The effects of dance on maternal childbirth: a systematic review and meta-analysis

Abstract

Background

Previous guidelines have clearly stated that dance is safe and beneficial during pregnancy and for childbirth. However, due to the small sample size of individual studies and different interventions, there were inconsistencies about the effect of dance on maternal childbirth.

Methods

We included studies evaluating the effect of dance on women in labor. Risk of bias was assessed using the revised Risk of bias assessment tool for randomized controlled trials (RCTs). Data analyses was performed using Review Manager Software version 5.4.

Results

A total of 12 RCTs comprising 1,486 pregnant women were included in the analysis. We found that the rate of natural childbirth and satisfaction with delivery were higher in the dance group than in the control group.The pain at 30 min and at 60 min after the intervention were lower in the dance group than in the control group. Meanwhile, the duration of the first stage, the second stage and the total labor duration was shorter in the dance group than in the control group.However, there were no statistically significant differences in the pain at 90 min after intervention, the duration of the third stage, and the rate of the normal 1-minute Apgar scores > 7 points between the two groups.

Conclusions

Dance during labor could reduce labor pain to an extent, shorten the duration of labor, promote natural childbirth, and improve satisfaction with labor, with no adverse effects on neonatal outcomes.

Trial registration

The protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-024-07132-4.

Background

Childbirth is an event of great psychological, emotional and social significance in a woman’s life. Women are increasingly expecting to have a sense of control [1], be provided with adequate information and support [2], and participate in decisions about their healthcare, especially during childbirth [3]. There are choices to be made during childbirth such as labor pain relief methods, and each method has benefits and risks, with different effectiveness, acceptability, and availability [4, 5].

Dance is a rhythmic moderate intensity physical activity accompanied with music [6].Study [7] had shown that moderate intensity aerobic exercise in women with uncomplicated pregnancies does not increase the risk of preterm birth, miscarriage, stillbirth and neonatal asphyxia, nor shorten the length of the cervical tube. Dance was widely used in mental health prevention and treatment of different patient groups, such as children with autism [8], college students with social anxiety [9, 10], older people with depression who are cognitively impaired [11], patients with breast cancer [12], etc. Moreover, the phenomenon of ‘square cabin dance’ [13]during the COVID-19 pandemic also highlighted the health and medical significance of dance.

Dance during labor was first founded by American fertility expert Stephanie [14], and it is a new type of exercise that combines fertility knowledge with dance. Dance during labor is a combination of obstetrics, anatomy, psychology, dance, music and other disciplines as well as religious or African and other primitive tribal celebrations [14]. Prenatal dance training enables pregnant women to better dominate and control their bodies, and reproductive education knowledge enhances maternal self-efficacy during childbirth and the mother’s sense of ritual [15].Dance during labor can cause the body to release endorphins, the body’s natural painkillers, which leads to increased pain tolerance [16].In addition, dance can promote the right brain to produce aesthetic pleasure, release dopamine, reduce tension and anxiety during childbirth, and have a therapeutic effect on both body and emotion [17].Listening to music affects the transfer of unpleasant feelings to limbic system of brain as emotions and feelings center by modifying the ability of neurotransmitters, and by increasing endorphin secretions intervenes behavior change and pain reduction [18].

Due to the peculiarities of physiological changes during pregnancy, dance was not previously widely engaged in by women during pregnancy and childbirth.However, the 2021 American College of Obstetricians and Gynecologists (ACOG) campaign guidelines [19] clearly stated that dance is one of the safe and beneficial programs during pregnancy and childbirth. Several studies [20–22] had shown that during childbirth, dance movements, including pelvic, left and right, and back and forth rocking movements, were prepared according to the special physiological conditions and birth mechanisms of women.This enabled women to maintain an upright posture and ease the tension and improve the elasticity of birth-related muscles such as the abdominal, low back, and pelvic floor muscles as well as increase the birth canal space to promote natural childbirth and obtain a better childbirth experience.

Currently, several studies [22–25] conducted in China and abroad had confirmed the safety of dance during childbirth and its effectiveness in shortening labor duration, reducing pain, and improving the rate of natural labor. However, these existing studies had limitations such as small sample size, different interventions (mostly concentrated on prenatal fertility dance course trainings), different intervention time and frequencies, and difference effects of the dance intervention. Therefore, this study aimed to explore the impact of dance during labor on women and newborn so that provide clinicians with evidence-based information regarding the effectiveness of dance for childbirth.

