[Benefits of maternal mobility during labour: Between international guidelines and clinical practice]

Maternal mobilisation and upright positions during labour are recommended by both the World Health Organization (WHO, 2018) and the French National Authority for Health (HAS, 2017) for low-risk women, and more recently by the 2025 SFAR-CARO-HAS guidelines on neuraxial analgesia. Physiologically, upright positions and postural changes optimise uterine dynamics through gravity, improve utero-placental perfusion by preventing aorto-caval compression, and take advantage of pelvic mobility which modifies the diameters of the pelvic inlet and outlet by several millimetres. Cochrane systematic reviews suggest that during the first stage of labour, upright positions and ambulation shorten labour duration and reduce the use of epidural analgesia, with moderate-quality evidence limited by methodological heterogeneity and risk of bias. During the second stage, upright positions shorten expulsion in women without epidural; the BUMPES trial and recent meta-analyses by Verastegui-Martín and Pan do not show a major clinical benefit of upright positions under low-dose epidural, although no detrimental effects are identified. According to the 2021 French Perinatal Survey, 82.7% of women received epidural analgesia and 74.2% used PCEA. Despite consistent guidelines, mobilisation remains underused. Barriers are organisational, technical (including the lack of one-to-one midwifery care), cultural and related to maternal preferences. Promoting a culture of mobility requires interprofessional training, suitable equipment and early antenatal information.