided analgesia of longer duration (287 +/- 171 min versus 156 +/- 72 min, P = 0.0001). The number of patients delivering during administration of only their study drug (without needing higher doses of local anesthetics) was 52% for BEF and 21% for FENT (P = 0.0005). Hip flexion weakness precluding ambulation occurred in 17% (P = 0.002) of BEF patients and orthostatic hypotension in 9% (P = 0.08). Neither problem occurred in FENT patients. Neonatal outcome was similar in both groups. Approximately 70% of women receiving epidural analgesia with fentanyl or ultra low-dose bupivacaine, epinephrine, and fentanyl may ambulate safely during labor.

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Section: Discussionmentioning

confidence: 99%

Epidural Anesthesia for Labor in an Ambulatory Patient

Breen

Shapiro

Glass

et al. 1993

Anesthesia & Analgesia

230

136

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“…For the duration of this study there has been a conservative policy regarding the induction of labour (Williams et al 1980). Those patients admitted in labour before 34 weeks gestation are transferred before delivery and are therefore excluded from this report.…”

Section: Methodsmentioning

confidence: 99%

“…1975); and is not altered by the use of epidural analgesia (Studd et ul. 1975), but these patients have been shown to have a longer first stage with more instrumental deliveries and caesarean sections and a higher incidcnce of infants with low Apgar scores (Studd et al 1980). In the iD.…”

mentioning

confidence: 99%

Predictive value of cervimetric labour patterns in primigravidae

Cardozo

Gibb

Studd

et al. 1982

BJOG

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From a study of 2000 consecutive labours the outcome of the 684 primigravid patients admitted in spontaneous labour has been examined according to their cervimetric progress during the first stage o f labour. A partogram and labour stencil were used to identify dysfunctional labour which was treated with a standard protocol of augmentation by oxytocin. This policy achieved labours with a mean 'observed first stage' of6.3 h and a caesarean section rate of 8.7%. There was one stillbirth due to multiple congenital abnormalities and no increase in perinatal morbidity. Our data show that the type of first stage cervimetric pattern is helpful in predicting the outcome of labour. A normal cervimetric pattern resulted in a vaginal delivery rate of 98.4%; primary dysfunctional labour, which could be improved by oxytocin, had a 93.85% incidence of vaginal delivery, but if there was no improvement in the rate of cervical dilatation when this was administered the vaginal delivery rate was only 22.7%. A prolonged latent phase was associated with a caesarean section rate of 16.7% and the incidence of neonatal intubation was nearly as high as that found in uncorrected primary dysfunctional labour. The neonatal asphyxia in secondary arrest was minimal with an overall caesarean section rate of 28.4%; there was no increased incidence of neonatal morbidity with this cervimetric type.

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“…Blood pressure was recorded before, and five minutes after, the administration of spinal analgesia. The intensity of pain was assessed using an 11-point NRS (0 being no pain, and 10 being the worst possible pain) before and after the administration of spinal analgesia and categorised as "none" (0), "mild" (1-3), "moderate" (4-7) or "severe" (8)(9)(10). Pain was determined before the administration of an intrathecal injection and five minutes afterwards.…”

Section: Methodsmentioning

confidence: 99%

Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation

Anabah

Olufolabi

Boyd

et al. 2015

Southern African Journal of Anaesthesia and Analgesia

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Background: While epidural analgesia for labour pain is standard in high-resource countries, minimal to no analgesia is usually provided in low-resource countries. Intrathecal local anaesthetics provide good pain relief, but the potential impact on ambulation is of concern. Our objective was to determine if a low-dose local anaesthetic combined with an opioid would provide reasonable pain relief, while allowing ambulation in a low-resource setting. Method: This prospective, observational study was conducted at the Tamale Teaching Hospital in Tamale, Ghana. Spinal analgesia was administered to healthy women in labour using a pencil-point 25-G spinal needle at the L3-L4 or L4-L5 interspace, with patients in the sitting position. The intrathecal mixture contained 25 μg of fentanyl, 2.5 mg of bupivacaine and 0.2 mg of morphine. The patient's ability to ambulate following the administration of a low-dose spinal injection was the primary outcome measured. Pain ratings, blood pressure, nausea, vomiting, pruritus, headaches and foetal bradycardia were also recorded. Results: Three hundred and thirty-two parturients consented to participate. Following spinal injection, 328 women (98.8%) experienced mild to no pain, and 4 (1.2%) moderate pain. The administration of spinal analgesia had no effect on ambulation in 291 (87.7%) patients, and a mild effect in 41 (12.3%) patients. Intrathecal analgesia did not severely limit ambulation in any of the patients. Conclusion: Low-dose intrathecal analgesia can provide effective analgesia for labouring patients in low-resource settings without limiting ambulation.

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A Study of the Benefits and Acceptability of Ambulation in Spontaneous Labour

Cited by 51 publications

References 7 publications

Epidural Anesthesia for Labor in an Ambulatory Patient

Epidural Anesthesia for Labor in an Ambulatory Patient

Predictive value of cervimetric labour patterns in primigravidae

Low-dose spinal anaesthesia provides effective labour analgesia and does not limit ambulation

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