Study designs of evaluations included in the review
Randomised controlled trials (RCTs) that reported adequate allocation concealment, outcome data for at least 80% of the participants and an intention-to-treat (ITT) analysis were eligible for inclusion in the review.
Specific interventions included in the review
Studies that compared ambulation or upright position versus recumbent position in the first stage of labour were eligible for inclusion. In the review, the upright position included walking, standing or sitting while the recumbent position included supine or lateral positions less than 45 degrees from the horizontal. The included studies used different epidural regimens (intermittent bolus, continuous infusion or combined spinal epidural) and ambulatory interventions (details were reported).
Participants included in the review
Studies of women with effective first-stage epidural analgesia in an uncomplicated pregnancy were eligible for inclusion. Studies that included women with complicated or high-risk pregnancies were excluded. In all of the studies, participants had singleton, cephalic presentation at term. Some studies only included nulliparous women, some only included women with spontaneous onset of labour, and others included women who had been induced.
Outcomes assessed in the review
Studies that assessed mode of delivery were eligible for inclusion. The primary review outcome was instrumental delivery. The secondary outcomes included Caesarean section (CS), spontaneous vaginal delivery, oxytocin augmentation, length of first stage, length of second stage, perineal laceration (including episiotomy), post-partum haemorrhage, inadequate pain relief, satisfaction with labour care, longer term outcomes including incontinence, and specified adverse maternal and infant outcomes.
How were decisions on the relevance of primary studies made?
Two reviewers independently selected studies and resolved any disagreements through discussion.