The effect of using birth ball and squatting position during labor on pain, duration, and satisfaction: A randomized controlled trial

AIM

The aim of this study is to assess the effect of using a birth ball and squatting position during labor on labor pain, duration of labor, and satisfaction.

METHODS

This study is a randomized controlled experimental trial. It was conducted in the delivery unit of Başakşehir Çam and Sakura City Hospital. The study sample consisted of a total of 159 women, 53 in the birth ball application room, 53 in the squatting position group, and 53 in the control group. The "Information Form," "Visual Analog Scale," "Partograph," and "Maternal Satisfaction Assessment at Delivery Scale-Normal Birth" were used in the data collection. Data were analyzed using analysis of variance, Pearson's Chi-square test, Pillai's trace test.

RESULTS

The present study revealed that the pain perception level was lower in the birth ball and squatting position groups compared to the control group, and there was a statistically significant difference between them (p < .05). The duration of the first and second stages of labor and the total duration of labor decreased in the birth ball and squatting position groups (p < .05). The difference was statistically significant in comparing the level of satisfaction (p < .05). It was found that the highest satisfaction was in the birth ball group.

CONCLUSION

Using a birth ball and squatting position during labor are effective methods of reducing labor pain, shortening the duration of labor, and increasing the level of satisfaction. There is a need for more studies on the effects of the birth ball and squatting position.

CLINICALTRIALS

gov Identifier: NCT05360823.

Using a birth ball to reduce pain perception in the latent phase of labour: a randomised controlled trial

BACKGROUND

Admission in the latent phase of labour is associated with higher rates of obstetric intervention. Women are frequently admitted due to pain. This study aimed to determine whether using a birth ball at home in the latent phase of labour reduces pain perception on admission.

METHOD

A prospective, pragmatic randomised controlled trial of 294 low risk pregnant women aged 18 and over planning a hospital birth. An animated educational video was offered at 36 weeks' gestation along with a birth ball. The primary outcome was pain on a Visual Analogue Scale on admission in labour. Participants who experienced a spontaneous labour were invited to respond to an online questionnaire 6 weeks' postpartum.

RESULTS

There were no differences in the mean pain scores; (6.3 versus 6.5; 90%CI -0.72 to 0.37 p = 0.6) or mean cervical dilatation on admission (4.7 cm versus 5.0 cm; 95% CI -1.1 to 0.5 p = 0.58). More Intervention participants were admitted in active labour (63.6% versus 55.7%; p = 0.28) and experienced an unassisted vaginal birth (70.3% v. 65.8%; p = 0.07) with fewer intrapartum caesarean sections (7.5% v. 17.9%; p = 0.07) although the trial was not powered to detect these differences in secondary outcomes. Most participants found the birth ball helpful (89.2%) and would use it in a future labour (92.5%).

CONCLUSION

Using the birth ball at home in the latent phase is a safe and acceptable strategy for labouring women to manage their labour, potentially postpone admission and reduce caesarean section. Further research is warranted.

Active pelvic movements on a Swiss ball reduced labour duration, pain, fatigue and anxiety in parturient women: a randomised trial

QUESTION

How much do active pelvic movements on a Swiss ball during labour affect maternal and neonatal outcomes?

METHOD

A randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis.

PARTICIPANTS

Two-hundred parturient women.

INTERVENTION

The experimental group performed pelvic anteversion and retroversion, lateral pelvic tilts and circular hip movements according to individual obstetric evaluation (foetal station and position, cervical dilatation and the presence of early pushing urge) on a Swiss ball. The control group received usual care. Both groups were permitted to walk and shower.

OUTCOME MEASURES

The primary outcome was the duration of the first stage of labour. The secondary outcomes were the duration of the second stage of labour, pain intensity, delivery mode, medication use, local swelling, fatigue, anxiety, satisfaction and neonatal outcomes.

RESULTS

The experimental intervention reduced the duration of labour by 179 minutes (95% CI 146 to 213) in stage one and 19 minutes (95% CI 13 to 25) in stage two. It decreased pain by approximately 2 points (95% CI 2 to 2) on a 0-to-10 scale at 30, 60 and 90 minutes. It reduced the risk of a caesarean section (ARR 0.14, 95% CI 0.03 to 0.25; NNT 7, 95% CI 4 to 32) and vulvar swelling (ARR 0.11, 95% CI 0.03 to 0.19; NNT 9, 95% CI 5 to 31). It reduced fatigue by 18 points (95% CI 16 to 21) on a 15-to-75-point scale and anxiety by 9 points (95% CI 8 to 11) on an 18-to-72-point scale. Other effects were negligible or unclear.