Methods

The systematic review with a meta-analysis of randomized clinical trials (RCTs) was conducted in accordance with the recommendations by the Cochrane Handbook [26] and the preferred reporting items for systematic review and meta-analysis statement [27]. The protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001.

Search strategy

We systematically searched the PubMed, Cochrane Library, Embase, Web of Science, Scopus, China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database, Wanfang Med Online, and China Biology Medicine disc(CBM disc) and manually searched Google Scholar and the ClinicalTrials. gov for studies up to October 17, 2023. The search was conducted by combining subject-specific and free words, and the search strategy was adjusted according to the characteristics of each database. Ongoing trials and pre-published articles were excluded. A manual search through reference lists of relevant primary and review articles was also performed for eligible studies that may have been missed.The complete electronic search strategy for each database is presented in Supplementary file 1.

Eligibility criteria and study selection

Studies had to fulfil the following inclusion criteria: [1]study design: RCT; [2]population: healthy pregnant women who were head presentation and voluntary vaginal births; [3]intervention: dance during labor, We didn’t exclude prenatal dance training, which could be considered just preliminary to the intervention itself, and not part of it; [4]comparison: routine intrapartum care; [5]outcomes: pain, duration of labor, the rate of natural childbirth, the rate of normal 1-minute Apgar scores (> 7 points), and satisfaction with labor.Studies published in English and Chinese were included.

Literature screening and data extraction

Two authors independently screened and cross-checked the literature according to the inclusion and exclusion criteria. Any disagreement was resolved by a third investigator. We used Endnote X9 to remove duplicate literature. We first screened the titles and abstracts of the studies and further read the full texts to eliminate non-conforming studies and to obtain the studies that were included in this review and meta-analysis.When needed, missing information and clarification about the statistics presented should always be sought from the authors [26]. The data extracted from the studies included name of the first author, publication year, country, study participants, sample size, interventions for the control and experimental groups, and outcome indicators.

Risk of bias assessment

The risk of bias in each included study was independently evaluated by two investigators using the Risk of Bias assessment tool (RoB2), 2019 edition [28] recommended by Cochrane based on the following five evaluation areas: [1] bias in the randomisation process [2], deviation from established interventions [3], missing outcome data [4], outcome measurements [5], selective reporting of results. The studies were judged by the authors and categorised as ‘low risk’, ‘some concerns’, or ‘high risk’ of bias. Any disagreements were resolved by a third author.

Evidence quality evaluation

GRADE profiler 3.6 software was used to evaluate the quality of evidence on four levels: High, moderate, low and very low.

Data synthesis and statistical analysis

Meta-analysis was performed using RevMan 5.4.1 software. The heterogeneity between the studies was determined using the chi-squared test (the test level was α = 0.1). If P > 0.1, I² < 50% indicated that the studies were homogeneous, and if P < 0.1, I² ≥ 50% indicated that the studies were heterogeneous [26]. If there was significant heterogeneity, sensitivity or descriptive analysis was used. The risk of small-study bias was examined visually through contour-enhanced funnel plots. For data with an asymmetric funnel plot, Egger’s linear regression test was additionally performed (Stata version 14). Because each study included different demographic characteristics, all analyses used random effects models to produce conservative effect estimates [26]. The risk ratio (RR) and 95% confidence interval (CI) of the variables were calculated as effects analysis statistics. When the same unit of measurement was used for a continuous variable in all the studies, the mean difference (MD) was calculated. When different unit of measurements were used, the standardised mean difference (SMD) was calculated. The CI was calculated for each effect.

Results

Literature selection process

A total of 269 relevant records were identified, of which 133 duplicate records were removed. After screening the titles and abstracts, 109 irrelevant records were excluded, and the full texts of 27 articles were assessed. Finally, twelve studies [16, 22, 24, 29–37] were eligible and included in this meta-analysis (1,486 pregnant women; Fig. 1).

Fig. 1.

