What is a “walking epidural”?

What is a “walking epidural”?

The term “walking epidural” has become popular, espe-cially in the lay community. The term refers to any epidural or spinal technique that allows the parturient to ambulate. Some initial retrospective data had suggested that ambu-lating or the upright position is associated with a shorter first stage of labor, less pain in early labor, and decreased analgesia requirements. However, prospective and ran-domized studies have not been able to document any medical benefit of ambulating, in terms of either duration of labor or mode of delivery.

Although few patients really want to ambulate, using a technique that produces minimal motor blockade will improve maternal satisfaction. Both epidural analgesia using dilute local anesthetic/opioid solutions or a CSE technique can achieve this goal. However, several precau-tions should be taken before allowing a parturient to walk after receiving epidural or CSE analgesia. First, it should be determined whether she is a candidate for intermittent fetal heart rate monitoring. Blood pressure and fetal heart rate should be monitored for 30–60 minutes after induc-tion of analgesia and reassessed at least every 30 minutes thereafter. Because even small doses of subarachnoid and epidural local anesthetics can produce motor deficits, motor function should be assessed. This is accomplished by asking the parturient to perform a modified deep knee bend or step up and down on a stool. She must have an escort at all times.