Non-pharmacological therapies applied in pregnancy and labor: an integrative review

Biana, Camilla Benigno; Cecagno, Diana; Porto, Adrize Rutz; Cecagno, Susana; Marques, Vanessa de Araujo; Soares, Marilu Correa

doi:10.1590/S1980-220X2019019703681

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

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Sumário

REVIEW • Rev. esc. enferm. USP 55 • 2021 • https://doi.org/10.1590/S1980-220X2019019703681 copy

Non-pharmacological therapies applied in pregnancy and labor: an integrative review

Terapias no farmacológicas aplicadas en el embarazo y el parto: una revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify non-pharmacological therapies applied during pregnancy and labor.

Method:

Integrative review conducted in the databases: PubMed, ScieLO and PEDro, searching for articles from 2008 in English, Spanish and Portuguese. The descriptors used were: pregnancy, childbirth, physiotherapy, alternative and complementary medicine, alternative therapy, non-pharmacological therapy, biomechanical therapy.

Results:

Forty-one articles were analyzed and subdivided into ten categories of nonpharmacological therapies: massage, perineal massage, hot bath, supportive care, childbirth preparation group, breathing techniques, pelvic floor exercises, transcutaneous electrostimulation, Swiss ball and spontaneous pushing. Six articles (60%) showed a positive outcome for reduction of pain in labor and all of them had a positive outcome for different variables of labor, such as reduction of time, anxiety and pelvic floor laceration rates.

Conclusion:

The use of non-pharmacological therapies was efficient to reduce the effects of labor and childbirth, such as pain, duration of labor, anxiety, laceration and episiotomy.

Complementary Therapies; Exercise Therapy; Pregnancy; Natural Childbirth; Obstetric Nursing; Review