CONCLUSION

Active pelvic movements on a Swiss ball during labour reduced the duration of labour, pain intensity, and maternal fatigue and anxiety; they also lowered the risk of caesarean section and vulvar swelling. Several effects exceeded the smallest worthwhile effect.

REGISTRATION

NCT04124835.

Birthing balls to decrease labor pain and peanut balls to decrease length of labor: what is the evidence?

Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural. A recent meta-analysis showed that the use of the birthing ball in labor significantly reduces maternal pain in labor by 1.7 points on a standard visual analog scale of 1 to 10 (mean difference, -1.70 points; 95% confidence interval, -2.20 to -1.20). The use of the birthing ball does not significantly affect the mode of delivery or the rate of other obstetrical complications. This suggests that its use is safe and can offer subjective improvement in maternal pain experienced during labor. The peanut ball is a peanut-shaped plastic ball placed between the knees of a person laboring in the lateral recumbent position, a position common in those laboring with an epidural. Traditionally, its use has been thought to allow for bent-knee positioning that can mimic a squatting position and facilitate frequent and optimal position changes during labor. Data regarding the effects of the peanut ball are mixed. A recent systematic review and meta-analysis found that the use of the peanut ball compared with no peanut ball is associated with a significantly decreased first stage of labor (mean difference, -87.42 minutes; 95% confidence interval, -94.49 to -80.34) and an 11% higher relative risk of vaginal delivery (relative risk, 1.11; 95% confidence interval, 1.02-1.22; n=669). The use of the peanut ball is not associated with increased incidences of obstetrical complications. As such, it is reasonable to offer to individuals in labor. There has been no reported risk of the use of either the birthing ball or the peanut ball. As such, both interventions can be offered to individuals in labor as an adjunct to labor management techniques based on moderate quality evidence.

Nonpharmacological Methods to Reduce Pain During Active Labor in A Real-life Setting

OBJECTIVE

 To evaluate the association between pain intensity in the active phase of the first stage of labor with the use or not of nonpharmacological methods for pain relief in a real-life scenario.

METHODS

 This was an observational cross-sectional study. The variables analyzed were obtained by a questionnaire with the mothers (up to 48 hours postpartum) to investigate the intensity of pain during labor using the visual analog scale (VAS). The nonpharmacological pain relief methods routinely used in obstetric practice were evaluated by consulting medical records. The patients were separated into two groups: Group I - patients who did not use nonpharmacological methods for pain relief and Group II -patients who used these methods.

RESULTS

 A total of 439 women who underwent vaginal delivery were included; 386 (87.9%) used at least 1 nonpharmacological method and 53 (12.1%) did not. The women who did not use nonpharmacological methods had significantly lower gestational age (37.2 versus 39.6 weeks, p < 0.001) and shorter duration of labor (24 versus 114 min, p < 0.001) than those who used the methods. There was no statistically significant difference in the pain scale score using the VAS between the group that used nonpharmacological methods and the group that did not (median 10 [minimum 2-maximum 10] versus 10 [minimum 6-maximum 10] p = 0.334).

CONCLUSION

 In a real-life setting, there was no difference in labor pain intensity between the patients who used nonpharmacological methods and those who did not use them during the active phase of labor.

Women’s knowledge about the physical therapist’s performance in women’s health

ABSTRACT This study aimed to evaluate the profile of knowledge of Brazilian women about the physical therapist’s role in women’s health. The women answered an online questionnaire containing: socioeconomic, demographic data, knowledge about the role of physical therapy in women’s health, and current health conditions. Descriptive analyses were carried out to characterize the sample, levels of knowledge and self-report of pelvic floor dysfunctions, and the association between general knowledge, self-report of dysfunctions, and knowledge of the sub-areas of physical therapy in women’s health. In total, 446 women from all regions of Brazil participated: 86.3% from the Southeast, 9.4% from the South, 1.6% from the Northeast, 1.3% from the Midwest, and 1.3% from the North. The mean age was 30.1±10.5 years; the self-report of pelvic floor dysfunctions was 20.4% urinary incontinence, 27.6% sexual dysfunctions, 25.8% intestinal symptoms, and 6.7% chronic pelvic pain. Of the participants, 61% had some knowledge about the role of physical therapy in women’s health and 96.9% would like to know more about this specialty. Although many women are aware of this area, a minority has been referred to or has undergone specialized physical therapy treatment for women’s health. There was a statistically significant association between the level of knowledge of women about the physical therapist’s role in women’s health with the self-report of pelvic floor dysfunctions and the level of knowledge of the sub-areas of performance.

