2. Characteristics of included Cochrane systematic reviews ‐ non‐pharmacological interventions.
| Review title | Date of search |
No. Studies included (No. Patients in included studies) |
Inclusion criteria for "Types of participants" | Comparison interventions (no. studies) | Outcomes for which data were reported that could be included in an analysis | Summary of quality of evidence in reviews (risk of bias) |
| Hypnosis for pain management during labour and childbirth (Madden 2012) | 7 September 2011 | 7 studies in 3 countries (Australia, USA, UK) between 1986 and 2010 (1213 women) |
Pregnant women including women in high risk groups e.g. preterm labour or following induction of labour | Self‐hypnosis or hypnotherapy versus control (standard childbirth preparation; a relaxation tape; supportive counselling; psychotherapy) (7 studies, 1070 women) Hypnosis & audio CD versus audio CD of hypnosis (1 study, 297 women) N.B. one study, n = 448, included three arms and so data for the different arms are included in the separate comparisons |
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Sequence generation: 2 studies low risk; 5 studies unclear risk Allocation concealment: 1 study low risk; 2 studies high risk; 4 studies unclear risk Blinding (participants & clinical staff): 3 studies low risk; 4 studies unclear risk Blinding (outcome assessors): 3 studies low risk; 4 studies unclear risk Incomplete outcome reporting: 3 studies low risk; 2 studies high risk; 2 studies unclear risk Selective outcome reporting: 3 studies low risk; 2 studies high risk; 2 studies unclear risk Other potential threats to validity: 3 studies low risk; 4 studies unclear risk |
| Biofeedback for pain during labour (Barragán 2011) | 20 March 2011 | 4 studies in 3 countries (UK, USA and Italy) between 1978 and 2000 (201 women randomised, 2 studies (103 women) contributed data to meta‐analysis) |
Women with low risk pregnancies e.g. healthy pregnant women likely to have a normal birth | Biofeedback versus no biofeedback/standard care (2 studies, 103 women) |
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Sequence generation: 1 study low risk; 3 studies unclear risk Allocation concealment: 4 studies unclear risk Blinding: 4 studies unclear risk Incomplete outcome reporting: 2 studies low risk; 2 studies high risk Selective outcome reporting: 1 study low risk; 3 studies high risk Other potential threats to validity: 4 studies low risk |
| Intracutaneous or subcutaneous sterile water injection for pain management in labour (Derry 2012) | 30 May 2011 | 7 studies in 5 countries (Sweden, Denmark, Iran, Thailand, India) between 1990 and 2009 (766 women) |
Women in active labour who requested analgesia for pain of moderate to severe intensity. There were no restrictions relating to place of birth or to maternal parity, risk status, age, weight, length of gestation, or stage of labour | Intracutaneous sterile water injection versus normal saline injection (4 studies, 467 women) Subcutaneous sterile water injection versus normal saline injection (2 studies, 200 women) Intracutaneous & subcutaneous sterile water injection versus normal saline injection (1 study, 99 women) |
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Sequence generation: 4 studies low risk; 3 studies unclear risk Allocation concealment: 4 studies low risk; 4 studies unclear risk Blinding (participants & clinical staff): 5 studies low risk; 1 study high risk; 1 study unclear risk Blinding (outcome assessors): 7 studies low risk Incomplete outcome reporting: 2 studies low risk; 1 study high risk; 4 studies unclear risk Selective outcome reporting: 4 studies low risk; 3 studies unclear risk Other potential threats to validity: 3 studies high risk; 4 studies unclear risk |
| Immersion in water in labour and birth (Cluett 2009) | 30 June 2011 | 12 studies in 11 countries (USA, Canada, UK, Sweden, Finland, Belguim, Iran, South Africa, Brazil, Australia) between 1993 and 2009 (3252 women) |
Nulliparous or multiparous women in labour with a singleton pregnancy, irrespective of gestation or labour characteristics | Immersion versus no immersion in the first stage of labour (8 studies, 2826 women) Immersion versus no immersion in the second stage of labour (3 studies, 286 women) Early versus late immersion during the first stage of labour (1 study, 200 women) N.B. one study, n = 60, included data for both first and second stages of labour and so is included in numbers for both comparisons |
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Sequence generation: 6 studies low risk; 2 studies high risk; 4 studies unclear risk Allocation concealment: 8 studies low risk; 3 studies high risk; 1 study unclear risk Blinding (participants/clinical staff/outcome assessor): 12 studies high risk Incomplete outcome reporting: 11 studies low risk; 1 study unclear risk Selective outcome reporting: 10 studies low risk; 1 study high risk; 1 study unclear risk Other potential threats to validity: 1 study low risk; 11 studies unclear risk |
