***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of this study was to determine whether women in labor report less pain when they are in a vertical ( sitting or st and ing ) position than in a horizontal ( side-lying or supine ) position .  Pain scores were obtained from 60 women in early labor ( dilation 2 - 5 cm ) who alternated between the two positions . The results show that about 35 % of women feel less front pain and 50 % feel less back pain when they are in a vertical position than in a horizontal position . The decrease in continuous back pain ( 83 % ) was particularly impressive , but the front and back pains associated with contractions were significantly diminished as well . These results , taken together with those of earlier studies , indicate that many women in early labor have less pain and are generally more comfortable in a vertical than in a horizontal position . Since early labor comprises a substantial proportion of the entire process of labor and delivery , any simple procedure which alleviates pain without danger to mother or child , such as shifting from a horizontal to a vertical position , should be promoted and employed There has been a relatively recent interest in alternative birthing techniques , including increased maternal mobility during labor . This literature review was pursued to evaluate the effect of upright maternal posture and ambulation on the first stage of labor . Although previous review s frequently assume that maternal ambulation speeds labor progress , the data presented in this review are not conclusive as to whether the upright maternal posture or ambulation during the first stage of labor shortens labor length or improves fetal outcome . However , it is clear that ambulation in labor is not harmful either to the mother or fetus . In addition , many investigators have reported that mobility in labor results in greater maternal comfort and ability to tolerate labor and decreased use of anesthesia and analgesia . Thus , acceptance of mobility in labor by patients and staff is generally reported . This information can serve as a guide to clinical management . However , there is a need for further analysis of the effect of maternal ambulation during labor , and specific suggestions for research are presented The cl aim that an upright maternal posture during labour improves the efficiency of the uterus to the benefit of both mother and fetus has been investigated in a r and omised prospect i ve study . 40 patients undergoing induction of labour were allocated to a recumbent group or an upright group . No differences were found between the groups in the length of labour , mode of delivery , requirements of oxytocic and analgesic drugs , or fetal and neonatal condition . Our data do not support calls to change conventional intrapartum nursing attitudes OBJECTIVE Our purpose was to test the hypothesis that the supine versus the lateral position is associated with a greater decrement in cardiac output after epidural analgesia in labor . STUDY DESIGN Twenty-one normal term subjects were r and omized to the left lateral or supine position in early labor .  Cardiac output measured by the acetylene rebreathing method , stroke volume , heart rate , mean arterial pressure , and systemic vascular resistance were obtained at 5-minute intervals , beginning before a 500 ml intravenous fluid bolus ( baseline ) and ending 45 minutes after epidural injection . RESULTS Mean baseline supine versus lateral group differences were significant for 21 % lower cardiac output , 21 % lower stroke volume , 19 % higher mean arterial pressure , 50 % higher systemic vascular resistance , and equivalent heart rate . In the supine group fluid bolus result ed in significantly increased cardiac output and stroke volume , decreased mean arterial pressure and systemic vascular resistance , and unchanged heart rate . In the supine group cardiac output and stroke volume decreased significantly after epidural injection . The lateral position group exhibited no hemodynamic alterations after fluid bolus or epidural . CONCLUSIONS In contrast to the lateral position , the supine position is associated with a significant postepidural decrement in cardiac output , not identified by a change in heart rate . This likely reflects an inability to maintain stable preload volume in the supine position Telemetry and conventional cardiotocography were compared by monitoring the labor of 60 patients with an uneventful pregnancy and delivery in the 38th-42nd week of pregnancy . 31 patients were monitored by telemetry  and 29 by cardiotocography .  