Flow diagram of the included studies

Description of included studies

Of the twelve included studies, eight were conducted in China, three in Turkey, and one in Iran. Ten studies used dance as the only intervention, one study compared dance and music with the control group, and one study compared dance with midwife or the spouses/partners and the control group. Specific characteristics of the included studies are presented in Table 1.

Table 1.

Basic characteristics of the included studies and reported outcomes (n = 12)

Author Year	Country	Study participants	Sample size		Intervention			Outcomes
					T		C
			T (T1/T2)	C	T1	T2
Yan 2018(22)	China	Primipara, ≥ 28 weeks	98	98	Participants received labor dance training once a week after 28 weeks of pregnancy, participants performed dance at least once every hour for 30 min during labor		Routine care	②③④
Tan 2020(32)	China	Pregnant woman	75	75	Participants received labor dance training once a week after 28 weeks of pregnancy, participants performed dance at least once every hour for 30 min during labor		Routine care	②③④
Lu 2021(31)	China	Primipara	55	55	Dance during labor at least once every hour for 30 min		Routine care	②③
Yan 2019(24)	China	Primipara	85	85	Participants received labor dance training once a week after 28 weeks of pregnancy; when cervical dilatation was 4 cm, participants performed dance at least once every hour for 30 min		Routine care	①
Zhang 2020(33)	China	Primipara	65	65	Participants received labor dance training once a week after 28 weeks of pregnancy; participants performed dance at least once every hour for 30 min in the second stage of labour		Routine care	③
Zhu 2021(34)	China	Primipara, ≥ 28 weeks	80	80	Participants received labor dance training once a week after 28 weeks of pregnancy; participants performed dance at least once two hours for 30 min during labour		Routine care	②③
Chen 2023(35)	China	Primipara, ≥ 28 weeks	36	36	Participants received labor dance training once a week after 28 weeks of pregnancy; when cervical dilatation was 4 cm, participants performed dance at least once every hour for 30 min		Routine care	①
Zheng 2022(36)	China	Primipara, ≥ 28 weeks	50	50	Participants received labor dance training once a week after 28 weeks of pregnancy; participants performed dance at least once two hours during labour		• Routine care•	①②③
Abdola-hian 2014(29)	Iran	Primipara with cervical dilatation between 4 and 10 cm	30	30	Women were instructed to stand upright while performing pelvic tilting and rocking of their hips back and forth or around in a circle while their partner massaged their back and sacrum for a minimum of 30 min		Routine care	①⑤
Akin 2020(30)	Turkey	Pregnant women, with cervical dilatation between 4 and 8 cm	80(40/40)	80	During the active phase, pregnant women in danced with the midwife	Received labor dance training by attending prenatal training with their spouses/partners in the perinatal period; During the active phase, pregnant women danced with their spouses/partners	Routine care	⑤
Gönenç 2020(16)	Turkey	Pregnant women at 38 to 42 weeks in the active phase of the first stage of labour (3–7 cm dilatation)	31	32	30 min labour dance, when cervical dilatation was 4–5 cm		Routine care	①
Dilek Kaloglu Binici 2023(37)	Turkey	Pregnant women, with cervical dilatation between 3 and 8 cm	59	56	Participants were exposed to a 15-min labor dance every hour when the cervical dilation was between 3 and 8 cm		Routine care	①②⑤

T: Treatment Group; T1: Treatment Group 1; T2: Treatment Group 2; C: Control group

①: Pain; ②: duration of labor; ③: the rate of natural childbirth; ④: the rate of normal 1-minute Apgar scores (> 7 points); ⑤: satisfaction with labor

Risk of bias assessment of the included studies

Eight studies were judged as low risk, two studies were determined as having some concerns, and two studies judged as high risk (Fig. 2). The risk of bias in the twelve RCTs is presented in Supplementary file 2.

Fig. 2.

Risk of bias assessment of the included studies (n = 12)

Results of the meta-analysis

Pain

Four studies [16, 24, 29, 35] reported on pain during labor. Because the standard deviation (SD) of the pain score was not reported in Abdolahian et al.’s study [29], the authors were failed to be contacted, and the relevant statistical data were not available for extrapolation, we used the SD provided in another study [16]. Sensitivity analysis was used to assess the risk of bias caused by the missing results.

