Efficacy of birthing ball exercises to reduce labor pain and cesarean rates: an updated meta-analysis of randomized controlled trials.

Purpose: This updated systematic review and meta-analysis aims to evaluate the impact of a birthing ball (BB) exercises on low-risk parturients during labor, offering a more comprehensive understanding through a larger sample size, robust analysis, and focus on relevant endpoints that were underexplored in previous studies due to limited data.

Methods: We searched PubMed, Embase, Scopus, and Cochrane Central for randomized controlled trials (RCTs) comparing BB (also named Swiss ball) exercises with no intervention or standard care in parturients undergoing low-risk labor. Risk ratios (RR) and mean differences (MD) were calculated using a random-effects model. I² heterogeneity was assessed. All statistical analyses were performed using Review Manager 5.4.

Results: We included 10 RCTs with 1,008 parturients, 51.2% of whom were assigned to BB exercises. In the pooled analysis, the BB group showed significantly lower cesarean section rates (MD 0.55, p = 0.007, I² = 32%), reduced pain scores at 4 and 8 cm dilation by approximately 20% (p < 0.001), and a reduction of over two hours in the duration of the first stage of labor (MD -130.12 min, p < 0.001). There were no significant differences between groups in the duration of the second stage of labor (p = 0.090) and in the incidence of instrumental delivery, amniotomy, labor induction, oxytocin use, or epidural analgesia.

Conclusions: BB exercises significantly reduced cesarean section rates, alleviated labor pain, and shortened the first stage of labor, supporting their use as a safe and effective non-pharmacological intervention in low-risk labor management.