Using a birth ball to reduce pain perception in the latent phase of labour; a randomised controlled trial

Background

Most births in high-income countries occur in hospital. However, hospital admission in the latent phase of labour is associated with higher rates of obstetric intervention, with the potential for increased maternal and fetal morbidity. Women sent home from hospital in the latent phase to 'await events' frequently feel anxious and unsupported. They also cite pain as their main drive to seeking hospital admission in the latent phase.

Confidence in labour is associated with less anxiety, a lower perception of pain and less obstetric intervention. Using a birth ball to assume upright positions and remain mobile in the latent phase of labour in hospital is associated with less pain and anxiety. However, no research had examined the effect of using birth balls at home in the latent phase on pain perception, latent phase hospital admission or obstetric intervention.

Aims

An antenatal evidence-based intervention was planned to promote birth ball use at home in the latent phase of labour to enhance women's self-efficacy and reduce their anxiety, in order to reduce their perception of pain and delay admission until labour was established.

Method

As a pragmatic randomised controlled single centre trial, 294 low risk women were randomly allocated to two groups. At 36 weeks’ gestation the Intervention Arm accessed the infomercial online and completed a modified Childbirth Self-Efficacy Inventory before and after viewing. They were also offered the loan of a birth ball to use at home. The Control Arm received standard care. On admission to hospital in spontaneous labour, all participants were asked to provide a Visual Analogue Scale score. Both groups were followed up six weeks postpartum with an online questionnaire. Data were analysed on an Intention To Treat basis.

Findings

A significant increase was found in Outcome Expectancy and Self-efficacy Expectancy after accessing the infomercial and Intervention Arm participants were more likely to be admitted in established labour. No significant differences were found between the VAS scores, or intervention rates. Most respondents (89.2%) described the birth ball as helpful and reported high satisfaction, with comfort, empowerment and progress.

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Discussion

The birth ball appears to be a promising intervention to support women in the latent phase of labour. High Induction of Labour rates in a low risk cohort reduced the number of spontaneous labours needed to detect a significant difference in pain perception and timing of labour admission. Nevertheless, the high satisfacttion and acceptability combined with a potential reduction latent phase admissions and CS rates warrant further research.