Comparison 1.
Immersion in water versus no immersion during first stage of labour
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Use of epidural/spinal analgesia/paracervical block | 6 | 2499 | Risk Ratio (M-H, Fixed, 95% CI) | 0.90 [0.82, 0.99] |
| 2 Pethidine/narcotic used | 4 | 1240 | Risk Ratio (M-H, Random, 95% CI) | 0.85 [0.46, 1.56] |
| 3 Use of transcutaneous nerve stimulation (TENS) | 2 | 845 | Risk Ratio (M-H, Fixed, 95% CI) | 1.05 [0.37, 2.94] |
| 4 Use of any analgesia | 5 | 653 | Risk Ratio (M-H, Random, 95% CI) | 0.72 [0.46, 1.12] |
| 5 Any pharmacological analgesia | 2 | 394 | Risk Ratio (M-H, Fixed, 95% CI) | 1.05 [0.80, 1.39] |
| 6 Experience of moderate to severe pain | 1 | Risk Ratio (M-H, Fixed, 95% CI) | Subtotals only | |
| 6.1 Ordinal description as moderate to severe, 30 mins after randomisation | 1 | 120 | Risk Ratio (M-H, Fixed, 95% CI) | 0.75 [0.62, 0.91] |
| 6.2 VAS scale 8 to 10, 30 mins after randomisation | 1 | 120 | Risk Ratio (M-H, Fixed, 95% CI) | 0.72 [0.58, 0.90] |
| 6.3 Ordinal scale pain faces 4 to 5, 30 mins after randomisation | 1 | 120 | Risk Ratio (M-H, Fixed, 95% CI) | 0.67 [0.51, 0.90] |
| 6.4 Ordinal description as moderate to severe, 1 hr after randomisation | 1 | 117 | Risk Ratio (M-H, Fixed, 95% CI) | 0.76 [0.63, 0.91] |
| 6.5 VAS scale 8 to 10, 1 hr after randomisation | 1 | 117 | Risk Ratio (M-H, Fixed, 95% CI) | 1.21 [0.69, 2.11] |
| 6.6 Ordinal scale pain faces 4 to 5, 1 hr after randomisation | 1 | 117 | Risk Ratio (M-H, Fixed, 95% CI) | 0.68 [0.53, 0.86] |
| 6.7 Ordinal description as moderate to severe, 2 hrs after randomisation | 1 | 57 | Risk Ratio (M-H, Fixed, 95% CI) | 0.76 [0.59, 0.98] |
| 6.8 VAS scale 8 to 10, 2 hrs after randomisation | 1 | 57 | Risk Ratio (M-H, Fixed, 95% CI) | 0.83 [0.66, 1.05] |
| 6.9 Ordinal scale pain faces 4 to 5, 2 hrs after randomisation | 1 | 57 | Risk Ratio (M-H, Fixed, 95% CI) | 0.72 [0.52, 0.98] |
| 6.10 Ordinal description as moderate to severe, 3 hrs after randomisation | 1 | 32 | Risk Ratio (M-H, Fixed, 95% CI) | 0.52 [0.23, 1.16] |
| 6.11 VAS scale 8 to 10, 3 hrs after randomisation | 1 | 32 | Risk Ratio (M-H, Fixed, 95% CI) | 0.69 [0.39, 1.23] |
| 6.12 Ordinal scale pain faces 4 to 5, 3 hrs after randomisation | 1 | 32 | Risk Ratio (M-H, Fixed, 95% CI) | 0.57 [0.25, 1.27] |
| 6.13 Ordinal description as moderate to severe, 24 hrs after randomisation | 1 | 119 | Risk Ratio (M-H, Fixed, 95% CI) | 0.64 [0.50, 0.82] |
| 6.14 VAS scale 8 to 10, 24 hrs after randomisation | 1 | 119 | Risk Ratio (M-H, Fixed, 95% CI) | 0.62 [0.49, 0.80] |
| 6.15 Ordinal scale pain faces 4 to 5, 24 hrs after randomisation | 1 | 119 | Risk Ratio (M-H, Fixed, 95% CI) | 0.69 [0.54, 0.87] |
| 7 Instrumental/surgical delivery | 9 | Risk Ratio (M-H, Fixed, 95% CI) | Subtotals only | |
| 7.1 Assisted vaginal deliveries | 7 | 2628 | Risk Ratio (M-H, Fixed, 95% CI) | 0.86 [0.71, 1.05] |
| 7.2 Caesarean section | 8 | 2712 | Risk Ratio (M-H, Fixed, 95% CI) | 1.21 [0.87, 1.68] |
| 7.3 Normal versus operative birth | 1 | 106 | Risk Ratio (M-H, Fixed, 95% CI) | 1.26 [1.09, 1.45] |
| 8 Duration of first stage (minutes) | 7 | 1461 | Mean Difference (IV, Fixed, 95% CI) | −32.40 [−58.67, −6.13] |
| 9 Duration of second stage (minutes) | 8 | 1569 | Mean Difference (IV, Fixed, 95% CI) | 0.47 [−3.45, 4.38] |
| 10 Duration of third stage (minutes) | 3 | 1165 | Mean Difference (IV, Random, 95% CI) | −0.52 [−1.84, 0.79] |
| 11 Duration of labour from randomisation till delivery | 0 | 0 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 12 Duration of total labour (all three stages) | 1 | 120 | Mean Difference (IV, Fixed, 95% CI) | −27.5 [−133.05, 78.05] |
| 13 Postpartum haemorrhage | 1 | 274 | Risk Ratio (M-H, Fixed, 95% CI) | 1.58 [0.80, 3.13] |
| 14 Blood loss | 2 | 153 | Mean Difference (IV, Fixed, 95% CI) | −14.33 [−63.03, 34.37] |
| 15 Perineal trauma after vaginal birth | 6 | Risk Ratio (M-H, Fixed, 95% CI) | Subtotals only | |