There were heterogeneity among the studies for pain at 30 min(I² = 98%), at 60 min(I² = 97%), and at 90 min(I² = 98%) after the intervention. Sensitivity analysis found that the deletion of any study could not significantly reduce the heterogeneity, indicating that this result is robust, and a random effects model was used for meta-analysis.The results showed that the pain scores at 30 min (SMD = − 2.55, 95% CI [− 4.69, − 0.42], P = 0.02) and at 60 min (SMD = − 2.22, 95% CI [− 3.96, − 0.48], P = 0.01) after the intervention were lower in the dance group than in the control group. However, there was no statistically significant difference in pain at 90 min after the intervention (SMD = − 1.64, 95% CI [− 3.56,0.29], P = 0.10) between the two groups.

The forest plot of the effect of dance on maternal labor pain is presented in Supplementary file 3.

The duration of labor

Five studies [22, 31, 32, 34, 36] reported on the duration of the first stage of labor. There were significant heterogeneity among the studies(I² = 97%).Sensitivity analysis found that the deletion of any study could not significantly reduce the heterogeneity, and a random effects model was used for meta-analysis.The results showed that the duration of the first stage of labor was shorter in the dance group than in the control group(SMD = − 3.53, 95% CI [− 4.94, − 2.12], P<0.001).

Six studies [22, 31, 32, 34, 36, 37] reported on the duration of the second stage of labor. There was significant heterogeneity among the studies(I² = 96%).Sensitivity analysis found that the deletion of any study could not significantly reduce the heterogeneity, and a random effects model was used for meta-analysis.The results showed that the duration of the second stage of labor was shorter in the dance group than in the control group (SMD = − 1.98, 95% CI [− 2.95, − 1.02], P < 0.0001).

Six studies [22, 31, 33, 34, 36, 37] reported on the duration of the third stage of labor. There was no significant heterogeneity among the studies(I² = 45%).A random effects model was used for meta-analysis.The results showed that there was no statistically significant difference between the two groups(SMD = − 0.09, 95% CI [− 0.29, 0.10], P = 0.36).

Three studies [22, 31, 32] reported on the duration of the total stage of labor. There was no significant heterogeneity among the studies(I² = 0%).A random effects model was used for meta-analysis.The results showed that the duration of the total stage of labor was shorter in the dance group than in the control group (SMD = − 5.21, 95% CI [− 5.64, − 4.78], P<0.001).

The forest plot of the effect of dance on the duration of labor is presented in Supplementary file 3.

The rate of natural childbirth

Six studies [22, 31–34, 36] reported on the rate of natural childbirth. In the random effects model, we observed that the rate of natural childbirth in the dance group was higher than that in the control group (RR = 1.20, 95% CI [1.10, 1.31], I² = 45%, P < 0.0001). The forest plot of the effect of dance on the rate of natural childbirth is presented in Supplementary file 3.

The rate of normal 1-minute apgar scores (> 7 points)

Two studies [22, 32] reported on the rate of the normal 1-minute Apgar scores (> 7 points). In the random effects model, the rate of the normal 1-minute Apgar scores (> 7 points) in the dance group was not statistically significantly different from that in the control group (RR = 1.02, 95% CI [1.00, 1.05], I² = 0%, P = 0.10). The forest plot of the effect of dance on the rate of 1-minute Apgar scores (> 7 points) is presented in Supplementary file 3.

Satisfaction with labor

Four studies [29, 30, 37] reported on satisfaction with labor. In the random effects model, satisfaction with labor in the dance group was higher than that in the control group (SMD = 0.69, 95% CI [0.49, 0.90], I² = 0%, P<0.001). The forest plot of the effect of dance on satisfaction with labor is presented in Supplementary file 3.

Publication bias

The funnel plots of all outcomes showed that except pain and the duration of labor, other outcomes were almost symmetrically distributed. Because the funnel plots for pain and duration of labor were asymmetrical and showed high heterogeneity, Egger’s linear regression test was additionally performed.The results showed that there was no statistically significant publication bias in the outcome indicator of pain at different intervention times(P > 0.05).As for the outcome indicator of labor duration, Egger’s test suggested the possible existence of publication bias in the first stage of labor(P = 0.021) and the second stage of labor(P = 0.001). The funnel plots of all the outcomes are presented in Supplementary file 4.

