Nonpharmacological (alternative) interventions (NPIs) for pain relief during vaginal delivery have gained popularity, as adjuncts to pharmacological interventions or as primary treatment.
Methods:
We searched PubMed/Medline, EMBASE, and Ovid Discovery for observational trials published through May 2024. This meta-analysis examined the effectiveness and safety of some NPIs for labor pain management using the Meta-Mar online software. NPIs, including massage, virtual reality, heat therapy, hydrotherapy, and aromatherapy, were compared with placebo or routine care (RC). The random-effects model was used for the meta-analysis due to significant variations in methodology among the included studies, including intervention duration, patient age, and intervention approaches. The quality of the included studies was assessed using the Cochrane risk of bias 2 (RoB 2). Network analysis was used to determine which NPIs were most associated with pain intensity and labor duration outcomes.
Results:
Of the 7,542 selected studies, 41 met the inclusion criteria. Compared with RC, heat therapy (standardized mean difference [SMD] = −1.26; 95% confidence interval [CI]: −1.84, −0.69; p < 0.001) and massage (SMD = −0.69; 95% CI: −1.14, −0.23; p = 0.017) reduced pain intensity during the first stage of labor. Compared with placebo, aromatherapy increased pain intensity during the first stage of labor (SMD = 0.23; 95% CI: 0.00, 0.45; p = 0.048). Compared with RC, heat therapy (SMD = −1.26; 95% CI: −1.84, −0.69; p < 0.001) and aromatherapy (SMD = −0.15; 95% CI: −0.18, −0.11; p < 0.01) reduced pain intensity during the first stage of labor in primiparous women. Compared with placebo, massage (SMD = −1.05; 95% CI: −3.19, −1.10; p < 0.01) reduced pain intensity during the first stage of labor in primiparous women. Compared with RC, NPIs were more effective in reducing pain intensity during the first stage of labor in both developing and developed countries. Virtual reality and heat therapy reduced the duration of the first stage of labor compared with RC. The current NPIs were more effective in reducing the duration of the second stage of labor in developing countries compared with RC. The incidence of emergency cesarean sections was higher in virtual reality (32%), massage (36%), and hydrotherapy (29%) and lower in aromatherapy (18%) than in RC. Most studies were of low quality with a high risk of bias.
Conclusions:
The present NPIs, such as heat therapy and massage, may reduce pain intensity and labor duration. However, the increased rate of emergency cesarean section and the high risk of bias indicated that caution should be exercised when interpreting these findings.
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