Methods	Randomisation stated but only described as ‘by lots’. Methodological qualities: selection bias: no information. performance bias: high risk of bias could have been introduced because researcher cannot be blind to group allocation after randomisation. exclusion bias: low risk of bias as no drop-outs reported. bias conclusion: moderate bias. 1 or more criteria partially met. May raise some doubt about the results
Participants	33 women, 18 water, 15 control. In labour (cervix 4 cm dilated). Low risk - term, 1 fetus, no complications in current or any previous pregnancy/birth
Interventions	Intervention was use of bath for max of 60 minutes. Bath was thermally insulted, oval, size 150 cm by 110 cm, by 70 cm deep. Volume was 730 litres Water temperature 37 degree Celsius. No pharmacological analgesia available to either control or intervention group during study hour After use of bath labour care as normal and could access ‘usual’ pain relief methods, positions No mention of 1-to-1 second care or not. First stage only study.
Outcomes	Duration of first and second stage of labour. Pain relief used, pain score before and after study period (1 hour), own assessment in postnatal questionnaire on day 2 postpartum Blood loss, perineal trauma, Apgars. Maternal pulse, temperature, blood pressure.
Notes	Undertaken in Finland - 1 hospital.
Risk of bias
Bias	Authors’ judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Randomised ‘by lots’ in translation.
Allocation concealment (selection bias)	High risk	Described as randomised but translation does not indicate how concealed
Blinding (performance bias and detection bias) All outcomes	High risk	High risk of bias could have been introduced because women, carers and researcher cannot be blind to group allocation after randomisation due to the nature of the intervention
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Not reported.
Selective reporting (reporting bias)	Unclear risk	Unable to assess this from translation.
Other bias	Unclear risk	Full translation not available, just extracts as requested on Cochrane Pregnancy and Childbirth Group translation sheet