Evidence quality evaluation

GRADE evidence profiles showed that the rate of natural childbirth was evaluated as high quality evidence.Meanwhile, the pain and the rate of normal 1-minute Apgar scores (> 7 points) were evaluated as moderate quality evidence, duration of labor and satisfaction with labor were evaluated as low quality evidence.The evidence quality evaluation of all the outcomes are presented in Table 2.

Table 2.

GRADE summary and findings

Outcomes	No of studies	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Overall bias certainty	Absolute effects 95% CI
Duration of labor	2483 (6 studies)	no serious risk of bias	Serious I2 = 98%	no serious indirectness	no serious imprecision	reporting biasc	⊕⊕ low	2.26 standard deviations lower (2.99 to 1.52 lower)
Satisfaction with labor	415 (4 studies)	no serious risk of bias	no serious inconsistency I2 = 0%	no serious indirectness	seriousb	reporting biasc	⊕⊕ low	0.69 standard deviations higher (0.49 to 0.90 higher)
Pain	1032 (4 studies)	no serious risk of bias	Serious I2 = 97%	no serious indirectness	no serious imprecision	none	⊕⊕⊕ moderate	2.17 standard deviations lower (3.17 to 1.18 lower)
The rate of normal 1-minute Apgar scores (> 7 points)	346 (2 studies)	Seriousa	no serious inconsistency I2 = 0%	no serious indirectness	no serious imprecision	none	⊕⊕⊕ moderate	RR 1.02 (1.00 to 1.05)
The rate of natural childbirth	846 (6 studies)	no serious risk of bias	no serious inconsistency I2 = 45%	no serious indirectness	no serious imprecision	none	⊕⊕⊕⊕ high	RR 1.20 (1.10 to 1.31)

CI: Confidence Interval; SMD: Standardized Mean Difference; RR: Relative Risk

a. Downgraded by one level for serious risk of bias

b. Downgraded by one level because adopted the objective evaluation scheme

c. Downgraded by one level because the bias test found possible publication bias

Due to imprecision, we believe that there are objective evaluation criteria for accuracy, and for risk of bias, we lower the rating when most studies have high ROB or some concerns, or when bias tests indicate a risk of publication bias. For other studies and general certainty, we follow GRADE recommendations

Discussion

Application of dance during labor could reduce pain to an extent

Herlyssa [23] reported that 60.4% of women experience mild pain during the first stage of labor. In Li et al.‘s study [38], 89% of the women reported that the intensity of contraction pain was moderate. Melzack [39] compared earlier studies on back pain, cancer pain, limb pain, and post-herpetic neuralgia with labor pain and reported that labor pain index were 8–10 times higher than the other pain index. These studies suggest that pain has severely affected the maternal experience of childbirth, reducing the sense of control and self-confidence in childbirth and that women who cannot tolerate pain are more likely to opt for caesarean Sects. [40, 41], which causes some women to consider childbirth as traumatic and makes some women prone to post-traumatic stress disorder [42].

One study [16] showed that dance can increase endorphin levels in the blood, thereby producing an analgesic effect, and its mechanism may be related to the inhibitory input as proposed by the gate control theory.According to this theory, a gating mechanism in the central nervous system can block the transmission of sensory and affective components of pain at the level of the spinal cord.The stimuli that stem from the movement through dance reorient the woman’s focus away from pain, produce muscular relaxation, via a descending inhibitory pathway may close the gate and reduce the transmission of painful stimuli to higher cortical centers. Meanwhile, dancing during labor always accompanied with music.Listening to music can affect the transfer of unpleasant feelings to limbic system of brain as emotions and feelings center by modifying the ability of neurotransmitters, and by increasing endorphin secretions intervenes behavior change and pain reduction [18]. Therefore, Dancing during labor can achieve non-drug analgesic effects, allowing women to complete childbirth in this fun auxiliary measure.

