The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis

doi:10.21203/rs.3.rs-4724968/v1

Download PDF

Research Article

The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis

https://doi.org/10.21203/rs.3.rs-4724968/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

This systematic review and meta-analysis aimed to evaluate the effectiveness of virtual reality (VR) in managing labor pain. A comprehensive search of databases including Embase, Scopus, PubMed, and Web of Science identified clinical trials exploring the efficacy of VR in reducing labor pain. The inclusion criteria focused on low-risk, full-term pregnant women receiving VR interventions through head-mounted displays or glasses during any stage of labor. Ten randomized controlled trials (RCTs) were included in the analysis.

The meta-analysis revealed a significant reduction in labor pain associated with VR interventions, with a pooled effect size of -0.7012 (95% CI: -0.8380 to -0.5644). Subgroup analyses indicated consistent pain reduction across different parity groups, though heterogeneity was noted among the primiparous and mixed parity groups. Meta-regression analysis identified cervical dilation stage, pain assessment tools, and blinding status as significant moderators of VR's effectiveness.

The findings support VR as a promising non-pharmacological intervention for labor pain management, offering significant analgesic effects without the adverse outcomes associated with pharmacological options. Future research should focus on standardizing VR protocols, exploring the optimal timing and duration of interventions, and understanding the long-term effects of VR during labor. This review underscores the potential of VR to enhance labor pain management strategies, improving outcomes for women in labor.

Virtual Reality

Labor Pain

Systematic Review

Pain Management

Pregnancy

Non-Pharmacological Interventions

Pregnancy and childbirth represent pivotal life experiences that can deeply influence a mother's well-being, both positively and adversely (Bastos et al., 2015). During pregnancy, women usually encounter physical discomfort such as back and pelvic pain, headaches, and reflux, alongside psychological challenges such as anxiety, stress, and fear of childbirth (Dennis et al., 2017; Levett et al., 2019; Persson et al., 2020). Post-traumatic stress disorder (PTSD) may be following the childbirth experience for some women, with the subjective perception of birthing pain playing a pivotal role in the development of PTSD and postpartum psychopathology (Grekin & O’Hara, 2014; Kountanis et al., 2022). Recent research illustrated that 2.9% of women in community samples and 14.1% in at-risk samples, characterized by psychiatric or trauma history, or perinatal complications, meet the criteria for PTSD related to childbirth (Grekin & O’Hara, 2014). Labor pain can instigate traumatic experiences, impede labor progression, and yield unfavorable physiological outcomes that jeopardize the well-being of both mother and baby, underscoring the imperative nature of selecting an appropriate pain management strategy (Santana et al., 2016).

A variety of pharmacological and alternative treatment options exist for reducing labor pain. While pharmacological interventions such as neuraxial blockade are considered the standard of care, they may lead to adverse effects. In contrast, alternative interventions are generally safe and cost-effective. Modalities including hydrotherapy, massage therapy, hypnosis, aromatherapy, virtual reality, and music therapy have demonstrated efficacy in alleviating physical pain and attending to the psychological needs of patients (Koyyalamudi et al., 2016; Lowe, 2002).

Virtual reality (VR) is an emerging technology that engenders a computer-generated, multi-sensory environment, immersing the user in a tangible, interactive experience. This simulated environment is experienced through a device known as a virtual reality headset or helmet(Chirico et al., 2016). VR effectively captures and directs the user's attention toward the virtual world. As the brain's attentional capacity is finite, an environment that incorporates all sensory inputs can diminish the perception of pain in the physical realm(Hoffman et al., 2020). Enhanced levels of immersion and diversion within VR result in more pronounced analgesic effects of the compelling sense of presence it offers(Hoffman, Seibel, et al., 2006). Functional MRI (fMRI) findings suggest that VR induces alterations in sensory and emotional pain processing, thereby attenuating pain-related brain activity (Hoffman, Richards, et al., 2006).

Numerous studies conducted in diverse healthcare settings, encompassing hospitalized patients, surgical patients, individuals with cancer, burn injuries, spinal pain, back pain, dental procedures, and various medical interventions, have consistently demonstrated the favorable impact of VR on pain mitigation (Ahern et al., 2020; Ahmad et al., 2020; Bordeleau et al., 2022; Ding et al., 2020; Georgescu et al., 2020; López-Valverde et al., 2020; Morris et al., 2009; Tashjian et al., 2017). Furthermore, select clinical trials have yielded promising outcomes about the application of VR technology during labor(Frey et al., 2019r & Apay, 2020). Specifically, a study indicated that VR effectively ameliorated sensory and cognitive pain during the initial stage of labor; however, no statistically significant disparity in pain reduction was observed between the VR and non-VR cohorts during the subsequent stage (Momenyan & Safaei, 2021). The consensus on the influence of VR on labor pain remains ambiguous and contradictory, warranting further substantiation for its precise efficacy. Notably, no systematic review to date has deliberated on the effectiveness of VR in alleviating labor pain.

This systematic review aims to evaluate the effects of VR during labor, considering the Parity status.