Nonpharmacological labor pain management methods and risk of cesarean birth: A retrospective cohort study

BACKGROUND

Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth.

METHODS

We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor.

RESULTS

Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR = 0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR = 2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR = 2.46; 95% CI 2.22-2.72), and primiparity (RR = 2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort.

DISCUSSION

The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor.

Perfil do conhecimento de mulheres sobre a atuação do fisioterapeuta na saúde da mulher

RESUMO Objetivou-se avaliar o perfil do conhecimento de mulheres brasileiras sobre a atuação do fisioterapeuta na saúde da mulher. As participantes preencheram um questionário online contendo: dados socioeconômicos e demográficos, questões acerca do conhecimento sobre a atuação da Fisioterapia na Saúde da Mulher e das atuais condições de saúde. Foram realizadas análises descritivas para a caracterização da amostra, os níveis de conhecimento e o autorrelato de disfunções do assoalho pélvico e para a associação entre o conhecimento geral, o autorrelato de disfunções e o conhecimento das subáreas da Fisioterapia na Saúde da Mulher. Participaram 446 mulheres de todas as regiões do Brasil, sendo 86,3% do Sudeste, 9,4% do Sul, 1,6% do Nordeste, 1,3% do Centro-Oeste e 1,3% do Norte. A média de idade foi de 30,1±10,5 anos. O autorrelato de disfunções do assoalho pélvico foi de 20,4% de incontinência urinária, 27,6% de disfunções sexuais, 25,8% sintomas intestinais e 6,7% de dor pélvica crônica. Das participantes, 61% apresentavam algum conhecimento sobre a área da Fisioterapia na Saúde da Mulher e 96,9% gostariam de conhecer mais sobre essa especialidade. Apesar de muitas mulheres terem conhecimento sobre essa área, uma minoria já foi encaminhada ou realizou tratamento especializado de Fisioterapia na Saúde da Mulher. Houve associação estatisticamente significativa entre o nível de conhecimento das mulheres sobre a atuação do fisioterapeuta na saúde da mulher com o autorrelato de disfunções do assoalho pélvico e o nível de conhecimento das subáreas de atuação.

Knowledge and Practice of and Attitude Toward Epidural Analgesia Among Pregnant Women in Jazan Region of Saudi Arabia

The aim of this study was to assess the knowledge, sources of knowledge, attitudes (fears and misconceptions) toward epidural analgesia (EA), and practices of parturient delivery in the Jazan region of Saudi Arabia. A cross-sectional study was conducted using a self-administered survey questionnaire distributed in the antenatal care clinics of the obstetric departments of major hospitals. A total of 454 women participated in this study. Of the participants, 219 (48%) belonged to the 31 to 40-year age group and 134 (30%) to the 21 to 30-year age group. Most participants (344, 76%) had a bachelor's degree. The prevalence of epidural catheter use was 23.6% among pregnant women. Statistically significant differences in educational level and residence were found between the women (p < 0.001). The two most common sources of information cited by the pregnant women were healthcare staff and family and friends. The most common motive reported by women was to relieve labor pain effectively, and the most frequently cited barriers preventing women from receiving EA were the possibility of injury to important organs and the inability to walk after EA. The present study demonstrates a low level of knowledge about EA among pregnant women in the region. More awareness and guidance about EA are warranted.

Birthing ball on promoting cervical ripening and its influence on the labor process and the neonatal blood gas index

BACKGROUND

Term pregnancy-induced labor refers to the use of artificial methods to induce uterine contractions and terminate pregnancy after 37 wk. It is a common method to prevent overdue pregnancy and to deal with high-risk pregnancies. In addition, it can alleviate maternal complications and cause the fetus to leave the adverse intrauterine environment early, which is beneficial to the outcome of pregnancy.

