Labor Analgesia: A systematic review and meta-analysis of non-pharmacological complementary and alternative approaches to pain during first stage of labor

Objective: the aim of the study was to conduct a meta-analysis to evaluate the efficacy of non-invasive and non-pharmacological techniques on labor first-stage pain intensity. Methods: Literature databases were searched from inception to May 2021, and research was expanded through the screening of previous systematic reviews. Inclusion criteria were: 1) Population: Women in first stage of labor; 2) Intervention: non-pharmacological, non-invasive or minimally-invasive intrapartum analgesic techniques, alternative and/or complementary to pharmacological analgesia; 3) Comparison: routine intrapartum care or placebos; 4) Outcomes: subjective pain intensity; 5) Study design: Randomized Controlled Trial. Risk of bias of included studies was investigated, data analysis was performed using R, version 3.5.1, Effect size was calculated as difference between the control and experimental groups at posttreatment in terms of mean pain score. Results A total of 63 studies were included, for a total of 6146 patients (3468 in the experimental groups and 2678 in the control groups). Techniques included were: massage (n=11), birth balls (n=5) mind-body interventions (n=8), heat application (n=12), music therapy (n=9), dance therapy (n=2), acupressure (n=16), TENS (n=8). Discussion. The present review found significant evidence in support of the use of Complementary and Alternative Medicine for labor analgesia, and different methods showed different impact. More high-quality trials are however needed.