In Reply:—

We appreciate with interest the concerns Dr. Sandefo et al . have regarding the lack of efficacy of walking with ambulatory epidural analgesia (AEA). Although our study did not have sufficient power to show statistical significance (if any) in the duration of stage II labor or total labor duration, we did show AEA with walking or sitting did not shorten labor duration from the time of epidural insertion to complete cervical dilatation. 1 

It is the opinion and experience (nonpublished) of Sandefo et al . that parturients who ambulate for a minimum of 1 h have shorter labors. The upright position and ambulation are reported to shorten labor. 1In our study, ambulatory patients walked for 25.0 ± 23.3 min and sat upright in a chair for 40.3 ± 29.7 min which, when combined, adds up to over 1 h. 1Interestingly, there are at least three other groups who have shown no significant difference in the duration of labor when allowed to ambulate with regional anesthesia. 2–4In addition, as in our study (P = NS), Asselineau found slightly higher labor duration with ambulation. 1,3 

Unfortunately, the incidence of low back pain after ambulatory analgesia was not one of our measured outcomes, but we did show no differences in Visual Analogue Scale (VAS) scores before and after epidural insertion, at complete cervical dilatation, and at the start of stage II labor. 1 

Regardless of the effect AEA has on labor duration, the biggest advantage of AEA is that it spares motor function, allowing for mobility during labor, and does not impede the ability to push during delivery.

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
Collis RE, Harding SA, Morgan BM: Effect of maternal ambulation on labour with low-dose combined spinal-epidural analgesia. Anaesthesia 1999; 54: 535–9
Asselineau D: Does ambulation under epidural analgesia during labor modify the conditions of fetal extraction? Contracept Fertil Sex 1996; 24: 505–8
Bloom SL, McIntire DD, Kelly MA, Beimer HL, Burpo RH, Garcia MA, Leveno KJ: Lack of effect of walking on labor and delivery. N Engl J Med 1998; 339: 76–9