Authors	Profession of therapist	Study location	Methodological design
Kimber, et al; 2008⁽¹²12 Kimber L, McNabb M, McCourt C, Haines A, Brocklehurst P. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. Eur J Pain. 2008;12(8):961-9. doi: 10.1016/j.ejpain.2008.01.004 https://doi.org/10.1016/j.ejpain.2008.01... ⁾	Midwives and therapists	Prenatal centers	Randomized pilot study
Mei-dan, et al; 2008⁽¹³13 Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008;10(7):499-502.⁾	Midwives and self applicable	Prenatal clinics and maternity	Controlled clinical study
Bergstrom, et al; 2009⁽¹⁴14 Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG. 2009;116(9):1167-76. doi: 10.1111/j.1471-0528.2009.02144.x https://doi.org/10.1111/j.1471-0528.2009... ⁾	Midwives	Prenatal clinics	Randomized clinical trial
Davim, et al; 2009⁽³3 Davim RMB, Torres GV, Dantas JC. Effectiveness of non-pharmacological strategies in relieving labor pain. Rev Esc Enferm USP [Internet]. 2009 [cited 2018 March 03]; 43(2):438-41. Available from: http://www.scielo.br/pdf/reeusp/v43n2/a25v43n2.pdf http://www.scielo.br/pdf/reeusp/v43n2/a2... ⁾	Nurse	Maternity	Clinical intervention study
Bahadoran, et al; 2010⁽¹⁵15 Bahadoran P, Asefi F, Oreyzi H, Valiani M. The effect of participating in the labor preparation classes on maternal vitality and positive affect during the pregnancy and after the labor. Iran J Nurs Midwifery Res [Internet]. 2010 [cited 2018 Dec 10];15 Suppl1:331-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208940/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Not informed	Public health centers	Quasi-experimental clinical study
Peng, et al; 2010⁽¹⁶16 Peng T, Li XT, Zhou SF, Xiong Y, Kang Y, Cheng HD. Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: a non-randomized controlled study. Chin J Integr Med. 2010;16(3):234-8. doi: 10.1111/jog.12345 https://doi.org/10.1111/jog.12345... ⁾	Nurse	Maternity	Non-randomized clinical study
Taghinejad, et al; 2010⁽¹⁷17 Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between massage and music therapies to relieve the severity of labor pain. Womens Health (Lond). 2010;6(3):377-81. doi: /10.2217/WHE.10.15 https://doi.org//10.2217/WHE.10.15... ⁾	Midwives	Maternity	Randomized clinical trial
Dias, et al; 2011⁽¹⁸18 Dias LAR, Driusso P, Aita DLCC, Quintana SM, Bø K, Ferreira CHJ. Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial. Rev Bras Fisiot. 2011;15(6):487-93. doi: 10.1590/S1413-35552011005000011 https://doi.org/10.1590/S1413-3555201100... ⁾	Physiotherapists	Maternity	Randomized clinical trial
Gau, et al; 2011⁽¹⁹19 Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery. 2011;27(6):e293-300. doi: 10.1016/j.midw.2011.02.004 https://doi.org/10.1016/j.midw.2011.02.0... ⁾	Midwives	Maternity	Randomized clinical trial
Geranmayeh, et al; 2011⁽²⁰20 Geranmayeh M, Habibabadi ZR, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet. 2012;285(1):77-81. doi: 10.1007/s00404-011-1919-5 https://doi.org/10.1007/s00404-011-1919-... ⁾	Midwives	Maternity	Randomized clinical trial
Dhany, et al; 2012⁽⁶6 Dhany AL, Mitchell T, Foy C. Aromatherapy and massage intrapartum service impact on use of analgesia and anesthesia in women in labor: a retrospective case note analysis. J Altern Complement Med. 2012;18(10):932-8. doi: 10.1089/acm.2011.0254 https://doi.org/10.1089/acm.2011.0254... ⁾	Not informed	Maternity	Retrospective clinical study
Karacam, et al; 2012⁽²¹21 Karaçam Z, Ekmen H, Calisir H. The use of perineal massage in the second stage of labor and follow-up of postpartum perineal outcomes. Health Care Women Int. 2012;33(8):697-718. doi: 10.1080/07399332.2012.655385 https://doi.org/10.1080/07399332.2012.65... ⁾	Nurses and midwives	Maternity	Randomized clinical trial
Low, et al; 2012⁽²²22 Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J. 2013;2(3):453-60. doi: 10.1007/s00192-012-1884-y https://doi.org/10.1007/s00192-012-1884-... ⁾	Nurses	Maternity	Randomized clinical trial
Mortazavi, et al; 2012⁽²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ⁾	Not informed	Maternity	Randomized clinical trial