| Aromatherapy for pain management in labour (Smith 2011c) | 31 October 2010 | 2 studies in 2 countries (Italy, New Zealand) between 2000 and 2007 (535 women) |
Women in labour, including high risk groups e.g. preterm labour or following induction | Aromatherapy versus standard care (1 study, 513 women) One type of aromatherapy (ginger) versus a different type of aromatherapy (lemon grass) (1 study, 22 women) |
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Sequence generation: 2 studies low risk Allocation concealment: 2 studies low risk Blinding: 1 study low risk; 1 study high risk Incomplete outcome reporting: 2 studies low risk Selective outcome reporting: 2 studies unclear risk Other potential threats to validity: 1 study low risk; 1 study high risk |
| Relaxation techniques for pain management in labour (Smith 2011b) | 30 November 2010 | 11 studies in 9 countries (USA, UK, Sweden, Italy, Turkey, Thailand, Iran, Taiwan, Brazil) between 1965 and 2010 (1574 women) |
Women in labour, including high risk groups e.g. preterm labour or following induction | Relaxation (progressive muscle relaxation; breathing; psychoprophylaxis) versus standard care (6 studies,1147 women) Yoga versus standard care (2 studies, 270 women) Music versus standard care (2 studies, 133 women) Audio‐analgesia versus standard care (1 study, 24 women) |
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Sequence generation: 6 studies low risk; 5 studies unclear risk Allocation concealment: 3 studies low risk; 8 studies unclear risk Blinding: 8 studies high risk; 3 studies unclear risk Incomplete outcome reporting: 5 studies low risk; 2 studies high risk; 4 studies unclear risk Selective outcome reporting: 1 study low risk; 10 studies unclear risk Other potential threats to validity: 5 studies low risk; 6 studies unclear risk |
| Acupuncture or acupressure for pain management in labour (Smith 2011a) | 31 October 2010 | 13 studies in 8 countries (Norway, Sweden, Denmark, India, Korea, Taiwan, China, Iran) between 2002 and 2010 (1986 women) |
Women in labour, including high risk groups e.g. preterm labour or following induction | Acupuncture or acupressure versus placebo/standard care/no treatment (12 studies, 1858 women) Acupuncture versus sterile water injection (1 study, 128 women) |
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Sequence generation: 12 studies low risk; 1 study unclear risk Allocation concealment: 9 studies low risk; 4 studies unclear risk Blinding: 3 studies low risk; 5 studies high risk; 5 studies unclear risk Incomplete outcome reporting: 9 studies low risk; 1 study high risk; 3 studies unclear risk Selective outcome reporting: 13 studies unclear risk Other potential threats to validity: 8 studies low risk; 3 studies high risk; 2 studies unclear risk |
| Massage, reflexology and other manual methods for pain management in labour (Smith 2012) | 30 June 2011 | 6 studies in 4 countries (USA, UK, Iran, Taiwan) between 1997 and 2010 (401 women randomised, 5 studies (326 women) contributed data to meta‐analysis) |
Women in labour, including high risk groups e.g. preterm labour or following induction | Massage versus usual care (4 studies, 225) Massage versus breathing exercises (1 study, 28 women) Massage versus music (1 study, 101 women) |
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Sequence generation: 4 studies low risk; 1 study high risk; 1 study unclear risk Allocation concealment: 1 study low risk; 5 studies unclear risk Blinding (participants & clinical staff): 5 studies high risk; 1 study unclear risk Blinding (outcome assessor): 4 studies low risk; 1 study high risk; 1 study unclear risk Incomplete outcome reporting: 5 studies low risk; 1 study unclear risk Selective outcome reporting: 1 study low risk; 5 studies unclear risk Other potential threats to validity: 3 studies low risk; 3 studies unclear risk |
| Transcutaneous electrical nerve stimulation (TENS) for pain management in labour (Dowswell 2009) | 30 April 2011 | 17 studies in 15 countries (USA, Canada, UK, Ireland, France, Sweden, Denmark, Germany, Norway, the Netherlands, India, Taiwan, China, Brazil, Australia) between 1978 and 2010 (1466 women) |
Women in labour (risk not stated) | TENS versus placebo or usual care (17 studies, 1455 women) TENS versus sterile water injection (1 study, 22 women) |
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Sequence generation: 3 studies low risk; 1 study high risk; 14 studies unclear risk Allocation concealment: 3 studies low risk; 1 study high risk; 14 studies unclear risk Blinding (participants): 8 studies high risk; 10 studies unclear risk Blinding (clinical staff): 8 studies high risk; 10 studies unclear risk Blinding (outcome assessor): 7 studies high risk; 11 studies unclear risk Incomplete outcome reporting: 10 studies low risk; 2 studies high risk; 6 studies unclear risk Other potential threats to validity: 18 studies unclear risk N.B. 17 studies contributed data to the review, but 18 studies were included and assessed for risk of bias |