Effects of Ambulation During First Stage of Labour on Maternal and Neonatal Outcomes
Effects of Ambulation During First Stage of Labour on Maternal and Neonatal Outcomes
This study investigates the effect of ambulation (walking) during first stage of labour on
 maternal and neonatal outcomes. In the intervention group women will be encouraged to
 ambulate and women in the control group will receive usual maternity care.
Walking and upright positions in the first stage of labour reduces the duration of labour,
 the risk of caesarean birth, and the need for epidurals. Movement is a safe and healthy
 coping strategy for pain, and confining labouring women to bed increases pain and decreases
 women's satisfaction with their birth experience . Despite that ambulation and upright
 positioning during labour does not harm mother, fetus, or newborn, women are still largely
 confined to bed during the first stage of labour. The increased use of medical interventions
 such as epidural analgesia, continuous electronic fetal monitoring, intravenous infusions for
 fluids and electrolytes, and a restrictive birthing environment limits women's instinctive
 responses to labour pain and contractions rather than assisting the woman to cope with the
 pain and anxiety of labour .

 In Jordan practices in maternity wards are not based on best evidence.The majority of health
 facilities restrict movement during labour, women were confined to bed in the lithotomy
 position and most of these facilities strap women in the delivery position, women have no
 choice to assume the position they prefer during labour and delivery. The practice of
 restricting women's movement in labour is contrary to the statements and recommendations of
 professional organizations advocate for women to move about during the first stage of labour,
 as long as they remain low-risk. Implementing evidence-based maternity care in developing
 countries with limited resources such as Jordan is particularly challenging, and requires
 commitment to applying the most up to date evidence to clinical decisions.

 The purpose of this study is to begin investigation that could help provide a better quality
 of care during birth and improve maternity outcomes in one Jordanian hospital. The process
 was introducing an evidence-based practice of encouraging women to ambulate and assume the
 upright position during the first stage of labour and observing if results would suggest low
 cost modifications for the maternity health service environment, especially the labour ward.
 This is the first study that has attempted to implement and evaluate such an intervention in
 Jordan.

 Methods A randomised controlled study will be conducted with primiparous women who come to
 give birth at Al- Karak Hospital in Jordan. Women will be subsequently randomised into the
 groups using a table of random numbers. "Ambulation during labour" here will refer to moving
 from place to place during the first stage of labour that reduces the amount of time a woman
 spends laying down during this stage (measured by recording the number of minutes spend on
 walking).

 The setting for this study will be the maternity ward at Al-Karak hospital, the main
 governmental and teaching hospital in the southern region of Jordan. In 2016 2,808 births
 occurred in this hospital, 59% were caesarean births . In this hospital, the woman usually
 labours in 26- bed ward with restrictions on movement. This is consistent practice
 nationally. Certified midwives, resident physicians, and obstetricians provide care. Midwives
 in this hospital work with uncomplicated labours and help obstetricians with complicated
 cases.

 The sample size was calculated using the G power version 3.1. Based on difference between two
 independent groups, alpha= 0.05, median effect size 0.3, power =95%, sample size required for
 each group is 88 women. To overcome attrition, 25% of the calculated sample will be added,
 the final sample size will be 110 women in each group.

 Data will be collected using structured tool developed by the researchers based on literature
 review of research related to the current topic. The tool composed of section collecting the
 socio-demographic data and another section collecting maternal and neonatal outcomes. The
 research tool was reviewed by a panel (n=3) of experts in maternity health field. Before
 starting the study, the final version of the tool will be tested in a pilot study to evaluate
 its feasibility, clarity, and reliability. Assistant researcher (midwife) will complete the
 first section of the tool, which related to socio-demographic data, and will allocate
 participants to control and intervention group according to the randomization list. The
 principal researcher will be kept blind for those participants who are in the intervention
 and control groups. Completing the second part of the study tool, which is related to
 maternal and infant health outcomes, will be in maternal ward and by the primary
 investigators 24 to 48 hours after birth.
Inclusion Criteria:

 -  primiparous women

 -  with uncomplicated singleton pregnancies

 -  between 37 and 41 weeks gestation, cephalic, with cervical dilatation 3 to 5cm

 Exclusion Criteria:

 -  multiparous

 -  with complicated pregnancies , multiple gestation,