Efficacy and safety of non‐pharmacological interventions for labour pain management: A systematic review and Bayesian network meta‐analysis

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aims and objectives</jats:title><jats:p>To compare and rank the efficacy and safety of non‐pharmacological interventions in the management of labour pain.</jats:p></jats:sec><jats:sec><jats:title>Background</jats:title><jats:p>Recently, various non‐pharmacological interventions have been applied to manage labour pain and have shown positive effects. However, evidence identifying which type of non‐pharmacological intervention is more efficient and safer is limited.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Systematic review and Bayesian network meta‐analysis based on PRISMA‐NMA.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Seven databases were searched from database inception–March 2020. Two reviewers independently performed study selection, quality appraisal and data extraction. Conventional meta‐analysis was conducted using either fixed‐effects model or random‐effects model according to statistical heterogeneity. The Bayesian network meta‐analysis was conducted using the consistency model.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>43 studies involving nine non‐pharmacological interventions were included. The Bayesian network meta‐analysis showed that acupressure (SMD = −2.00, 95% CrI −3.09 to −0.94), aromatherapy (SMD = −2.01, 95% CrI −3.70 to −0.35) and massage therapy (SMD = −1.26, 95% CrI −2.26 to −0.30) had significant positive effects on alleviating labour pain, with aromatherapy being the most effective. The results also revealed that yoga (SMD = −130.85, 95% CrI −212.01 to −59.32) and acupressure (SMD = −10.14, 95% CrI −20.24 to −0.41) were the most effective interventions for shortening the first stage and the second stage of labour, respectively. There were no significant differences between non‐pharmacological interventions and usual care or placebo control on the use of pharmacological methods and neonatal 5‐min Apgar score.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The evidence in this network meta‐analysis illustrates that non‐pharmacological interventions are effective and safe for labour pain management in low‐risk pregnant women. In the future, well‐designed studies are needed to validate the conclusion of this network meta‐analysis.</jats:p></jats:sec><jats:sec><jats:title>Relevance to clinical practice</jats:title><jats:p>The results support the use of non‐pharmacological interventions, especially aromatherapy and acupressure, to relieve labour pain in low‐risk pregnant women. Non‐pharmacological interventions for labour pain management are recommended to apply according to maternal women's preference and values.</jats:p></jats:sec>