Ismail, et al; 2013⁽²⁴24 Ismail SIMF, Emery SJ. Patient awareness and acceptability of antenatal perineal massage. J Obstet Gynaecol. 2013;33(8):839-43. doi: 10.3109/01443615.2013.828027 https://doi.org/10.3109/01443615.2013.82... ⁾	Obstetrician, midwives and physiotherapists	Maternity	Descriptive study
Gallo, et al; 2013⁽²⁵25 Gallo RBS, Santana LC, Ferreira CHJ, Marcolin AC, PoliNeto OB, Duarte G, et al. Massage reduced severity of pain during labour: a randomised trial. J Physiother. 2013;59(2):109-16. doi: 10.1016/S1836-9553(13)70163-2 https://doi.org/10.1016/S1836-9553(13)70... ⁾	Physiotherapist	Maternity	Randomized clinical trial
Lee, et al; 2013⁽²⁶26 Lee SL, Liu CY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28. doi: 10.1111/j.1552-6909.2012.01424.x https://doi.org/10.1111/j.1552-6909.2012... ⁾	Nurses	Maternity	Randomized clinical trial
Miquelutti, et al; 2013⁽²⁷27 Miquelutti MA, Cecatti JG, Makuch MY. Antenatal education and the birthing experience of Brazilian women: a qualitative study. BMC Pregnancy Childbirth. 2013;13:171. doi: 10.1186/1471-2393-13-171 https://doi.org/10.1186/1471-2393-13-171... ⁾	Physiotherapist	Maternity	Qualitative study
Akbarzadeh,et al; 2014⁽²⁸28 Akbarzadeh M, Masoudi Z, Hadianfard MJ, Kasraeian M, Zare N. Comparison of the effects of maternal supportive care and acupressure (BL32 acupoint) on pregnant women's pain intensity and delivery outcome. J Pregnancy. 2014;2014:129208. doi: 10.1155/2014/129208 https://doi.org/10.1155/2014/129208... ⁾	Doulas	Maternity	Randomized clinical trial
Reilly, et al; 2014⁽²⁹29 Reilly ETC, Freeman RM, Waterfield AE, Steggles P, Pedlar F. Prevention of pospartum stress incontinence in primigravidae with increased blader neck mobility: a randomized controlled trial of antenatal pelvic floor exercises. BJOG.2014;121 Suppl 7:58-66. doi: https://doi.org/10.1111/1471-0528.13213 https://doi.org/10.1111/1471-0528.13213... ⁾	Physiotherapist	Prenatal clinic	Randomized clinical trial
Adams, et al; 2015⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾	Not informed	Retrospective: database	Longitudinal study
Demirel, et al; 2015⁽³¹31 Demirel G, Golbasi Z. Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet. 2015;131(2):183-6. doi: https://doi.org/10.1016/j.ijgo.2015.04.048 https://doi.org/10.1016/j.ijgo.2015.04.0... ⁾	Not informed	Maternity	Randomized clinical trial
Fritel, et al; 2015⁽³²32 Fritel X, Tayrac R, Bader G, Savary D, Gueye A, Deffieux X, et al. Preventing urinary incontinence with supervised prenatal pelvic floor exercises: a randomized controlled trial. Obstet Gynecol. 2015;126(2):370-7. doi: https://doi.org/10.1097/AOG.0000000000000972 https://doi.org/10.1097/AOG.000000000000... ⁾	Physiotherapist or midwives	Prenatal centers	Randomized clinical trial
Gayeski, et al; 2015⁽⁵5 Gayeski ME, Brüggemann OM, Monticelli M, Santos EKA. Application of nonpharmacologic methods to relieve pain during labor: the point of view of primiparous women. Pain Manag Nurs. 2015;16(3):273-84. doi: 10.1016/j.pmn.2014.08.006 https://doi.org/10.1016/j.pmn.2014.08.00... ⁾	Obstetric nurse	Maternity	Cross-sectional
Hanjini, et al; 2015⁽³³33 Moghimi-Hanjini S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran [Internet]. 2015 [cited 2018 June 10];53(8):507-11. Available from: http://acta.tums.ac.ir/index.php/acta/article/view/4277 http://acta.tums.ac.ir/index.php/acta/ar... ⁾	Not informed	Maternity	Randomized clinical trial
Akbarzadeh, et al; 2016⁽³⁴34 Akbarzadeh M, Masoudi Z, Zare N, Kasraeian M. Comparison of the effects of maternal supportive care and acupressure (at BL32 Acupoint) on labor length and infant's apgar score. Glob J Health Sci.2016;8(3):237-44. doi: https://doi.org/10.5539/gjhs.v8n3p236 https://doi.org/10.5539/gjhs.v8n3p236... ⁾	Doulas	Maternity	Randomized clinical trial
Boaviagem, et al; 2016⁽³⁵35 Boaviagem A, Melo Junior E, Lubambo L, Sousa P, Aragão C, Albuquerque S, et al. The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: a randomized controlled clinical trial. Complement Ther Clin Pract. 2017;26:30-5. doi: https://doi.org/10.1016/j.ctcp.2016.11.004 https://doi.org/10.1016/j.ctcp.2016.11.0... ⁾	Physiotherapists	Maternity	Randomized clinical trial