AIM

To explore the effect of a birthing ball on labor by inducing cervical ripening and its influence on labor and the neonatal blood gas index.

METHODS

Twenty-two women who were scheduled to undergo labor induction and delivery in the obstetrics department of our hospital were randomly divided into two groups: the delivery ball group (childbirth ball combined with COOK balloon induction) and the conventional group (COOK balloon induction alone). The cervical Bishop score before and after intervention, duration of labor at each stage, mode of delivery, neonatal umbilical venous blood pH, oxygen partial pressure (PO₂), carbon dioxide partial pressure (PCO₂), and the 1-min Apgar score were recorded.

RESULTS

After the intervention, the cervical Bishop score of the delivery ball group (7.84 ± 1.52) was significantly higher than that of the conventional group (7.32 ± 1.29) (P < 0.05), and the cervical Bishop scores of the two groups after intervention were significantly higher than those before intervention (P < 0.05). After the intervention, the first stage of labor (510.9 ± 98.7 min), the second stage of labor (43.0 ± 8.5 min), and the total duration of labor (560.0 ± 120.9 min) in the delivery ball group were lower than those in the routine group, with a first stage of labor of 602.1 ± 133.2 min, a second stage of labor of 48.4 ± 9.1 min, and a total duration of labor of 656.8 ± 148.5 min (P < 0.05). There was no significant difference in the time of the third stage of labor between the two groups (P > 0.05). There was no significant difference in the pH, PO₂, and PCO₂ values of newborns between the delivery ball group and the conventional group (P > 0.05). The 1-min Apgar score of the delivery ball group was higher than that of the conventional group (9.10 ± 0.38 points vs 8.94 ± 0.31 points, P < 0.05). The natural delivery rate of the delivery ball group was higher than that of the conventional group (91.00% vs 78.00%, P < 0.05).

CONCLUSION

The use of a birthing ball combined with a COOK balloon for inducing labor has a better effect on promoting cervical ripening, shortening the time of labor, and improving the Apgar score of newborns.

Birthing ball for reducing labor pain: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Multiple factors are thought to affect a woman's sensation of pain during the process of labor. Birthing balls are round exercise balls upon which a woman sits during labor and performs different movements such as rocking back and forth and pelvic rotation. Midwives and nurses have been using birthing balls (also known as Swiss balls) to increase maternal comfort, widen the pelvic outlet, and facilitate progression of labor for women laboring without an epidural. Therefore, the aim of this systematic review and meta-analysis of randomized controlled trials is to assess whether the use of the birthing ball in labor decreases maternal pain during labor.

DATA SOURCES

Research was conducted using PubMed, Scopus, ClinicalTrial.gov, OVID and Cochrane Library as electronic databases. Randomized controlled trials were identified using the following search strategy: "birthing ball" OR "birth ball" OR "swiss ball" OR "exercise ball" AND labor from the inception of each database to June 2019. No restrictions for language or geographic location were applied.

STUDY ELIGIBILITY CRITERIA

Selection criteria included randomized trials of pregnant women with a singleton, cephalic fetus who were randomized to either birthing ball or control group (i.e. no birthing ball) for use in labor.

STUDY APPRAISAL AND SYNTHESIS METHODS

Seven trials with 533 pregnant women were included. 287 (53.8%) were randomized to the intervention group (birthing ball) and 246 (46.2%) were randomized to the control group (no birthing ball). All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. The primary outcome was labor pain in the first stage of labor. The summary measures were reported as summary relative risk (RR) or as summary mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird.

RESULTS

Labor pain significantly decreased by 1.70 points in the birthing ball group compared to the control group (MD -1.70 points; 95% CI -2.20 to -1.20). Use of the birthing ball versus no birthing ball did not result in a significant difference in incidence of spontaneous vaginal delivery, operative vaginal delivery, cesarean delivery, or perineal lacerations.

CONCLUSION

The birthing ball is an effective method of pain reduction during labor for women laboring without an epidural.

