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.