"Freedom of movement": focus on walking epidurals during childbirth

Typically, when an epidural is administered, and this is the wish expressed by more than 90% of women in labor, the expectant mother finds herself confined to bed. For decades, this immobility has been the norm in French maternity wards. But since last summer, the Saint-Jean polyclinic in Cagnes-sur-Mer has been offering a novel alternative in the department: the walking epidural, which allows women to continue walking, use a ball, do yoga or exercise... while still benefiting from effective analgesia.

More physiological childbirth

"The goal is to promote a more physiological labor, while preserving the comfort of the patients," summarizes Dr. Benjamin Gafsou, the originator of the project. A project that is based on a recommendation from the SFAR (French Society of Anesthesia and Resuscitation) showing that mobility during labor reduces certain obstetric complications, even facilitates recovery after delivery, without increasing the risks for the baby or the mother. "The technique is based on lower doses of anesthetic, administered via a small pump that the patient controls herself," explains the anesthesiologist-resuscitator. We warn that there may be a few more contractions felt, but the trade-off is freedom of movement."

"Implementing this type of epidural was not easy," the specialist acknowledges. "In the delivery room, traditional monitoring requires wired connections, forcing the patient to remain in bed. The clinic therefore invested in wireless monitors and sensors for both maternal and fetal monitoring." The team also developed a precise protocol to ensure that the patient maintains sufficient muscle strength and can move around safely.

In practice, the choice of this technique is validated during an anesthesia consultation (mandatory in the third trimester) after explanations and verification of the absence of contraindications (neurological problems, motor deficit, certain severe pathologies, etc.). "The patient remains in control of her analgesia and can return to a non-ambulatory epidural at any time."

A practice that is still rare

While the device is popular with women who have already benefited from it, it is more restrictive for the teams. "You have to support them when they first get up, regularly check their leg sensitivity and strength... but for women, it's a real plus."

In France, some large Parisian maternity hospitals and a few establishments in Switzerland already offer it, but in the department, the maternity ward of the Saint-Jean polyclinic (level 1) is a pioneer. "We know that many women are looking for a less medicalized birth, while still having good comfort. The walking epidural is an ideal compromise."