The patients were matched for age ( + /- 5 years ) , duration of pregnancy ( + /- 7 days ) and parity ( I or II ) . The husb and attended labor and delivery in 42 % of the cases in the telemetry group and in 59 % of the cases in the control group . Induction of labor by amniotomy was performed in 32 % of the cases in the telemetry group and in 24 % of the cases in the cardiotocography group . The patients monitored subjective pain every half hour during the opening phase . The telemetric patients were encouraged to sit or walk during the first stage . No maternal or fetal complications occurred . All infants were born in good condition with APGAR scores greater than or equal to 7 recorded at one and five minutes . There were 4 operative deliveries in the telemetry group and 5 in the control group . Indications for these were maternal or uterine exhaustion with the exception of two control patients where fetal asphyxia was suspected . The duration of the first stage of labor did not differ significantly between the telemetry and the cardiotocography groups . The telemetric patients received less analgesics than the controls but this difference was not significant . In spite of less analgesia in the telemetry group , the secondparas of the telemetry group experienced significantly less ( p less than 0.01 ) labor pain than the controls . In addition , the secondparas of the telemetry group considered the present labor less painful than the previous one significantly more often than the controls . Among the primiparous patients there was no difference in the amount of pain experienced by the patients Our purpose was to study the feasibility and results of encouraging ambulation during the first stage of labor in routine obstetric practice . Six-hundred and thirty low risk mothers with intact membranes were r and omized into an ambulant and a control group . The results in the ambulant group were not better than in the control group . Our study suggests that , in principle ambulation may be beneficial , but that the concomitant changes in practice should be different from those in our study A prospect i ve study of 300 consecutive deliveries has been made to assess the benefits and acceptability of ambulation during spontaneous labour . Ambulation during the first stage occurred in 48 patients with 55 non‐ambulant patients acting as controls . No difference in the length of first or second stage , incidence of fetal distress or mode of delivery was observed . In spite of the lack of apparent advantage to the fetal condition , ambulation was acceptable to both patients and nursing staff and should not be discouraged The purpose of this study was to determine if women who assumed upright positions during the phase of maximum slope would have a shorter phase of maximum slope in their labor and experience more comfort than women who assumed recumbent positions . Forty laboring women were r and omly assigned to either an upright or recumbent position group . Subjects assumed the positions of their assigned group during the phase of maximum slope in their labor ( cervical dilatation from 4 cm to 9 cm ) . Every hour during the phase of maximum slope , each subject was examined vaginally to determine her cervical dilatation and assessed for her level of comfort using the Maternal Comfort Assessment Tool . Women in the upright position group had a significantly shorter phase of maximum slope in labor , but did not significantly differ in comfort level from women in the recumbent group . Newborn Apgar scores were not significantly different between the two groups . Nurses need to be aware that the upright labor positions have the distinct advantages of facilitating efficient uterine contractions and reducing the duration of the phase of maximum slope in labor , with no increase in the discomfort experienced or adverse effect on newborn well-being Background Ambulatory epidural analgesia ( AEA ) is a popular choice for labor analgesia because ambulation reportedly increases maternal comfort , increases the intensity of uterine contractions , avoids inferior vena cava compression , facilitates fetal head descent , and relaxes the pelvic musculature , all of which can shorten labor . However , the preponderance of evidence suggests that ambulation during labor is not associated with these benefits . The purpose of this study is to determine whether ambulation with AEA decreases labor duration from the time of epidural insertion to complete cervical dilatation . Methods In this prospect i ve , r and omized study , 160 nulliparous women with AEA were r and omly assigned to one of two groups : AEA with ambulation and AEA without ambulation . AEA blocks were initiated with 15–20 ml ropivacaine ( 0.07 % ) plus 100 & mgr;g fentanyl , followed by a continuous infusion of 0.07 % ropivacaine plus 2 & mgr;g/ml fentanyl at 15–20 ml/h . Maternal measured variables included ambulation time , time from epidural insertion to complete dilatation , stage II duration , pain Visual Analogue Scale scores , and mode of delivery . APGAR scores were recorded at 1 and 5 min . Results are expressed as mean ± SD or median and analyzed using the t test , chi-square , or the Mann – Whitney test at P ≤ 0.05 . Results The ambulatory group walked 25.0 ± 