***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 
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    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 BACKGROUND Childbirth is an important life event for which a positive experience is important to many women . METHODS As secondary outcomes from the r and omised controlled Comparative Obstetric Mobile Epidural Trial , various aspects of satisfaction were assessed in women who had one of three types of regional analgesia ( two of which were low-dose techniques and a high-dose control using 0.25 % epidural bupivacaine ) and a comparison group who did not have epidural analgesia , shortly after delivery and 12 months later . RESULTS The predominant finding was satisfaction with spontaneous vaginal delivery whatever the mode of analgesia . The overall immediate and long-term satisfaction was similar for all three neuraxial techniques . Satisfaction with the speed of pain relief and the amount of mobility were significantly greater for the combined spinal-epidural technique compared with the low-dose infusion ( P<0.001 ) . The degree of control felt by women who had combined spinal-epidural analgesia was greater than with the high-dose ( P<0.05 ) . Women in the non-epidural comparison group did not report a greater feeling of control . Among those who delivered spontaneously , more women in the combined spinal-epidural group ( 30 % ) felt in full control compared with the high-dose group ( 17 % ) ( P<0.05 ) . By comparison 22 % in the low-dose infusion group and only 15 % who had no epidural felt in full control . CONCLUSIONS Whilst satisfaction with the experience of childbirth appears intimately related to the attainment of a spontaneous delivery , mobile epidurals enhance women 's feeling of control in labour and are popular for future choice of regional analgesia 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 Objectives To determine whether snoring , sleep position , and other sleep practice s in pregnant women are associated with risk of late stillbirth . Design Prospect i ve population based case-control study . Setting Auckl and , New Zeal and Participants Cases : 155 women with a singleton late stillbirth ( ≥28 weeks ’ gestation ) without congenital abnormality born between July 2006 and June 2009 and booked to deliver in Auckl and . Controls : 310 women with single ongoing pregnancies and gestation matched to that at which the stillbirth occurred . Multivariable logistic regression adjusted for known confounding factors . Main outcome measure Maternal snoring , daytime sleepiness ( measured with the Epworth sleepiness scale ) , and sleep position at the time of going to sleep and on waking ( left side , right side , back , and other ) . Results The prevalence of late stillbirth in this study was 3.09/1000 births . No relation was found between snoring or daytime sleepiness and risk of late stillbirth . However , women who slept on their back or on their right side on the previous night ( before stillbirth or interview ) were more likely to experience a late stillbirth compared with women who slept on their left side ( adjusted odds ratio for back sleeping 2.54 ( 95 % CI 1.04 to 6.18 ) , and for right side sleeping 1.74 ( 0.98 to 3.01 ) ) . The absolute risk of late stillbirth for women who went to sleep on their left was 1.96/1000 and was 3.93/1000 for women who did not go to sleep on their left . Women who got up to go to the toilet once or less on the last night were more likely to experience a late stillbirth compared with women who got up more frequently ( adjusted odds ratio 2.28 ( 1.40 to 3.71 ) ) . Women who regularly slept during the day in the previous month were also more likely to experience a late stillbirth than those who did not ( 2.04 ( 1.26 to 3.27 ) ) . Conclusions This is the first study to report maternal sleep related practice s as risk factors for stillbirth , and these findings require urgent confirmation in further studies An investigation was conducted on the maintenance of control in labor , using a 28-item revised Labor Agentry Scale with an estimated reliability of .98 . Thirty low-risk subjects who had attended prenatal classes were r and omly allocated during labor to either the control group , which received st and ard electronic fetal monitoring , or the experimental group , which received radiotelemetric fetal monitoring . Significant differences ( 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 Dense perineal block from epidural analgesia increases the risk of urinary catheterization in 
    Output:
    
There were no significant differences between groups for other outcomes including duration of the second stage of labour , or other outcomes related to the well being of mothers and babies .
AUTHORS ' CONCLUSIONS There is clear and important evidence that walking and upright positions in the first stage of labour reduces the duration of labour , the risk of caesarean birth , the need for epidural , and does not seem to be associated with increased intervention or negative effects on mothers ' and babies ' well being .