Efficacy and safety of non-pharmacological interventions for labour pain management: A systematic review and Bayesian network meta-analysis.
Study Goal
The researchers aimed to compare and rank the efficacy and safety of non-pharmacological interventions, including massage therapy, for managing labor pain.
Results Summary
The study found that massage therapy (SMD = -1.26, 95% CrI -2.26 to -0.30) had significant positive effects on alleviating labor pain, though it was less effective than aromatherapy and acupressure. No significant differences were noted between non-pharmacological interventions and usual care regarding pharmacological method use or neonatal outcomes.
Population
Low-risk pregnant women
Effective Dosage
Not available
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
acupressure | decrease | labour pain | low-risk pregnant women | SMD = -2.00, 95% CrI -3.09 to -0.94 | had significant positive effects on alleviating | #1 |
aromatherapy | decrease | labour pain | low-risk pregnant women | SMD = -2.01, 95% CrI -3.70 to -0.35 | had significant positive effects on alleviating | #2 |
massage therapy | decrease | labour pain | low-risk pregnant women | SMD = -1.26, 95% CrI -2.26 to -0.30 | had significant positive effects on alleviating | #3 |
yoga | decrease | the first stage of labour | low-risk pregnant women | SMD = -130.85, 95% CrI -212.01 to -59.32 | was the most effective intervention for shortening | #4 |
acupressure | decrease | the second stage of labour | low-risk pregnant women | SMD = -10.14, 95% CrI -20.24 to -0.41 | was the most effective intervention for shortening | #5 |
non-pharmacological interventions | no change | use of pharmacological methods | low-risk pregnant women | - | no significant differences | #6 |
non-pharmacological interventions | no change | neonatal 5-min Apgar score | low-risk pregnant women | - | no significant differences | #7 |
AIMS AND OBJECTIVES: To compare and rank the efficacy and safety of non-pharmacological interventions in the management of labour pain. BACKGROUND: Recently, various non-pharmacological interventions have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non-pharmacological intervention is more efficient and safer is limited. DESIGN: Systematic review and Bayesian network meta-analysis based on PRISMA-NMA. METHODS: Seven databases were searched from database inception-March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta-analysis was conducted using either fixed-effects model or random-effects model according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model. RESULTS: 43 studies involving nine non-pharmacological interventions were included. The Bayesian network meta-analysis showed that acupressure (SMD = -2.00, 95% CrI -3.09 to -0.94), aromatherapy (SMD = -2.01, 95% CrI -3.70 to -0.35) and massage therapy (SMD = -1.26, 95% CrI -2.26 to -0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = -130.85, 95% CrI -212.01 to -59.32) and acupressure (SMD = -10.14, 95% CrI -20.24 to -0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non-pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5-min Apgar score. CONCLUSIONS: The evidence in this network meta-analysis illustrates that non-pharmacological interventions are effective and safe for labour pain management in low-risk pregnant women. In the future, well-designed studies are needed to validate the conclusion of this network meta-analysis. RELEVANCE TO CLINICAL PRACTICE: The results support the use of non-pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in low-risk pregnant women. Non-pharmacological interventions for labour pain management are recommended to apply according to maternal women's preference and values.