Activity level during a one-hour labor check evaluation: walking versus bed rest

Abstract

Purpose: Determine if bed rest or walking during a 1-hour labor check evaluation affects progression to delivery.

Study design: Randomized controlled trial.

Methods: Convenience sample of nulliparous full-term, low-risk women with an initial negative exam for active labor (cervical dilatation < 4 cm; intact membranes) were randomly assigned to bed rest or walking for 1 hour prior to reassessment. Cervical dilatation and comfort level were evaluated before and after 1 hour of bed rest or walking. For patients who delivered within 24 hours, time to delivery was documented. Data were analyzed with Student's t-test and c-test. Positive and negative predictive values were calculated for the 1-hour labor check evaluation as a screen for delivery within 24 hours (negative screen = no change in cervical dilatation after 1 hour; positive screen = ≥1 cm change in cervical dilatation after 1 hour).

Results: Sixty-three participants were studied before and after a 1-hour period of bed rest (n = 32) or walking (n = 31). No differences were found between the groups in changes of cervical dilatation, time to delivery, number of women delivering within 24 hours, or maternal comfort after the 1-hour labor check evaluation. Predictive values of the 1-hour labor check evaluation to determine delivery within 24 hours were 88.2% (positive predictive value) and 54.3% (negative predictive value).

Clinical implications: Cervical dilatation and time to delivery were similar for nulliparous, full-term, low-risk women regardless of activity level during a 1-hour, in-hospital labor check evaluation. The woman's preference can be used to determine activity level during a labor check evaluation. Positive 1-hour labor check evaluations were highly predictive of delivery within 24 hours. A negative 1-hour labor check evaluation, however, was not a good predictor of delivery within 24 hours.