Pilates for low risk pregnant women: Study protocol for a randomized controlled trial

BACKGROUND

Pilates has growing appeal to pregnant women, as a form of exercise and relaxation. It is purported to benefit lumbo-pelvic stability, as well as motor control, strength and endurance. Some suggest that modified Pilates exercises may assist low risk pregnant women to enjoy a healthier pregnancy and prepare for the physical demands of labour and birth. The feasibility and safety of Pilates during pregnancy is poorly understood. We describe the protocol for a feasibility study designed to compare a midwife-led 6-week community-based Pilates intervention with standard antenatal care.

METHODS

A convenience sample of 30 low-risk pregnant women will be recruited from private obstetric clinics in Melbourne, Australia. Participants shall be randomly allocated to a six-week, 1-h weekly Pilates exercises group session or to usual care. The Pilates exercise class will have a warm-up phase, Pilates exercises, breathing exercises, and a cool down phase. Exercises have been designed to prepare for active birth. The primary outcome will be feasibility of implementation, determined by recruitment, retention, adherence and safety. Secondary outcomes include women's health (quality of life, pain, mobility for daily activities, lower extremity performance, abdominal separation, continence) and labour and birth outcomes (duration of first stage and second stage labour, analgesia used, mode of birth). Validated questionnaires will include the Quality of life 12-item short form survey; Pregnancy Mobility Index, and International Consultation on Incontinence Questionnaire. Lower extremity performance and abdominal separation will also be measured.

DISCUSSION

This trial will provide preliminary data regarding the feasibility and safety of Pilates exercise in healthy pregnant women. It will also provide preliminary outcome data used to inform the design of a future large scale, multi-centre RCT.

TRIAL REGISTRATION

This clinical trial has been registered with the Australian and New Zealand Clinical Trials Registry 2016 (ACTRN12616000809437).

A Systematic Review and Meta-Analysis of the Effect of Acupressure on Relieving the Labor Pain

BACKGROUND

Numerous studies have been conducted on the effect of acupressure on labor pain, some of which have reported conflicting results. Thus, the present study was performed to critically review the previous studies related to the effect of acupressure administered during labor for relieving labor pain.

MATERIALS AND METHODS

In this study, databases of the Cochrane Central Register of the Controlled Trials, PubMed/MEDLINE, Scopus, and Web of Science were searched from their establishment until November 5, 2019. All the Randomized Controlled Trials (RCTs) that had compared the use of acupressure with either placebo or nonintervention for relieving the labor pain were included in the study. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software Version 2. The random-effects model was used for pooling the effect sizes across the included studies. The p value <0.05 was considered as statistically significant.

RESULTS

Totally, 5853 primary papers were identified in the search, which were narrowed down to 22 studies. The results of meta-analysis showed that the acupressure decreased the labor pain in the intervention group vs. control (-1.67 [-2.29 to -1.05], z = -5.25, p < 0. 001) (Q-value = 788.98, p < 0.001, I-squared = 96.83). No publication bias was found in the included studies (Egger's regression intercept = -1.02, p = 0.76).

CONCLUSIONS

Although the findings of this meta-analysis showed that the acupressure significantly reduced the labor pain during the active phase of labor compared to the nonintervention or placebo; considering that the quality of the included studies was generally moderate, rigorous RCTs with better design and higher quality are needed to obtain definitive conclusions.

Ropivacaine vs. levobupivacaine: Analgesic effect of combined spinal-epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs

The present study aimed to investigate and compare the analgesic effect and safety of ropivacaine or levobupivacaine in combined spinal-epidural anesthesia during childbirth and their effects on neonatal Apgar scores, as well as maternal and neonatal vital signs. A total of 615 maternal patients undergoing labor between April 2016 and March 2017 were divided into two groups according to the analgesic used for combined spinal-epidural anesthesia during childbirth: The ropivacaine group (n=318) and the levobupivacaine group (n=297). The onset time of analgesia in the two groups was determined and the pain score on the visual analog scale was assessed at the time of delivery (T3). At pre-analgesia, 30 min after analgesia (T2), at T3 and during maternal wound suturing (T4), the systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were assessed. The cesarean section rate, neonatal 1- and 5-min Apgar scores and neonatal asphyxia at T4 were also determined. The onset time of analgesia in the ropivacaine group was significantly reduced compared with that in the levobupivacaine group (P<0.05). At T2 and T4, the SBP was significantly higher in the levobupivacaine group than that in the ropivacaine group (P<0.05). At T2, T3 and T4, the DBP was significantly lower in the levobupivacaine group compared with those in the ropivacaine group (P<0.05). At T2, the HR was significantly lower in the levobupivacaine group than that in the ropivacaine group (P<0.05). The cesarean section rate was significantly lower in the ropivacaine group compared with that in the levobupivacaine group [4.09% (n=13) vs. 22.89% (n=68); P<0.01]. In conclusion, the use of combined spinal-epidural anesthesia with ropivacaine or levobupivacaine has an excellent analgesic effect during childbirth. However, compared with levobupivacaine, ropivacaine for labor analgesia had a faster onset and a lesser impact on maternal vital signs, and was associated with a reduced maternal cesarean section rate among patients who did not opt for cesarean section in the beginning; therefore, it is useful in clinical practice.

