To the Editor:—

We read the article by Dr. Vallejo et al.  1with great interest. In their report the authors found that epidural analgesia followed by walking or sitting does not shorten the labor duration from epidural insertion to complete cervical dilatation.

Our opinion is that the lack of efficacy of walking shown in your study may be caused by the short duration of the walking time. Our experience is that walking for a minimum of 1 h results in shortening of the first stage of labor. It would be interesting to know if in your study a correlation between walking duration and total labor duration was found.

The incidence of low back pain after epidural analgesia does not seem to have been taken into account, and we were very surprised by this. The hypothesis of unnatural position (lack of mobility) following sensory block is frequently evoked as one of important etiology of new onset postpartum back pain after epidural analgesia. 2–5 

The use of ambulation after epidural analgesia could improve and decrease the incidence of low back pain after childbirth. We would welcome your point of view on this point.

Vallejo MC, Firestone LL, Mandell GL, Jaime F, Makishima S, Ramanathan S: Effect of epidural analgesia with ambulation on labor duration. A nesthesiology 2001; 95: 857–61
MacArthur C, Lewis M, Knox EG, Crawford JS: Epidural anaesthesia and long term backache after childbirth. BMJ 1990; 301: 9–12
Russell R, Groves P, Taub N: Assessing long term backache after childbirth. BMJ 1993; 306: 1299–303
Breen TW, Ransil BJ, Groves PA, Oriol NE: Factors associated with back pain after childbirth. A nesthesiology 1994; 81: 29–34
MacArthur A, MacArthur C: Epidural anaesthesia and low back pain after delivery: a prospective cohort study. BMJ 1995; 311: 1336–9