Pregnant Pacing

By Christine Gorman

What's the best way for a woman to give birth? You'd think after millions of years of practice, we'd have the answer nailed by now. But as a study in last week's New England Journal of Medicine makes clear, there's still a lot about birthing babies that even obstetricians don't know. Take something as simple as walking during the early stages of labor, which was the focus of last week's report. Many women find that it helps them to relax, to work through their contractions before the often tough job ahead. In addition, midwives have long believed that walking reduces the need for pain killers and Caesarean sections because it allows the birthing process to work with gravity.

But most doctors--in the U.S. at least--argue that walking during labor is just a fad. It's much safer, they say, for the expectant mom to take to her hospital bed immediately, where the risk of falling is low and it is easier to monitor the baby.

Who's right? "We found that the truth was somewhere in between," says Dr. Steven Bloom, an obstetrician at the University of Texas Southwestern Medical Center at Dallas and the lead author of the study. Bloom and his colleagues examined 1,067 moms-to-be with routine pregnancies and randomly divided them into a group who walked during the first stage of labor and another group who stayed in bed. To their surprise, the researchers found that walking didn't shorten the labor or reduce the need for pain killers, nor did it lower the rate of C-sections. But a full 99% of the women who walked said they'd like to do it again for their next delivery. "Walking gave the women more of a sense of control," Bloom says. "Since it didn't hurt either the baby or the mom, it seems reasonable to let a woman walk during early labor if that's what she wants to do."

You can bet that a lot of obstetricians are going to resist that kind of advice. Their reluctance has more to do with the demands of high-tech medicine, however, than with any real concern about the dangers of walking.

Twenty years ago, many doctors encouraged their patients to walk during labor. Then they started using electronic monitors on a regular basis. But the monitors, which measure the baby's condition during delivery, tethered the mother to a machine, making it impossible for her to walk. Physicians and nurses became more dependent on the high-tech instruments--though studies have shown that using a specialized stethoscope during routine deliveries is just as good at measuring a baby's vital signs as an electronic monitor.

So if you want to walk during the early stages of labor, don't let anyone talk you out of it. You may find nurse midwives more sympathetic to your need to ambulate than obstetricians. (A recent study by the Centers for Disease Control found that, all other things being equal, the risk of infant death was 19% lower for full-term deliveries attended by certified nurse midwives than for those attended by physicians--perhaps because midwives are slower to turn to higher-risk procedures like C-sections and forceps deliveries.) And if you want to keep tabs on what else is and isn't known about birthing babies, check in with the Cochrane Collaboration, an international group of researchers that reviews medical data. For nearly 20 years they've been sorting fact from fiction in childbirth. Now that's a true labor of love.

For more on walking during labor, see time.com/personal Reach the Cochrane Collaboration on the web at cochrane.org