Henrique, et al; 2016⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾	Obstetric nurse	Maternity	Randomized clinical trial
Karimi, et al; 2016⁽³⁷37 Karimi S, Kazemi F, Masoumi SZ, Shobeiri F, Roshanaei G. Effect of consultation and educating in preparation classes for delivery on pregnancy consequences: a randomized controlled clinical trial. Electron Physician. 2016;8(11):3177-83. doi: http://dx.doi.org/10.19082/3177 http://dx.doi.org/10.19082/3177... ⁾	Not informed	Prenatal clinics	Randomized clinical trial
Masoumi, et al; 2016⁽³⁸38 Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeli-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health [Internet]. 2016 [cited 2016 Sep 10];1(3):115-21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241355/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Midwives	Maternity	Randomized clinical trial
Taavoni, et al; 2016⁽³⁹39 Taavoni S, Sheikhan F, Abdolahian S, Ghavi F. Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management. Complement Ther Clin Pract. 2016;24:99-102. doi: https://doi.org/10.1016/j.ctcp.2016.04.001 https://doi.org/10.1016/j.ctcp.2016.04.0... ⁾	Midwives	Maternity	Randomized clinical trial
Santana, et al; 2016⁽⁴⁰40 Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016;62(1):29-34. doi: https://doi.org/10.1016/j.jphys.2015.11.002 https://doi.org/10.1016/j.jphys.2015.11.... ⁾	Physiotherapist	Maternity	Randomized clinical trial
Sut, et al; 2016⁽⁴¹41 Sut HK, Kaplan PB. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35(3):417-22. doi: https://doi.org/10.1002/nau.22728 https://doi.org/10.1002/nau.22728... ⁾	Not informed	Obstetric center	Randomized clinical trial
Aziato, et al; 2017⁽⁴²42 Aziato L, Acheampong AK, Umoar KL. Labour pain experiences and perceptions: a qualitative study among post-partum women in Ghana. BMC Pregnancy Childbirth. 2017;17:73. doi: https://doi.org/10.1186/s12884-017-1248-1 https://doi.org/10.1186/s12884-017-1248-... ⁾	Nurse	Tertiary health center	Qualitative descriptive exploratory study
Cicek, et al; 2017⁽⁴³43 Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract. 2017;29:213-9. doi: https://doi.org/10.1016/j.ctcp.2017.10.006 https://doi.org/10.1016/j.ctcp.2017.10.0... ⁾	Not informed	Maternity	Randomized clinical trial
Erdogan, et al; 2017⁽⁴⁴44 Erdogan SU, Yanikkerem E, Goker A. Effects of low back massage on perceived birth pain and satisfaction. Complement Ther Clin Pract. 2017;28:169-75. doi: https://doi.org/10.1016/j.ctcp.2017.05.016 https://doi.org/10.1016/j.ctcp.2017.05.0... ⁾	Nurses	Maternity	Experimental study with control group
Miquelutti, et al; 2017⁽⁴⁵45 Miquelutti MA, Cecatii JG. Kinesio Taping for pain control during labor: protocol of a randomized, controlled trial. Nurs Health Sci. 2017;19(1):95-9. doi: https://doi.org/10.1111/nhs.12321 https://doi.org/10.1111/nhs.12321... ⁾	Physiotherapist and Obstetrician	Maternity	Randomized clinical trial
Shahoei, et al; 2017⁽⁴⁶46 Shahoei R, Shahghebi S, Rezaei M, Naqshbandi S. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: a clinical trial. Complement Ther Clin Pract. 2017;28:176-80. doi: https://doi.org/10.1016/j.ctcp.2017.05.004 https://doi.org/10.1016/j.ctcp.2017.05.0... ⁾	Midwives	Maternity	Clinical study
Vanderlaan, et al; 2017⁽⁴⁷47 Vanderlaan J. Retrospective cohort study of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2017:46(3)403-10. doi: https://doi.org/10.1016/j.jogn.2016.11.018 https://doi.org/10.1016/j.jogn.2016.11.0... ⁾	Nurses and midwives	Maternity	Retrospective cohort study
Yuksel, et al; 2017⁽⁴⁸48 Yuksel H, Cayir Y, Kosan Z, Tastan K. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 2017;15(6):456-61. doi: https://doi.org/10.1016/S2095-4964(17)60368-6 https://doi.org/10.1016/S2095-4964(17)60... ⁾	Not informed	Maternity	Randomized clinical trial
Ugwu, et al; 2018⁽⁴⁹49 Ugwu EO, Iferikigwe ES, Obi SN, Eleje GU, Ozumba BC. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: a randomized controlled trial. J Obstet Gynaecol Res. 2018;44(7):1252-8. doi: https://doi.org/10.1111/jog.13640 https://doi.org/10.1111/jog.13640... ⁾	Self-applicable	Prenatal clinics	Randomized clinical trial