Birth ball for pregnant women in labour research protocol: a multi-centre randomised controlled trial

Background

Birth ball is one of the non-pharmacologic pain relief methods to help mothers cope with the labouring process. A randomised controlled trial (RCT) is conducted to evaluate the effectiveness, safety and harm of birth ball use by pregnant women in labour compared to treatment as usual group.

Methods

A prospective multi-centre randomised controlled trial (RCT) will be conducted in Obstetrics and Gynaecological units of five public hospitals in Hong Kong, China. Data will be collected from March 2016 onward for 2 years. The target population is Chinese women with an uncomplicated singleton pregnancy at gestational age of 37 to 42 weeks. Participants are randomised based on parity (nulliparous and multiparous) and type of labour onset (spontaneous and induced). Women in the intervention group are actively offered and taught how to use a birth ball; those in the control group receive the usual midwifery care. The target sample size is 512. The primary outcome measures are maternal pain intensity, satisfaction with pain relief, sense of control in labour, assisted delivery and satisfaction with childbirth experience. Labour pain relief is measured by visual analogue scale (VAS). Other outcomes will be measured through four different validated questionnaires. To control for potential cluster effects, a linear mixed model will be used. An intention-to-treat analysis is adopted and performed by researchers unknown to subjects’ group allocation.

Discussion

Results will provide rigorous scientific evidence for policy development and practice. We are using stratified randomisation according to potential confounders of parity and type of labour onset to give four possible combinations. If the results are favourable, it will facilitate systematic implementation to promote birth ball use for women in labour.

Trial registration

Chinese Clinical Trial Register (ChiCTR), Registration number: ChiCTR-IIC-16008275, Date of registration 12 April 2016 (retrospectively registered), Date of enrolment of the first participant to the trial 1 March 2016.

Birthing ball versus pethidine and haloperidol in satisfaction with childbirth

OBJECTIVE

To determine the effects on maternal satisfaction of the use of the birthing ball as a method of pain relief compared to the subcutaneous administration of pethidine (50mg) and haloperidol (2.5mg), during the latent phase of labour.

METHOD

Randomised, unicentric, parallel and controlled clinical trial.

PARTICIPANTS

Low-risk pregnant women hospitalised in a pathological pregnancy ward at the Gregorio Marañón University General Hospital (Madrid) due to prolonged pregnancy, premature rupture of membranes, or labour prodromes.

INTERVENTION

once the patient's labour had become painful, a series of pre-established movements were implemented with a birthing ball in the intervention group, or pethidine and haloperidol were administered at the same dose subcutaneously. After the intervention and on the post-natal ward, satisfaction was measured with the Mackey Satisfaction Childbirth scale, validated in Spanish in 2016, in the first 48-72hours after delivery.

ANALYSIS

group comparisons: Student's t for continuous variables and Chi-squared for categorical variables. Significance at p<0.05.

RESULTS

The maternal satisfaction was significantly higher in the experimental group than in the comparison group, in all the domains of the scale: obstetrician (4.24/3.87), dilatation (4.02/3.35), second stage (4.27/3.67), newborn (4.72/4.43), accompaniment and comfort (4.78/4.44). There were, however, no statistically significant differences in the midwife subscale, although the scores were equally high (4.65/4.45).

CONCLUSION

Using birthing balls during the latent phase of labour increases women's satisfaction with their labour process more than administering pethidine and haloperidol during this period.

Birth ball use for women in labor: A systematic review and meta-analysis

OBJECTIVE

To evaluate, with the best level of evidence, the possible benefits of using birth balls during labor in maternal and neonatal outcomes.

