Methods	Randomised trial.
Participants	160 women. Inclusion criteria - nulliparous women, 36 - 42 weeks’ gestation, singleton pregnancy in the vertex position and 3-5 cm cervical dilatation at the time of epidural insertion. Women with uncomplicated pregnancies who presented in spontaneous labour or who were scheduled to be admitted for elective induction of labour (indications for elective IOL included post dates (> 42 weeks) and patient preference). Exclusion criteria - pre-eclampsia, diabetes mellitus, preterm gestation (< 36 weeks) and post-term gestation (> 42 weeks)
Interventions	Intervention group: AEA with ambulation, sitting in a chair or both (n = 75). After 1 hour, women with a modified Bromage score of 5 who could stand on one foot (right and left) without assistance (all women in this group were able to do this) and without hypotension (systolic blood pressure < 100 mmHg or a decrease of 20 mmHg), were encouraged to ambulate with a support person (spouse or friend). If the woman could not comply with ambulation, she was encouraged to sit in a chair. Ambulation was defined as a minimum of 5 min of walking per hour. Women were not allowed to ambulate if there were persistent fetal decelerations and were not allowed to be out of bed in the second stage of labour when women were actively pushing. Comparison group: AEA without ambulation or sitting in a chair (n = 76). Women were confined to bed, encouraged to stay recumbent in a lateral position, and were not allowed to raise the head of the bed more than 45 degrees from horizontal. All - AEA blocks initiated with 15-25 ml ropivacaine (0.07%) plus 100 g/ml fentanyl, no test dose, to achieve a T10 dermatome sensory level. After achieving adequate pain relief, a continuous infusion of 0.07% ropivacaine plus 2 g/ml fentanyl at 15-20 ml/hour was administered
Outcomes	Length of first stage. Type of delivery. Pain. Length of second stage. Augmentation. Apgar.
Notes
Risk of bias
Item	Authors’ judgement	Description
Adequate sequence generation?	Yes	Described as ‘random number computer-generated program’.
Allocation concealment?	Unclear	Not stated.
Blinding? Women	No	Not feasible.
Blinding? Clinical staff	No	Not feasible.
Blinding? Outcome assessor	Unclear	Not stated.
Incomplete outcome data addressed? All outcomes	No	9 women were excluded.