Four studies [16, 24, 29, 35] included in this meta-analysis showed that dance during labor can relieve pain at 30 and 60 min after the intervention compared with that observed in the control group, but there was no statistically significant difference in the effect of dance on pain at 90 min after the intervention. These results could be explain by the fact that the effect of dance may be limited, and as labor progresses, the frequency of contractions increases, intensity increases, and effect of non-drug analgesic measures gradually reduces. Due to the small sample size and geographical limitations of this study, we recommend that future studies on dance for childbirth should be conducted in different regions and cultures and that maternal pain tolerance before dance interventions should be assessed to ensure similarity in baseline measures between the groups.

Application of dance during labor could shorten the duration of labor

Childbirth is a natural physiological process, and the four major factors affecting childbirth are productivity, birth canal, foetus, and mental and psychological condition of the mothers. Healthy Birth Practice [20] stated that free movement during childbirth is a safe and healthy coping strategy that promotes normal physiological childbirth. Women who use upright/changing positions frequently not only helps they cope with the pain of labor, but the use of gravity brings the baby down, and movement of the bones of the pelvis helps the baby find the best fit [43]. Compared with women in recumbent position, women who use the upright position and move freely during childbirth have shorter labor durations, require less interventions, are less likely to undergo caesarean births, report less severe pain, and report more satisfaction with their childbirth experience.

Studies by Herlyssa [23] and Jackson [44] have shown that belly dancing during childbirth can improve the tone and elasticity of birth-related muscles such as the abdominal, lumbar, and pelvic floor muscles, which could enhance the force of labor, keep their joint ligaments relaxed and soft, which is conduci-ve to the smooth passage of the fetus through the birth canal, finally shorten the duration of labor.Abd-olahian’s study [29] showed that pelvic movement, rocking in an upright position, or rocking the pelvis back and forth on a chair, can increase pelvic movement, increase pelvic space, and simultaneously promote fetal head descent and labor due to gravity, thereby shortening the duration of the first and second stages of labor.

Six studies [22, 31, 32, 34, 36, 37] included in this study, measured the duration of each stage of labor and reported that dance during labor could shorten the duration of the first stage of labor, the second stage of labor and the total duration of labor. However, it had no significant effect on the duration of the third stage of labor. In the future, midwives can develop appropriate dance movements and guide women for whom movement is not contraindicated to dance during labor to promote childbirth and shorten the duration of labor.

Dancing during labor could increase the rate of natural childbirth

Natural childbirth is currently the recommended mode of labor for women, but due to the lack of knowledge about childbirth, due to fear and nervousness about the pain of childbirth, etc., the rate of caesarean section has increased. A new World Health Organization study in 2021 [45] showed that caesarean section rates continue to rise globally, currently accounting for one in five (21%) of all births worldwide. This study also highlighted that this number will continue to increase over the next decade, with nearly one-third (29%) of births likely to caesarean sections by 2030. The Healthy Childbirth Practice guidelines [20] state that free movement during childbirth increases the sense of control and confidence in childbirth. Women who use upright positions and are mobile during labor have shorter labor duration, less intervention, fewer cesarean births, and report less severe pain, describe more satisfaction with their childbirth experience than women in recumbent positions.One of the most crucial components of labor dance is the physical and emotional support offered during labor [30]. Through dance, integrating elements such as music, accompaniment, and movement, the regulatory functions of the body’s nervous system and body fluids are activated. This promotes the secretion of sedative hormones such as enkephalin, endorphin, and serotonin in the female pituitary gland. Under the stimulation of hormones, women’s body and mind are in a relatively relaxed and pleasant state, resist the tension of pain, fear and anxiety, gain confidence in childbirth, and firmly believe in natural childbirth [46].

Six studies [22, 31–34, 36] included in this study reported that the natural birth rate in the dance labor group was higher than that in the control group. Since these six studies were conducted in China and may be limited by geography, more high-quality studies in other countries and regions are still needed to further explore the role of dancing during childbirth on natural childbirth.

Dancing during labor could improve satisfaction with labor

Low labor satisfaction is an important factor causing traumatic childbirth perceptions and post traumatic stress disorder [42]. Previous studies [47–49] have suggested that maternal satisfaction with labor is influenced by factors such as pain, duration of labor, levels of fear and anxiety, sense of control over childbirth, care by midwives, and collateral effects of the drugs administered. Among them, pain is the key factor affecting their satisfaction.

