No study has ever compared a policy of unrestricted mobility and support of spontaneous behavior with a policy of restricted and directed behavior. Instead, maternal movements and physiologically normal behaviors are framed as “interventions.” Using mobility as an example, researchers then ask, “What is the effect of walking?” rather than, “What is the effect of prohibiting walking?” This has implications for both the design and interpretation of research. When researchers design a trial, they pit an intervention against either another intervention or the standard of care. To enhance trial validity, investigators define and describe the intervention with exactness and attempt to minimize noncompliance. These requirements do not easily adapt to studying the effects of free mobility and autonomy, concepts that do not lend themselves to specific delineation. Existing trials of maternal positioning, for instance, assign some women to assume certain upright positions for a certain amount of time and restrict them from assuming others (e.g., supine) during that time. However, requiring a woman to assume any position in labor overrides natural instinct and restricts mobility. We do not know the potential harms of the standard practice of discouraging mobility without controlled trials that compare confinement to bed with complete freedom of movement.

Passage from chapter 8, Promoting Progress in First-Stage Labor: Yes We Can
image credit, Andrea Lythgoe, MaternalFocus.com, Sandy, Utah

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