NPT	Positive outcome	Inconclusive or negative outcome
Massage	Reduction of pain in labor⁽³3 Davim RMB, Torres GV, Dantas JC. Effectiveness of non-pharmacological strategies in relieving labor pain. Rev Esc Enferm USP [Internet]. 2009 [cited 2018 March 03]; 43(2):438-41. Available from: http://www.scielo.br/pdf/reeusp/v43n2/a25v43n2.pdf http://www.scielo.br/pdf/reeusp/v43n2/a2... ^,⁵5 Gayeski ME, Brüggemann OM, Monticelli M, Santos EKA. Application of nonpharmacologic methods to relieve pain during labor: the point of view of primiparous women. Pain Manag Nurs. 2015;16(3):273-84. doi: 10.1016/j.pmn.2014.08.006 https://doi.org/10.1016/j.pmn.2014.08.00... ^,¹⁷17 Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between massage and music therapies to relieve the severity of labor pain. Womens Health (Lond). 2010;6(3):377-81. doi: /10.2217/WHE.10.15 https://doi.org//10.2217/WHE.10.15... ^, ²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ^,²⁵25 Gallo RBS, Santana LC, Ferreira CHJ, Marcolin AC, PoliNeto OB, Duarte G, et al. Massage reduced severity of pain during labour: a randomised trial. J Physiother. 2013;59(2):109-16. doi: 10.1016/S1836-9553(13)70163-2 https://doi.org/10.1016/S1836-9553(13)70... ^,³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ^,⁴⁴44 Erdogan SU, Yanikkerem E, Goker A. Effects of low back massage on perceived birth pain and satisfaction. Complement Ther Clin Pract. 2017;28:169-75. doi: https://doi.org/10.1016/j.ctcp.2017.05.016 https://doi.org/10.1016/j.ctcp.2017.05.0... ⁾ Reduction of anxiety in labor⁽²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ^,³³33 Moghimi-Hanjini S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran [Internet]. 2015 [cited 2018 June 10];53(8):507-11. Available from: http://acta.tums.ac.ir/index.php/acta/article/view/4277 http://acta.tums.ac.ir/index.php/acta/ar... ⁾ Greater satisfaction with childbirth⁽²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ^,³⁴34 Akbarzadeh M, Masoudi Z, Zare N, Kasraeian M. Comparison of the effects of maternal supportive care and acupressure (at BL32 Acupoint) on labor length and infant's apgar score. Glob J Health Sci.2016;8(3):237-44. doi: https://doi.org/10.5539/gjhs.v8n3p236 https://doi.org/10.5539/gjhs.v8n3p236... ⁾ Reduced use of epidural and spinal analgesia and anesthesia⁽⁶6 Dhany AL, Mitchell T, Foy C. Aromatherapy and massage intrapartum service impact on use of analgesia and anesthesia in women in labor: a retrospective case note analysis. J Altern Complement Med. 2012;18(10):932-8. doi: 10.1089/acm.2011.0254 https://doi.org/10.1089/acm.2011.0254... ⁾ Reduction of labor time⁽³³33 Moghimi-Hanjini S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran [Internet]. 2015 [cited 2018 June 10];53(8):507-11. Available from: http://acta.tums.ac.ir/index.php/acta/article/view/4277 http://acta.tums.ac.ir/index.php/acta/ar... ⁾ Reduced perception of labor time⁽⁴⁴44 Erdogan SU, Yanikkerem E, Goker A. Effects of low back massage on perceived birth pain and satisfaction. Complement Ther Clin Pract. 2017;28:169-75. doi: https://doi.org/10.1016/j.ctcp.2017.05.016 https://doi.org/10.1016/j.ctcp.2017.05.0... ⁾ Association with increased breastfeeding⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾ Higher frequency of vaginal delivery⁽³³33 Moghimi-Hanjini S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Med Iran [Internet]. 2015 [cited 2018 June 10];53(8):507-11. Available from: http://acta.tums.ac.ir/index.php/acta/article/view/4277 http://acta.tums.ac.ir/index.php/acta/ar... ⁾	Association with increased laceration and use of forceps⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾ Pain and satisfaction in childbirth⁽¹²12 Kimber L, McNabb M, McCourt C, Haines A, Brocklehurst P. Massage or music for pain relief in labour: a pilot randomised placebo controlled trial. Eur J Pain. 2008;12(8):961-9. doi: 10.1016/j.ejpain.2008.01.004 https://doi.org/10.1016/j.ejpain.2008.01... ⁾
Perineal massage	Reduced frequency of episiotomy⁽¹⁴14 Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG. 2009;116(9):1167-76. doi: 10.1111/j.1471-0528.2009.02144.x https://doi.org/10.1111/j.1471-0528.2009... ^,²⁰20 Geranmayeh M, Habibabadi ZR, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet. 2012;285(1):77-81. doi: 10.1007/s00404-011-1919-5 https://doi.org/10.1007/s00404-011-1919-... ^,³¹31 Demirel G, Golbasi Z. Effect of perineal massage on the rate of episiotomy and perineal tearing. Int J Gynaecol Obstet. 2015;131(2):183-6. doi: https://doi.org/10.1016/j.ijgo.2015.04.048 https://doi.org/10.1016/j.ijgo.2015.04.0... ⁾ Reduction of the second stage of labor⁽²⁰20 Geranmayeh M, Habibabadi ZR, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet. 2012;285(1):77-81. doi: 10.1007/s00404-011-1919-5 https://doi.org/10.1007/s00404-011-1919-... ⁾ Good technique acceptance⁽²⁴24 Ismail SIMF, Emery SJ. Patient awareness and acceptability of antenatal perineal massage. J Obstet Gynaecol. 2013;33(8):839-43. doi: 10.3109/01443615.2013.828027 https://doi.org/10.3109/01443615.2013.82... ⁾ Increased incidence of perineal integrity⁽⁴⁹49 Ugwu EO, Iferikigwe ES, Obi SN, Eleje GU, Ozumba BC. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: a randomized controlled trial. J Obstet Gynaecol Res. 2018;44(7):1252-8. doi: https://doi.org/10.1111/jog.13640 https://doi.org/10.1111/jog.13640... ⁾	Increased laceration grades 1 and 2⁽²⁰20 Geranmayeh M, Habibabadi ZR, Fallahkish B, Farahani MA, Khakbazan Z, Mehran A. Reducing perineal trauma through perineal massage with vaseline in second stage of labor. Arch Gynecol Obstet. 2012;285(1):77-81. doi: 10.1007/s00404-011-1919-5 https://doi.org/10.1007/s00404-011-1919-... ⁾ No difference regarding postpartum urinary incontinence⁽¹³13 Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008;10(7):499-502.^,²²22 Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J. 2013;2(3):453-60. doi: 10.1007/s00192-012-1884-y https://doi.org/10.1007/s00192-012-1884-... ⁾ No differences regarding perineal trauma in general⁽¹³13 Mei-dan E, Walfisch A, Raz I, Levy A, Hallak M. Perineal massage during pregnancy: a prospective controlled trial. Isr Med Assoc J. 2008;10(7):499-502.^,²¹21 Karaçam Z, Ekmen H, Calisir H. The use of perineal massage in the second stage of labor and follow-up of postpartum perineal outcomes. Health Care Women Int. 2012;33(8):697-718. doi: 10.1080/07399332.2012.655385 https://doi.org/10.1080/07399332.2012.65... ⁾
Hot bath	Reduction of pain in labor⁽³3 Davim RMB, Torres GV, Dantas JC. Effectiveness of non-pharmacological strategies in relieving labor pain. Rev Esc Enferm USP [Internet]. 2009 [cited 2018 March 03]; 43(2):438-41. Available from: http://www.scielo.br/pdf/reeusp/v43n2/a25v43n2.pdf http://www.scielo.br/pdf/reeusp/v43n2/a2... ^,²⁶26 Lee SL, Liu CY, Gau ML. Efficacy of warm showers on labor pain and birth experiences during the first labor stage. J Obstet Gynecol Neonatal Nurs. 2013;42(1):19-28. doi: 10.1111/j.1552-6909.2012.01424.x https://doi.org/10.1111/j.1552-6909.2012... ^,³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ^,³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ^,⁴⁷47 Vanderlaan J. Retrospective cohort study of hydrotherapy in labor. J Obstet Gynecol Neonatal Nurs. 2017:46(3)403-10. doi: https://doi.org/10.1016/j.jogn.2016.11.018 https://doi.org/10.1016/j.jogn.2016.11.0... ⁾ Association with increased breastfeeding⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾ Improvement of the delivery experience⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾ Increased frequency of uterine contractions during labor⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾ Reduction of duration of labor⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾	Associated with increased laceration⁽³⁰30 Adams J, Frawley J, Steel A, Broom A, Sibbritt D. Use of pharmacological and non-pharmacological labour pain management techniques and their relationship to maternal and infant birth outcomes: examination of a nationally representative sample of 1835 pregnant women. Midwifery. 2015;31(4):458-63. doi: https://doi.org/10.1016/j.midw.2014.12.012 https://doi.org/10.1016/j.midw.2014.12.0... ⁾ Increased fetal heart rate⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾
Supportive care	Reduction of pain in labor⁽²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ^,²⁸28 Akbarzadeh M, Masoudi Z, Hadianfard MJ, Kasraeian M, Zare N. Comparison of the effects of maternal supportive care and acupressure (BL32 acupoint) on pregnant women's pain intensity and delivery outcome. J Pregnancy. 2014;2014:129208. doi: 10.1155/2014/129208 https://doi.org/10.1155/2014/129208... ⁾ Increased incidence of vaginal delivery⁽²⁸28 Akbarzadeh M, Masoudi Z, Hadianfard MJ, Kasraeian M, Zare N. Comparison of the effects of maternal supportive care and acupressure (BL32 acupoint) on pregnant women's pain intensity and delivery outcome. J Pregnancy. 2014;2014:129208. doi: 10.1155/2014/129208 https://doi.org/10.1155/2014/129208... ⁾ Reduction of duration of labor⁽³⁴34 Akbarzadeh M, Masoudi Z, Zare N, Kasraeian M. Comparison of the effects of maternal supportive care and acupressure (at BL32 Acupoint) on labor length and infant's apgar score. Glob J Health Sci.2016;8(3):237-44. doi: https://doi.org/10.5539/gjhs.v8n3p236 https://doi.org/10.5539/gjhs.v8n3p236... ⁾ Resulted in Apgar scores greater than 8⁽³⁴34 Akbarzadeh M, Masoudi Z, Zare N, Kasraeian M. Comparison of the effects of maternal supportive care and acupressure (at BL32 Acupoint) on labor length and infant's apgar score. Glob J Health Sci.2016;8(3):237-44. doi: https://doi.org/10.5539/gjhs.v8n3p236 https://doi.org/10.5539/gjhs.v8n3p236... ⁾ Reduction of anxiety⁽²³23 Mortazavi SH, Khaki S, Moradi R, Heidari K, Rahimparvar SFV. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet. 2012;286(1):19-23. doi: 10.1007/s00404-012-2227-4 https://doi.org/10.1007/s00404-012-2227-... ⁾