Four studies [29, 30, 37] included in this study.The results of this study showed that the satisfaction of women in the dance group was higher than that in the control group. This result could be explained by the fact that dancing during childbirth can fully mobilise the subjective initiative of women, increase maternal self-confidence and sense of control in childbirth, and reduce pain and relieve tension to an extent to help women have a pleasant childbirth experience.Meanwhile, study [44] has described dance during childbirth as joyful, relaxing, strengthening, and offering a connection between the mother and her baby.

Akin and Saydam [30] divided the dance childbirth group into two groups, spouse support and midwifery support, and they comprehensively assessed maternal satisfaction based on the following five dimensions: self-satisfaction, satisfaction with babies, satisfaction with midwives, satisfaction with doctors, and satisfaction with childbirth. The results showed that the overall satisfaction score of the spouse support group was higher than that of the midwife support group, which to an extent showed that spousal participation was also a factors affecting maternal satisfaction with childbirth. In other studies [24, 31, 34], midwives instructed women to dance during childbirth, and spouses and families were not involved. We recommend that follow-up studies should invite spouses and family members to be involved in the dance performed by mothers during labor to improve the mother’s childbirth experience and effectively increase their satisfaction with childbirth.

The use of dance during labor had no adverse effects on neonatal outcomes

Several national guidelines for exercise during pregnancy [19, 50, 51] clearly state that moderate-intensity aerobic exercises in healthy pregnant women do not increase the risk of preterm birth, stillbirth, miscarriage, etc. nor does it cause adverse neonatal outcomes such as neonatal asphyxia. There are currently no studies that demonstrate that free movement during childbirth is harmful to healthy women who give birth naturally [20]. Support, mobility, and non pharmacological methods provided to women during labor can reduce their anxiety, shorten the labor duration because of the pressure on the cervix, and positively affect the newborns [30, 37].

The results of this study showed that there was no statistically significant difference in the rate of normal 1-minute Apgar score (> 7 points) in the dance group compared with those in the control group, indicating that dance under midwife guidance was safe in women for whom sports is not contraindicated.

Limitations

This study had some limitations:①We only searched published literature in the Chinese and English languages; other languages and grey literature were not searched, so the article searches may be incomplete; ②only 12 studies were included, of which eight studies were conducted in China, which may have introduced a publication bias; ③the number of studies included for each outcome was small, and the strength of evidence for the final outcome was insufficient; ④the heterogeneity of the included studies was high, and although sensitivity analyses were performed, the sources of heterogeneity could not be fully explored, so the effect of dance during labor on labor needs to be further validated by more high-quality studies.

Conclusions

The results of this study showed that dance during labor could reduce labor pains to an extent, shorten the duration of labor, promote spontaneous maternal labor, and improve maternal satisfaction with childbirth, with no adverse effect on neonatal outcomes. Due to the limitations in the number and quality of included studies and the geographical limitations of the studies, the above conclusions have to be verified by more high-quality studies. In the future, music types, dance movements, dance duration should be standardised to limit confounding variables, standardise interventions, and promote the generalizability of the results.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

RCTs

Randomized controlled trials

ACOG

American College of Obstetricians and Gynecologists

PROSPERO

International prospective register of systematic reviews

CNKI

China National Knowledge Infrastructure

CBM disc

China Biology Medicine disc

RoB2

Risk of Bias assessment tool

GRADE

Grading of Recommendations Assessment, Development and Evaluation

STATA

Statistical Software for Data Sciences

RR

Risk ratio

CI

Confidence interval

MD

Mean difference

SMD

Standardised mean difference

Author contributions

Luping Zhang and Zhiwei Zhang researched literatures and analysed datas; Luping Zhang, Zhiwei Zhang and Ru Yue wrote the main manuscript text; Fulan Wang supervised the study and prepared Supplementary file 1-2;Ru Yue and Luping Zhang prepared Supplementary file 3-4;Zhiwei Zhang and Feng Xiao prepared figures and tables. All authors reviewed the manuscript.

Funding

This work was been financially supported by Chongqing key specialty construction “Clinical nursing” quality construction project (0203 【2023】 N0.47 202336). The founder was Chongqing Health Commission in China.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.