Ask an answerable question (PICO)：
Pain is the most common care issue during childbirth. There are various ways to reduce pain, among which a birthing ball is a non-invasive and safe tool. Using a birthing ball not only helps relax the expectant mother’s pelvic area but also helps the baby’s head descend through the birth canal. However, whether using a birthing ball can ease pain during labor remains underexplored. This study used an empirical approach to determine whether providing a birthing ball can ease labor pain in primiparas and to apply it to clinical practice. The study population was primiparas, and the intervention involved using a birthing ball. We compared the usual care to measure the outcome of pain levels during labor.
The Method and Analysis of Literature Review：
(1) Literature search databases included PubMed, Embase, Cochrane Library, and CEPS (Chinese Electronic Periodical Services).
(2) Keywords included: population (primiparity, primigravida, primipara, pregnancy, labor*, delivery, obstetrics, primipara, pregnant women), intervention (birthing ball, peanut ball, a birthing ball), outcome (labor pain, delivery pain, pain). This study used Boolean logic “AND” for the intersection of P and I to search for keywords, MeSH terms, and text words. We used truncation* to restrict the languages to Chinese and English.
Critical Appraisal：
The initial search elicited 150 articles. After removing 26 duplicate articles, there were 95 articles whose titles and abstracts did not match the topic and 20 articles without full texts for browsing. As such, this study conducted two systematic reviews (SR) for evaluation. We used the CASP Systematic Review Checklist (2018) as an evaluation tool. Based on the Oxford Centre for Evidence-Based Medicine (OCEBM), the evidence level of both SRs was determined to be Level I.
The results showed that lying down/sitting and holding a birthing ball in a comfortable lying position during the first active stage of labor can reduce the average pain score during labor by 1.46 points (95% confidence interval -2.15, -0.76; p < 0.00001) and 1.70 points (95% CI -2.20, -1.20; p = 0.003), respectively.
Clinical Application of Evidence：
This study used the seven steps of empirical knowledge translation. We recruited primiparas from the delivery room at a regional teaching hospital in northern Taiwan from February 1, 2021 to March 31, 2021 as the subjects. This study used purposive sampling and excluded pregnant women who underwent cesarean section, used pain medication, or had no companion in the delivery room. When participants in the experimental group had their cervix dilated between 4 and 8 cm, in addition to usual care, including massage, warm compress, or analgesics, participants were placed in a comfortable lying position to hold a birthing ball in a lying down or sitting position. The control group only received usual care, including massage, warm compress, or analgesics. The outcome measure (pain level) was scored using a numerical rating scale (NRS; 0 to 10 points), with higher scores indicating more severe pain. The experimental group received the birthing ball intervention, while the control group received usual care. Post-intervention, pain scores were measured at 30, 60, and 90 minutes in both groups to compare the pain relief effects between the two groups.
Evaluation of Effectiveness：
This study enrolled 19 primiparas, 11 in the experimental group and eight in the control group. There were no statistically significant differences between the two groups regarding basic data such as mean age and gestational weeks. The experimental group began using birthing balls when they felt pain. After 30 minutes of using a birthing ball, the pain score of the experimental group was 0.58 points higher than that of the control group, but there was no statistically significant difference (t = 1.394; 95% CI: - 0.3 ~ 1.46; p = 0.181). However, after 60 and 90 minutes of using a birthing ball, the pain scores of the experimental group were significantly reduced, which were 1.51 points (t = -4.923; 95% CI: -2.16 ~ -0.86; p = 0.001) and 2.05 points lower than those of the control group, respectively (t = -3.355; 95% CI: -3.18 ~ -0.73; p = 0.004). This finding suggests that using a birthing ball significantly relieved labor pain after 60 and 90 minutes.
Conclusions and Recommendations：
The birthing ball is a non-invasive measure, and the participants did not need to pay any extra fee for using it. Under the nurse's guidance during delivery, the operation skill of a birthing ball is safe and straightforward, which is widely praised by primiparas and their families. To further promote the use of a birthing ball, this research has led to the production of a health education video on using a birthing ball. The aim is for expectant mothers and their families to watch the video repeatedly to learn the operation skills and to improve the promotion efficiency of using a birthing ball. We suggest that using a birthing ball can benefit pregnant women by giving them a more comfortable and effective labor pain relief experience during the delivery period.
張綺紋
