In my personal experience most patients find that when they are actually in labor they do not really want to walk. (Others say that most of their patients DO walk...) Whether walking actually occurs or not, the maintenance of muscular strength is still beneficial in that it allows the patient to position themselves, sit up if they desire, use the bathroom with assistance, etc. In addition, the patient is better able to push when it comes to time of actual delivery.

Whether ambulation, or maintenance of muscular strength influences fetal outcome is debatable. Some studies seem to show a lower incidence of prolonged labor and instrument-assisted delivery when the technique of "walking epidural" or so-called minimal sensory block epidural is utilized. What is agreed upon is that there are no harmful effects of using this form of anesthesia.

The idea of a combined spinal-epidural is to utilize the benefits of each while avoiding the drawbacks of each:

• Use of intrathecal allows quick onset of pain relief with minimal slowing of early labor
• Placement of epidural catheter allows additional medication to be given when intrathecal wears off
• Placement of epidural catheter allows continuous infusion of medication to be given to prevent pain relief from wearing off
• Epidural catheter can be utilized for anesthesia should a cesarean section become necessary down the line