Childbirth preparation groups	Control of anxiety and feeling of security⁽²⁷27 Miquelutti MA, Cecatti JG, Makuch MY. Antenatal education and the birthing experience of Brazilian women: a qualitative study. BMC Pregnancy Childbirth. 2013;13:171. doi: 10.1186/1471-2393-13-171 https://doi.org/10.1186/1471-2393-13-171... ⁾ Increased comfort and mobility during childbirth⁽²⁷27 Miquelutti MA, Cecatti JG, Makuch MY. Antenatal education and the birthing experience of Brazilian women: a qualitative study. BMC Pregnancy Childbirth. 2013;13:171. doi: 10.1186/1471-2393-13-171 https://doi.org/10.1186/1471-2393-13-171... ⁾ Increased satisfaction with childbirth⁽²⁷27 Miquelutti MA, Cecatti JG, Makuch MY. Antenatal education and the birthing experience of Brazilian women: a qualitative study. BMC Pregnancy Childbirth. 2013;13:171. doi: 10.1186/1471-2393-13-171 https://doi.org/10.1186/1471-2393-13-171... ⁾ Reduction of fear of vaginal delivery⁽⁴³43 Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract. 2017;29:213-9. doi: https://doi.org/10.1016/j.ctcp.2017.10.006 https://doi.org/10.1016/j.ctcp.2017.10.0... ⁾ Reduction of anxiety⁽⁴³43 Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract. 2017;29:213-9. doi: https://doi.org/10.1016/j.ctcp.2017.10.006 https://doi.org/10.1016/j.ctcp.2017.10.0... ⁾ Increased positive thinking⁽¹⁵15 Bahadoran P, Asefi F, Oreyzi H, Valiani M. The effect of participating in the labor preparation classes on maternal vitality and positive affect during the pregnancy and after the labor. Iran J Nurs Midwifery Res [Internet]. 2010 [cited 2018 Dec 10];15 Suppl1:331-6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208940/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Increased choice of vaginal delivery⁽³⁷37 Karimi S, Kazemi F, Masoumi SZ, Shobeiri F, Roshanaei G. Effect of consultation and educating in preparation classes for delivery on pregnancy consequences: a randomized controlled clinical trial. Electron Physician. 2016;8(11):3177-83. doi: http://dx.doi.org/10.19082/3177 http://dx.doi.org/10.19082/3177... ^,³⁸38 Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeli-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health [Internet]. 2016 [cited 2016 Sep 10];1(3):115-21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241355/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Higher rates of non-instrumental delivery⁽³⁸38 Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeli-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health [Internet]. 2016 [cited 2016 Sep 10];1(3):115-21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241355/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾ Higher weight of the baby⁽³⁷37 Karimi S, Kazemi F, Masoumi SZ, Shobeiri F, Roshanaei G. Effect of consultation and educating in preparation classes for delivery on pregnancy consequences: a randomized controlled clinical trial. Electron Physician. 2016;8(11):3177-83. doi: http://dx.doi.org/10.19082/3177 http://dx.doi.org/10.19082/3177... ^,³⁸38 Masoumi SZ, Kazemi F, Oshvandi K, Jalali M, Esmaeli-Vardanjani A, Rafiei H. Effect of training preparation for childbirth on fear of normal vaginal delivery and choosing the type of delivery among pregnant women in Hamadan, Iran: a randomized controlled trial. J Family Reprod Health [Internet]. 2016 [cited 2016 Sep 10];1(3):115-21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241355/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Childbirth experience⁽¹⁴14 Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG. 2009;116(9):1167-76. doi: 10.1111/j.1471-0528.2009.02144.x https://doi.org/10.1111/j.1471-0528.2009... ⁾ Use of analgesia⁽¹⁴14 Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG. 2009;116(9):1167-76. doi: 10.1111/j.1471-0528.2009.02144.x https://doi.org/10.1111/j.1471-0528.2009... ⁾ Stress in maternity⁽¹⁴14 Bergström M, Kieler H, Waldenström U. Effects of natural childbirth preparation versus standard antenatal education on epidural rates, experience of childbirth and parental stress in mothers and fathers: a randomised controlled multicentre trial. BJOG. 2009;116(9):1167-76. doi: 10.1111/j.1471-0528.2009.02144.x https://doi.org/10.1111/j.1471-0528.2009... ⁾
Breathing techniques	Reduction of pain⁽³3 Davim RMB, Torres GV, Dantas JC. Effectiveness of non-pharmacological strategies in relieving labor pain. Rev Esc Enferm USP [Internet]. 2009 [cited 2018 March 03]; 43(2):438-41. Available from: http://www.scielo.br/pdf/reeusp/v43n2/a25v43n2.pdf http://www.scielo.br/pdf/reeusp/v43n2/a2... ^,⁴³43 Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract. 2017;29:213-9. doi: https://doi.org/10.1016/j.ctcp.2017.10.006 https://doi.org/10.1016/j.ctcp.2017.10.0... ^,⁴⁸48 Yuksel H, Cayir Y, Kosan Z, Tastan K. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 2017;15(6):456-61. doi: https://doi.org/10.1016/S2095-4964(17)60368-6 https://doi.org/10.1016/S2095-4964(17)60... ⁾ Reduction of duration of labor⁽⁴⁸48 Yuksel H, Cayir Y, Kosan Z, Tastan K. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration: a randomized controlled trial. J Integr Med. 2017;15(6):456-61. doi: https://doi.org/10.1016/S2095-4964(17)60368-6 https://doi.org/10.1016/S2095-4964(17)60... ⁾ Reduction of anxiety in labor⁽⁴³43 Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract. 2017;29:213-9. doi: https://doi.org/10.1016/j.ctcp.2017.10.006 https://doi.org/10.1016/j.ctcp.2017.10.0... ⁾	There was no difference for anxiety, pain, fatigue, satisfaction, type of delivery, duration of labor and Apgar scores⁽³⁵35 Boaviagem A, Melo Junior E, Lubambo L, Sousa P, Aragão C, Albuquerque S, et al. The effectiveness of breathing patterns to control maternal anxiety during the first period of labor: a randomized controlled clinical trial. Complement Ther Clin Pract. 2017;26:30-5. doi: https://doi.org/10.1016/j.ctcp.2016.11.004 https://doi.org/10.1016/j.ctcp.2016.11.0... ⁾
