Effectiveness of breathing exercises during first stage of labor: A systematic review and meta-analysis

Introduction

Breathing appears to be an important outcome during labor. Therefore, this systematic review aims to evaluate, using the highest level of evidence, the benefits and potential risks of using breathing exercises during the first stage of labor on maternal and neonatal outcomes.

Methods

A search was conducted in the MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, PEDro, EMBASE, CINAHL, Web of Science, Scopus databases and gray literature was also searched, with no restrictions on period or language. The terms "Breathing Exercises" and "Labor" were used. Randomized and quasi-randomized clinical trials comparing a group using breathing exercises during the first stage of labor with a control group receiving usual care were included. The Cochrane tool (RoB 2.0) was used to assess the risk of bias, and the certainty of evidence was evaluated using the GRADE system. Quantitative analysis was performed through meta-analyses.

Results

Thirteen studies were included. There was a reduction in pain by -1.64 (95 % CI: -2.81 to -0.46, eight studies, I² 99 %; T2 2.82; p < 0.00001), based on very low certainty of evidence, and a reduction in the duration of the second stage of labor by -7.23 min (95 % CI: -11.08 to -3.38, three studies, random-effects: I² 0 %; T2 0.00; p < 0.0002), based on moderate certainty of evidence.

Conclusion

There is moderate evidence that the use of breathing exercises during the first stage of labor can reduce the duration of the pushing stage and decrease pain intensity, although with very low certainty of evidence. However, there was no difference in other maternal and neonatal outcomes.