The impact of mobilisation with epidural analgesia
in labour on mode of delivery
Stuart Davis, Louise Symons, Zeeshan Arshad, Naomi Hyndman, Julia Critchley
Introduction
•The Royal Infirmary of Edinburgh (RIE) is a large tertiary obstetric centre
•Supports ~7,000 births annually
•Previous quality improvement work focused on:
•Increasing mobilisation after epidural insertion during labour
•Using staff surveys and mobility checklists
•Aiming to improve staff confidence and support safe mobilisation
•Factors influencing mobilisation with an epidural include:
•Epidural infusion regimens
•Local anaesthetic concentration
•Attitudes of the labouring woman & midwife
•Epidural analgesia is associated with:
•Increased risk of instrumental delivery
•Uncertainty remains about:
•Whether mobilisation after epidural reduces the risk of instrumental delivery
•Some evidence suggests:
•Increased mobility may be linked to higher rates of unassisted vaginal birth
•Study aim:
•To determine whether mobilisation with epidural analgesia in labour is associated with mode of delivery at RIE
Methods
•Study design:
•Retrospective review
•Population:
•Low-risk women who received epidural analgesia in labour
•Timeframe: March 2024 – August 2025
•Definition of low risk:
•Spontaneous labour
•Age <40 years
•BMI <40 kg/m²
•Singleton pregnancy
•Livebirth
•No previous caesarean section
•Data collection:
•Patient records reviewed
•Key variables assessed:
•Post-epidural mobility status
•Mode of delivery
•Definition of mobility:
•Women classified as mobile if they stood off the bed at any point after epidural insertion
•Data points collated and analysed
Results
•844 low-risk women received epidurals
•301 (36%) mobilised after insertion
•Delivery outcomes (mobile vs non-mobile):
•Spontaneous + ventouse: 36% in both groups
•Forceps + caesarean: 64% in both groups
•No difference between groups in mode of delivery
Discussion
•Key finding:
•Mobilisation after epidural insertion was not associated with a difference in mode of delivery
•Mobilisation rate:
•36% of women mobilised with epidural analgesia
•Indicates room for improvement
•Factors influencing mobilisation:
•Timing of epidural insertion during labour
•Late insertion may limit time available to mobilise
•Early insertion may be confounded by other factors affecting delivery mode
•Interpretation:
•No observed impact of mobilisation on delivery outcomes in this cohort
•Potential benefits of mobilisation:
•May improve maternal satisfaction and overall experience
•Conclusion:
•No association between mobilisation and mode of delivery in low-risk women with epidurals at RIE
•Implications:
•Further research needed
•Explore maternal experience outcomes
•Assess wider service-level impacts
References
[1]
Antonakou, A., & Papoutsis, D. (2016). The effect of epidural analgesia on the delivery outcome of induced labour: a retrospective case series. Obstetrics and gynecologyinternational, 2016(1), 5740534.
[2]
George, R. B., Allen, T. K., & Habib, A. S. (2013). Intermittent epidural bolus compared with continuous epidural infusions for labor analgesia: a systematic review and meta-analysis. Anesthesia & Analgesia, 116(1), 133-144.