METHODS

This research was made using MEDLINE/PubMed, LILCAS, CINAHL, CENTRAL, and SCOPUS databases, with no period or language restrictions. The terms "labor" and "birth ball" were used. Clinical trials (randomized and non-randomized) were included when compared a group with parturients using birth ball with control group under usual care. The following primary outcomes were: maternal outcomes: pain intensity; length of first and second stage; perineal trauma and episiotomy. Neonatal outcomes: APGAR score, admission to neonatal intensive care unit and delivery room resuscitation. The quality of evidence was evaluated by the GRADE system. Quantitative analysis through meta-analysis was also applies whenever possible.

RESULTS

Seven studies were included. The pain outcome showed differences in the subgroups of 20/30 min on the birth ball (mean difference) -1,46; 95% Confidence Interval: 2,15 to -0,76, p < 0.0001), 60 min (mean difference -1,95; 95% Confidence Interval: 2,68 to -1,22; p < 0.00001) and 90 min (mean difference -1,72; 95% Confidence Interval: 2,44 to -1,00; p < 0.0001), based in a moderated quality of evidence. Other outcomes did not showed differences between groups after the interventions, with a low and very low level of evidence.

CONCLUSIONS

Use the birth ball reduced pain after 20-90 min of use and there was no difference in the other outcomes. The low quality of the studies included in this meta-analysis suggests that new trials with better methodology quality are necessary.

A prática de métodos não farmacológicos para o alívio da dor de parto em um hospital universitário no Brasil

Objetivo: identificar a prática de métodos não farmacológicos implementadas para o alívio da dor de parto em um hospital de ensino, os motivos que levaram a utilizá-los e o grau de satisfação.Materiais e métodos: estudo transversal, desenvolvido com 586 puérperas em um hospital de ensino do Brasil. A coleta de dados ocorreu entre fevereiro e setembro de 2016, tendo como fonte os registros dos prontuários, a carteira de pré-natal e um questionário estruturado aplicado 12 horas após o parto. Procedeu-se a uma análise descritiva por meio do SPSS, versão 18.Resultados: os métodos não farmacológicos mais conhecidos pelas mulheres foram banho (83,1 %) e deambulação (81,4 %). No hospital universitário, 55,5 % receberam orientação/informação sobre os métodos e o mais aceito foi o banho (66,6 %). O motivo mais relatado foi diminuição da intensidade/alívio da dor (71,8 %); 89,4 % consideram que a prática deste método lhes trouxe benefícios; para 79,9 %, o grau de satisfação foi maior ou igual a sete.Conclusão: o uso de métodos não farmacológicos é uma prática eficiente para o alívio da dor de parto. É importante empoderar e informar as parturientes quanto às estratégias disponíveis para o alívio da dor durante o trabalho de parto para que possam, nesse momento e em conjunto com os profissionais de saúde, escolher o melhor método.

Facility Design: Reimagining Approaches to Childbirth in Hospital and Birth Center Settings

Few maternity care clinicians are aware of the current regulations that guide design standards for childbirth facilities in the United States or the regulatory history. There is considerable variance among state regulations as well as oversight of facility standards for healthcare settings. Understanding evidence-based recommendations on how facility design affects health outcomes is critical to reversing the rise in maternal mortality and morbidity. A variety of measures can be implemented that promise to improve user satisfaction, quality of care, and efficiency for all who engage in the childbirth environment. Recommendations for change include broader assessment to better understand how clinicians and consumers simultaneously maneuver within a complex system. Key metrics include evaluation of workflow within available space, patient acuity and census patterns, integration of evidence-based recommendations, and options that promote physiologic birth. For the changes to succeed, human centered design must be implemented and diverse clinicians and consumers engaged in all phases of planning and implementation. Exploring characteristics and outcomes of low-risk women who receive care in a freestanding birth center or the European alongside maternity unit provides opportunity to reimagine and address improvements for inpatient, hospital birth.

Randomized Controlled Trial of Use of the Peanut Ball During Labor

PURPOSE

The purpose of this study was to evaluate the efficacy of peanut ball use on duration of first stage labor and pushing time in women who were scheduled for elective induction of labor at ≥39 weeks gestation and planning an epidural.

