title: Effect of birth ball on labor pain relief: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To critically evaluate the available evidence related to the impact of using a birth ball on labor pain relief.
  
  
  METHODS
  The Cochrane library, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed and Scopus were searched from their inception to January 2015 using keywords: (Birth* OR Swiss OR Swedish OR balance OR fitness OR gym* OR Pezzi OR sport* OR stability) AND (ball*) AND (labor OR labour OR Obstetric). All available randomized controlled trials involving women using a birth ball for pain relief during labor were considered. The search resulted in 341 titles and abstracts, which were narrowed down to eight potentially relevant articles. Of these, four studies met the inclusion criteria. Pain intensity on a 10 cm visual analogue scale was used as the main outcome measure. Risk of bias was assessed using the Cochrane Risk of Bias tool. Comprehensive Meta-Analysis Version 2 was used for statistical analysis.
  
  
  RESULTS
  Four RCTs involving 220 women were included in the systematic review. One study was excluded from the meta-analysis because of heterogeneous interventions and a lack of mean and standard deviation results of labor pain score. The meta-analysis showed that birth ball exercises provided statistically significant improvements to labor pain (pooled mean difference -0.921; 95% confidence interval -1.28, -0.56; P = 0.0000005; I(2)  = 33.7%).
  
  
  CONCLUSIONS
  The clinical implementation of a birth ball exercise could be an effective tool for parturient women to reduce labor pain. However, rigorous RCTs are needed to evaluate the effect of the birth ball on labor pain relief.
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Makvandi
authors.affiliation: Evidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Robab
authors.initials: R
authors.lastname: Latifnejad Roudsari
authors.affiliation: Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Sadeghi
authors.affiliation: Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Karimi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000628:therapy*; D007743:Labor, Obstetric; D059408:Pain Management; D010147:Pain Measurement; D036801:Parturition; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011247:Pregnancy; D016896:Treatment Outcome
keywords: birth ball; childbirth; pain management