23.3 min , sat upright 40.3 ± 29.7 min , or both . Time from epidural insertion to complete dilatation was 240.9 ± 146.1 min in the ambulatory group and 211.9 ± 133.9 min in the nonambulatory group ( P = 0.206 ) . Conclusion Ambulatory epidural analgesia with walking or sitting does not shorten labor duration from the time of epidural insertion to complete cervical dilatation Background The authors recently showed that “ mobile ” epidural analgesia , using low-dose local anesthetic-opioid mixtures , reduces the impact of epidural analgesia on instrumental vaginal delivery , relative to a traditional technique . The main prespecified assessment of pain relief efficacy , women 's postpartum estimates of labor pain after epidural insertion , did not differ . The detailed analgesic efficacy and the anesthetic characteristics of the techniques are reported here . Methods A total of 1,054 nulliparous women were r and omized , in labor , to receive boluses of 10 ml 0.25 % bupivacaine ( traditional ) , combined spinal-epidural ( CSE ) analgesia , or low-dose infusion ( LDI ) , the latter groups utilizing 0.1 % bupivacaine with 2 & mgr;g/ml fentanyl .  Visual analog scale pain assessment s were collected throughout labor and delivery and 24 h later . Details of the conduct of epidural analgesia , drug utilization , and requirement for anesthesiologist reattendance were recorded . Results A total of 353 women were r and omized to receive traditional epidural analgesia , 351 received CSE , and 350 received LDI . CSE was associated with a more rapid onset of analgesia , lower median visual analog scale pain scores than traditional in the first hour after epidural insertion , and a significant reduction in bupivacaine dose given during labor . Pain scores reported by women receiving LDI were similar to those in the traditional group throughout labor and delivery . Anesthesiologist reattendance was low but greater with each mobile technique . Conclusions Relative to traditional epidural analgesia , LDI is at least as effective and CSE provided better pain relief in the early stages after insertion . The proven efficacy of mobile epidurals and their beneficial impact on delivery mode make them the preferred techniques for epidural pain relief in labor Published reports imply that intrapartum ambulation may improve labor . This suggests the possible efficacy of ambulation in labors requiring augmentation , provided that adequate monitoring surveillance is maintained . Fourteen patients who failed to progress in active-phase labor , and who required augmentation for " inadequate " contractions were r and omized into ambulation ( eight ) and oxytocin ( six ) groups .  Internal fetal monitoring was used in all patients for 30 minute baseline and 2 hour study periods , with two-channel telemetry used in ambulating patients . Oxytocin was administered by infusion pump . Study parameters included changes in cervical dilation and station , contraction frequency , intensity and baseline tonus , and uterine activity . Labor progress was slightly but not significantly better in the ambulatory group . A mean increase in uterine activity units ( UAU ) in the ambulatory group was immediate to ranges not reached in the oxytocin group for 2 hours . Increase in Montevideo units was slightly greater in the ambulatory group during the first hour , but was exceeded by the oxytocin group during the second hour . These initial observations seem to indicate that , in terms of labor progress and initial effects on uterine activity , ambulation is as effective as oxytocin for the enhancement of labor and warrants further investigation Ambulation during labor is becoming more popular , although its impact on the progress of labor and on pain intensity remains unclear . We wondered whether prolonged ambulation with epidural analgesia had a possible effect on duration of labor and pain . In this prospect i ve , r and omized trial , 61 parturients with uncomplicated term pregnancies were allocated to be recumbent ( n = 31 ) or to ambulate ( n = 30 ) . Epidural analgesia was provided with intermittent administrations of 0.08 % bupivacaine-epinephrine plus 1 & mgr;g/mL of sufentanil . Of the 30 women assigned to the ambulatory group , 25 actually walked . Their ambulating time was 64 ± 34 min ( mean ± sd ) , i.e. , 29 % ± 16 % of the first stage . There were no differences between the two groups in the length of labor and in pain visual analog scale scores . However , the ambulatory group received smaller doses of bupivacaine ( 6.4 ± 2.2 mg/h versus 8.4 ± 3.6 mg/h ; P = 0.01 ) and of oxytocin ( 6.0 ± 3.7 mUI/min versus 10.2 ± 8.8 mUI/min ; P < 
    Output:
    
For women who had epidural analgesia there were no differences between those r and omised to upright versus recumbent positions for any of the outcomes examined in the review .
There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers ' and babies ' wellbeing .