STUDY DESIGN AND METHODS

In this randomized controlled trial, women having labor induction and planning a labor epidural were assigned (1:1) to one of two groups: one group used a peanut ball and one group did not. Outcome variables were time spent in first stage labor and time spent pushing. Factors included group assignment (peanut ball, no peanut ball), parity (primiparous, multiparous), and race. Age and maximum oxytocin dose served as covariates.

RESULTS

Among women having elective induction with epidural analgesia, use of a peanut ball reduced first stage labor duration for primiparous patients significantly more than multiparous patients, p = 0.018. There was no significant difference in the reduction of length of first stage labor for multiparous women, p = 0.057 with use of the peanut ball. Peanut ball use did not alter length of pushing time for either group, p > 0.05.

CLINICAL IMPLICATIONS

Use of peanut balls may reduce total labor time to a greater degree in primiparous patients than multiparous patients having elective induction at ≥39 weeks with epidural analgesia.

A systematic review and meta-analysis on the treatment of liver hydatid cyst: Comparing laparoscopic and open surgeries

BACKGROUND AND STUDY AIMS

There is an academic debate regarding surgical interventions for liver hydatid cyst disease. The purpose of the current systematic review and meta-analysis study was to analyse the pros and cons of open surgery and laparoscopic techniques, considering the outcomes of liver hydatid cysts.

METHODS

Descriptive Boolean queries were used to search PubMed and Scopus for articles published between January 2000 and December 2016 to evaluate the outcomes of liver hydatid cyst in terms of mortality, post-operative complications, cure rate and recurrences. The data related to the four outcomes of liver hydatid cyst were extracted, assessed and then used as their corresponding effect sizes in the meta-analysis process.

RESULTS

Six studies totally consisting of 1028 patients [open surgery group=816 (+7 converted to lap) and laparoscopic group=212] were analysed. In this meta-analysis study, random effects models of outcomes (i.e. post-operative complications, mortalities, recurrences and cure rate) of the two procedures were OR=0.852, LL=0.469, UL=1.546, Z=-0.526, p=0.599 (for post-operative complications); OR=0.849, LL=0.141, UL=5.105, Z=-0.179, p=0.858 (for mortality); OR=0.903, LL=0.166, UL=4.906, Z=-0.119, p=0.906 (for recurrence); and OR=0.459, LL=0.129, UL=1.637, Z=-1.201, p=0.230 (for cure rate). Meta-analysis and illustrated forest plots showed that there are no superiorities between the two approaches. The results of heterogeneity tests of the above mentioned outcomes were Q=8.083, df=5, p=0.152, I²=38.142% for post-operative complications; Q=0.127, df=2, p=0.938, I²=0% for mortality; Q=4.984, df=2, p=0.083, I²=59.874% for recurrence; and Q=10.639, df=5, p=0.059, I²=53.001% for cure rate. The results of regression tests based on Egger's, smoothed variance based on Egger (SVE) and smoothed variance based on Thomson (SVT) showed that the p values are not significant, and there are neither significant statistical differences nor publication bias between the outcomes of the two treatment procedures.

CONCLUSION

The results show no promising trends towards advantages of open versus laparoscopic surgeries in the treatment of liver hydatid cyst. However, informative measurement values for comparing these surgeries could be derived for complications, recurrence, mortality and cure rates. Furthermore, all three tests, namely Egger's, SVE and SVT regression models, were used to assess publication bias and showed no evidence for the existence of publication bias.

Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management

OBJECTIVE

Labor pain and its management is a major concern for childbearing women, their families and health care providers. This study aimed to investigate the effects of two non-pharmacological methods such as birth ball and heat therapy on labor pain relief.

MATERIAL & METHODS

This randomized control trial was undertaken on 90 primiparous women aged 18-35 years old who were randomly assigned to two intervention (birth ball and heat) and control groups. The pain score was recorded by using Visual Analogue Scale (VAS) before the intervention and every 30 min in three groups until cervical dilatation reached 8 cm.

RESULTS

The mean pain severity score in the heat therapy group was less than that of in control group at 60 and 90 min after intervention (p < 0.05). In addition there were significantly differences between the pain scores in the birth ball group after all three investigated times in comparison to control group.

CONCLUSION

Both heat therapy and birth ball can use as inexpensive complementary and low risk treatment for labor pain.