By Birth & Baby University · Last updated: October 2026 · 3 min read
Encouraging movement is close to a default in doula practice. The research supports it as safe for most people and associated with benefits in some trials, but the strongest claims, such as “walking speeds labor” or “a birth ball lowers cesareans,” outrun what the evidence can establish. This article separates what is known from what is hoped.
Key takeaways
- A Cochrane review of 25 trials associated upright and ambulant first-stage labor with shorter labor and fewer cesareans, but with variable trial quality.
- For people with epidurals, walking and upright positions have shown no clear benefit to delivery outcomes and no obvious harm.
- Birth balls reduced reported pain in several meta-analyses. Evidence for their effect on cesarean or labor length is inconsistent between reviews.
- None of the sources reviewed here isolated swaying or dancing from broader movement, so claims about those specifically are not backed by direct trial evidence in this article.
What the research says
Walking and upright activity
The Cochrane review of maternal positions and mobility in first stage labour found, across 25 trials with 5,218 women, a first stage about 82 minutes shorter and a lower cesarean rate (RR 0.71, 95% CI 0.54 to 0.94) with upright and ambulant positions compared with recumbent ones. Heterogeneity was very high and the authors urged caution. The review found no evidence that labouring in bed benefits women or babies, although it may be more convenient for staff.
Movement with an epidural
A meta-analysis of five trials with 1,161 women found no statistically significant difference in mode of birth when people with effective epidurals walked or stayed upright in the first stage compared with staying recumbent, no difference in oxytocin use or labor duration, and no apparent adverse effects, though few trials reported data. A 2026 meta-analysis of 12 randomized studies (5,439 women) with low-dose epidurals found that bed-based activity shortened first and second stages, and that combined upright and bed activity lowered cesarean and assisted vaginal birth. It also found an 8% higher risk of assisted vaginal birth (RR 1.08, 95% CI 1.01 to 1.15) with upright activity alone, and its cesarean estimate (RR 0.12, 95% CI 0.02 to 0.96) is very imprecise. The authors themselves said upright-only findings warrant cautious interpretation.
Birth balls
A 2023 review in the American Journal of Obstetrics and Gynecology reported that a birth ball reduced pain by about 1.7 points on a 10-point visual analog scale in a meta-analysis (95% CI -2.20 to -1.20) without a significant effect on mode of birth or complications, and judged it safe. For peanut balls, data were mixed. A 2025 meta-analysis of 10 trials with 1,008 low-risk laboring people reported lower cesarean rates, lower pain scores and a first stage over two hours shorter with birth ball exercises. The two reviews disagree about the effect on cesarean and on labor length, which is a reason to treat that benefit as unproven, while the pain benefit appears more consistent.
What this means for doulas
- Frame movement as comfort and choice. It is reasonable to say that moving freely is safe for most people and may help some. Avoid promises about faster labor or fewer interventions.
- Adapt to the setting. Monitoring equipment, IV lines and epidurals alter what is practical. Ask the team what is possible.
- Do not oversell tools. A birth ball may ease pain for some people. Reviews disagree about whether it changes mode of birth.
- Swaying and dancing are comfort strategies. Reasonable to offer, but not supported here by direct outcome trials.
Putting the evidence into practice
- In prenatal visits, practice several simple movement options and discuss how they might change with monitoring or an epidural.
- In labor, invite position and activity changes at regular intervals if the person is willing. Pause suggestions when rest is what the person wants.
- With an epidural, ask the nurse about supported position changes and use your hands and body to help with comfort rather than to “get labor moving.”
- Follow clinical instructions when movement is restricted, such as for fetal monitoring concerns or bleeding.
The bottom line
Movement during labor is low risk and valued by many people, and trials give some support for benefits on duration and interventions. Results vary between reviews and quality is variable, so doulas serve clients best by offering movement as an option and leaving outcome claims out of the conversation.
This article is for professional education. It is not medical, legal or tax advice. Check the standards of your certifying organization and the rules where you work.
Sources and further reading
- Lawrence A, et al. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013. Read the source
- Roberts CL, et al. Impact of first-stage ambulation on mode of delivery among women with epidural analgesia. Australian and New Zealand Journal of Obstetrics and Gynaecology 2004. Read the source
- Pan WL, et al. Effects of upright and bed activities on labour progression in women receiving low-dose epidural analgesia: a systematic review and meta-analysis of randomised controlled studies. Midwifery 2026. Read the source
- Grenvik JM, et al. Birthing balls to decrease labor pain and peanut balls to decrease length of labor: what is the evidence? American Journal of Obstetrics and Gynecology 2023. Read the source
- Terres MT, et al. Efficacy of birthing ball exercises to reduce labor pain and cesarean rates: an updated meta-analysis of randomized controlled trials. Archives of Gynecology and Obstetrics 2025. Read the source
Practical comfort and movement skills are part of birth doula preparation. Browse the online training and mentorship options on the For Doulas page.
More for professionals: the Professionals Blog.
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