| 15.1 Intact | 5 | 1337 | Risk Ratio (M-H, Fixed, 95% CI) | 1.16 [0.99, 1.35] |
| 15.2 Episiotomy | 5 | 1272 | Risk Ratio (M-H, Fixed, 95% CI) | 0.93 [0.80, 1.08] |
| 15.3 Second-degree tear | 5 | 1286 | Risk Ratio (M-H, Fixed, 95% CI) | 0.94 [0.74, 1.20] |
| 15.4 Third- or fourth-degree tears | 5 | 2401 | Risk Ratio (M-H, Fixed, 95% CI) | 1.37 [0.86, 2.17] |
| 16 Satisfication with labour | 0 | 0 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.1 Labour and delivery satisfaction index | 0 | 0 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 16.2 Dissatisfied measured using ordinal scale | 0 | 0 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 17 Self reports pain score on visual analogue scale of 0-10 | 2 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 17.1 Pain score at start of assessment period (time zero) | 2 | 141 | Mean Difference (IV, Fixed, 95% CI) | −0.01 [−0.54, 0.52] |
| 17.2 Pain score up to 60 minutes later | 2 | 141 | Mean Difference (IV, Fixed, 95% CI) | −0.81 [−1.34, −0.28] |
| 18 Does not wish to use bath with next labour/delivery | 1 | 119 | Risk Ratio (M-H, Fixed, 95% CI) | 0.38 [0.14, 0.98] |
| 19 Artificial rupture of membranes | 3 | 926 | Risk Ratio (M-H, Fixed, 95% CI) | 1.02 [0.90, 1.16] |
| 20 Amniotic fluid index | 0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 21 Presence of meconium stained liquor | 5 | 1260 | Risk Ratio (M-H, Fixed, 95% CI) | 0.95 [0.76, 1.19] |
| 22 Use of oxytocin for augmentation of labour | 5 | 1125 | Risk Ratio (M-H, Random, 95% CI) | 0.64 [0.32, 1.28] |
| 23 Systolic blood pressure | 1 | 120 | Mean Difference (IV, Fixed, 95% CI) | −7.20 [−13.12, −21.28] |
| 24 Diastolic blood pressure | 1 | 120 | Mean Difference (IV, Fixed, 95% CI) | −10.20 [−13.70, −6.70] |
| 25 Mean arterial blood pressure | 1 | 120 | Mean Difference (IV, Fixed, 95% CI) | −10.5 [−14.68, −6.32] |
| 26 Maternal infection (perineal, systemic, uterine or increase in temperature) | 5 | 1295 | Risk Ratio (M-H, Fixed, 95% CI) | 0.99 [0.50, 1.96] |
| 27 Low self-esteem | 0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 28 Postpartum depression EPDS more than 11 | 2 | 370 | Risk Ratio (M-H, Fixed, 95% CI) | 1.38 [0.85, 2.24] |
| 29 Not breastfeeding after six weeks postdelivery | 2 | 363 | Risk Ratio (M-H, Fixed, 95% CI) | 1.17 [0.64, 2.15] |
| 30 Abnormal fetal heart rate patterns | 3 | 487 | Risk Ratio (M-H, Random, 95% CI) | 0.75 [0.34, 1.67] |
| 31 Apgar score less than seven (five minutes) | 5 | 1834 | Risk Ratio (M-H, Fixed, 95% CI) | 1.58 [0.63, 3.93] |
| 32 Apgar score at five minutes | 2 | 893 | Mean Difference (IV, Fixed, 95% CI) | −0.03 [−0.11, 0.06] |
| 33 Umbilical artery pH less than 7.20 | 1 | 110 | Risk Ratio (M-H, Fixed, 95% CI) | 5.18 [0.25, 105.51] |
| 34 Neonate temperature | 1 | Risk Ratio (M-H, Fixed, 95% CI) | Subtotals only | |
| 34.1 Temperature less than 36.2 degrees C at birth |
0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 34.2 Temperature greater than 37.5 degrees C at birth |
0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 34.3 Temperature greater than 37.8 degrees C as an indicator for infection |
1 | 274 | Risk Ratio (M-H, Fixed, 95% CI) | 1.0 [0.06, 15.83] |
| 35 Admission to neonatal intensive care unit | 3 | 1571 | Risk Ratio (M-H, Fixed, 95% CI) | 1.06 [0.71, 1.57] |
| 36 Neonatal infection | 5 | 1295 | Risk Ratio (M-H, Fixed, 95% CI) | 2.00 [0.50, 7.94] |
| 37 Lung hypoplasia present | 0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 38 Perinatal deaths | 0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 39 Caregiver injuries | 0 | 0 | Risk Ratio (M-H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| 40 Neonatal gestational age at birth | 9 | 2820 | Mean Difference (IV, Fixed, 95% CI) | −0.01 [−0.82, 0.80] |
| 41 Birthweight in grams | 9 | 2820 | Mean Difference (IV, Fixed, 95% CI) | −22.74 [−66.44, 20.96] |