Pelvic floor exercises	Less susceptibility to urinary incontinence in the postpartum period⁽²⁹29 Reilly ETC, Freeman RM, Waterfield AE, Steggles P, Pedlar F. Prevention of pospartum stress incontinence in primigravidae with increased blader neck mobility: a randomized controlled trial of antenatal pelvic floor exercises. BJOG.2014;121 Suppl 7:58-66. doi: https://doi.org/10.1111/1471-0528.13213 https://doi.org/10.1111/1471-0528.13213... ⁾ Increased pelvic floor muscle strength⁽⁴¹41 Sut HK, Kaplan PB. Effect of pelvic floor muscle exercise on pelvic floor muscle activity and voiding functions during pregnancy and the postpartum period. Neurourol Urodyn. 2016;35(3):417-22. doi: https://doi.org/10.1002/nau.22728 https://doi.org/10.1002/nau.22728... ⁾	Postpartum urinary incontinence⁽³²32 Fritel X, Tayrac R, Bader G, Savary D, Gueye A, Deffieux X, et al. Preventing urinary incontinence with supervised prenatal pelvic floor exercises: a randomized controlled trial. Obstet Gynecol. 2015;126(2):370-7. doi: https://doi.org/10.1097/AOG.0000000000000972 https://doi.org/10.1097/AOG.000000000000... ⁾ Type of delivery, frequency of perineal laceration and neonatal variables⁽¹⁸18 Dias LAR, Driusso P, Aita DLCC, Quintana SM, Bø K, Ferreira CHJ. Effect of pelvic floor muscle training on labour and newborn outcomes: a randomized controlled trial. Rev Bras Fisiot. 2011;15(6):487-93. doi: 10.1590/S1413-35552011005000011 https://doi.org/10.1590/S1413-3555201100... ⁾
TENS	Reduction of pain in labor⁽¹⁶16 Peng T, Li XT, Zhou SF, Xiong Y, Kang Y, Cheng HD. Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: a non-randomized controlled study. Chin J Integr Med. 2010;16(3):234-8. doi: 10.1111/jog.12345 https://doi.org/10.1111/jog.12345... ^,⁴⁰40 Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016;62(1):29-34. doi: https://doi.org/10.1016/j.jphys.2015.11.002 https://doi.org/10.1016/j.jphys.2015.11.... ^,⁴⁶46 Shahoei R, Shahghebi S, Rezaei M, Naqshbandi S. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: a clinical trial. Complement Ther Clin Pract. 2017;28:176-80. doi: https://doi.org/10.1016/j.ctcp.2017.05.004 https://doi.org/10.1016/j.ctcp.2017.05.0... ⁾ Postponement of the use of epidural analgesia⁽⁴⁰40 Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC. Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. J Physiother. 2016;62(1):29-34. doi: https://doi.org/10.1016/j.jphys.2015.11.002 https://doi.org/10.1016/j.jphys.2015.11.... ⁾ Reduced postpartum blood loss⁽¹⁶16 Peng T, Li XT, Zhou SF, Xiong Y, Kang Y, Cheng HD. Transcutaneous electrical nerve stimulation on acupoints relieves labor pain: a non-randomized controlled study. Chin J Integr Med. 2010;16(3):234-8. doi: 10.1111/jog.12345 https://doi.org/10.1111/jog.12345... ⁾
Swiss ball	Reduction of pain in labor⁽¹⁹19 Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery. 2011;27(6):e293-300. doi: 10.1016/j.midw.2011.02.004 https://doi.org/10.1016/j.midw.2011.02.0... ^,³⁹39 Taavoni S, Sheikhan F, Abdolahian S, Ghavi F. Birth ball or heat therapy? A randomized controlled trial to compare the effectiveness of birth ball usage with sacrum-perineal heat therapy in labor pain management. Complement Ther Clin Pract. 2016;24:99-102. doi: https://doi.org/10.1016/j.ctcp.2016.04.001 https://doi.org/10.1016/j.ctcp.2016.04.0... ⁾ Increased confidence in relation to labor⁽¹⁹19 Gau ML, Chang CY, Tian SH, Lin KC. Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan. Midwifery. 2011;27(6):e293-300. doi: 10.1016/j.midw.2011.02.004 https://doi.org/10.1016/j.midw.2011.02.0... ⁾ Reduction of duration of labor⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾ Increased frequency of uterine contractions during labor⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾	Increased fetal heart rate⁽³⁶36 Henrique AJ, Gabrielloni MC, Cavalcanti ACV, Melo PS, Barbieri M. Hydrotherapy and the Swiss ball in labor: randomized clinical trial. Acta Paul Enferm. 2016;29(6):686-92. doi: http://dx.doi.org/10.1590/1982-0194201600096 http://dx.doi.org/10.1590/1982-019420160... ⁾
Spontaneous pushing	Reduction in the incidence of perineal laceration⁽²²22 Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J. 2013;2(3):453-60. doi: 10.1007/s00192-012-1884-y https://doi.org/10.1007/s00192-012-1884-... ⁾	Postpartum urinary incontinence⁽²²22 Low LK, Miller JM, Guo Y, Ashton-Miller JA, DeLancey JOL, Sampselle CM. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial. Int Urogynecol J. 2013;2(3):453-60. doi: 10.1007/s00192-012-1884-y https://doi.org/10.1007/s00192-012-1884-... ⁾

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[1] Corresponding author: Camilla Benigno Biana Universidade Federal de Pelotas Rua Quinze de Novembro, 1611, Apto. 302, Centro CEP 96015-000 - Pelotas, RS, Brazil camillacbb@gmail.com