Data Sources and Searches

The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with a protocol registered in INPLASY (identification number 202100035 and DOI 10.37766/inplasy2021.10.0035). A comprehensive search strategy was developed to identify clinical trials exploring the efficacy of VR in mitigating labor pain. Systematic searches were conducted in databases including Embase, Scopus, PubMed, and Web of Science using specific terms related to labor, childbirth, and virtual reality. The complete search strategy is outlined in Supplementary 1. Furthermore, the reference lists of relevant review articles identified during the search were manually scrutinized. Subsequently, search results were managed using EndNote (version X7, Clarivate Analytics) for reference organization and duplicate elimination. The web-based application Rayyan QCRI(Ouzzani et al., 2016) was utilized for further duplicate removal and screening.

Study Selection

A review was conducted on English-language randomized controlled trials (RCTs) published in peer-reviewed journals concerning the use of VR for the management of labor pain. The study participants comprised low-risk pregnant women at full term, both nulliparous and multiparous, with no age or ethnicity restrictions. VR interventions encompassed any VR-based modality delivered through head-mounted displays or glasses, without limitations on content, duration, or immersion level. The intervention could be administered at any stage of labor. Control groups received standard care in the labor ward, a placebo, or sham VR. The primary outcome of the included studies was the prioritization of labor pain as well as the use of valid pain assessment tools for quantitative measurement. Studies were not excluded based on the provision of analgesia access throughout the labor process.

Data Extraction and Quality Assessment

A data extraction form was created to encompass the following elements: first author, publication year, country, participant characteristics, study design, setting, VR intervention (device type, content, duration, number of sessions), tools for pain assessment, and mean and standard deviation of pain scores. Two independent reviewers conducted data extraction and assessed bias risk, resolving any discrepancies through discussion.

The randomized controlled trials (RCTs) were assessed using a modified Downs and Black (Downs & Black, 1998)checklist comprising 27 questions with response options including "YES," "NO," and "unable to determine." This checklist serves to evaluate internal validity, external validity, and reporting. Some questions were omitted due to their lack of relevance to the present study.

Data Synthesis and Analysis

The effect sizes for each article were calculated using the mean and standard deviation of pain scores employing Hedges' g formula. R software (Version 4.4.1) was utilized to assess the combined effect size and heterogeneity. Heterogeneity was evaluated utilizing the I² test, with a random-effects model for substantial heterogeneity (I² ≥ 50%) and a fixed-effects model for relatively homogeneous data (I² < 50%). Funnel plot asymmetry tests were performed to scrutinize publication bias.

Moderators Analysis

The meta-regression analysis sought to assess various moderators including the stage of cervical dilation, measurement tools, and blinding status to elucidate the sources of heterogeneity and the conditions under which VR proves effective.

Subgroup Analyses

Subgroup analyses were conducted to examine the varying impact of VR interventions on labor pain among nulliparous, primiparous, and mixed parity groups. These analyses aimed to elucidate the effect size discrepancies and heterogeneity within each parity category. The research sought to provide insights into the differential effects of VR interventions on labor pain among women with different parity statuses.

Study Selection

In the process of study selection, a total of 6,197 records underwent screening, resulting in the identification of 46 reports for comprehensive evaluation. Consequently, 35 reports were deemed ineligible due to incongruent outcomes, settings, conference abstracts, and varying classifications, encompassing review articles and letters. Notably, two studies (El-Sayed Hussein et al., 2022(El-Sayed Hussein et al., 2022); El Sharkawy et al., 2022(El Sharkawy et al., 2022)) exhibited identical statistical findings, prompting concern regarding data authenticity as a result of conspicuously similar participant characteristics and methodologies. Consequently, these two studies were excluded. Furthermore, the study conducted by Mahalan et al. 2023(Mahalan & Smitha, 2023) was omitted from consideration due to a lack of reported standard deviation. This rigorous selection process culminated in the inclusion of 10 studies in the final systematic review and meta-analysis, thereby ensuring the reliability and integrity of our findings.

Study Characteristics

The characteristics of the 10 included studies exemplify a varied and comprehensive exploration of the utilization of VR for the management of labor pain. These studies were carried out in diverse countries, such as Iran, Indonesia, Turkey, the United States, New Zealand, and India, indicating a global interest in this interventionanalgesricomp(Akin et al., 2021; Carus et al., 2022; Ebrahimian et al., 2022; Frey et al., 2019r & Apay, 2020; Massov et al., 2023; Mohammadi et al., 2023; Momenyan & Safaei, 2021; Pratiwi et al., 2017; Wong et al., 2021). The publication years spanned from 2017 to 2023, underscoring recent progress and increasing research in this domain. Participant demographics encompassed nulliparous and multiparous women in low-risk, full-term pregnancies. The VR interventions exhibited wide-ranging disparities in content, duration, and level of immersion, incorporating natural scenes, underwater simulations, and guided meditations, with typical session durations of 10–20 minutes. Pain assessment methodologies also varied across the studies, with the Numerical Rating Scale (NRS) and Visual Analog Scale (VAS) being the most preponderant. This divergence in study design and VR content underscores the broad relevance and potential of VR as a tool for managing labor pain across various contexts and demographics.

Table 1

Study Characteristics
Study	Momenyan et al(2020)	Pratiw et al (2017)	Gür et al (2020)	Wong et al (2020)	Akin et al (2021)	Ebrahimian et al (2022)	Mohammadi et al (2023)	Carus et al (2022)	Massov et al (2023)	Frey et al (2019)
Title	Immersive virtual reality analgesia in un-medicated laboring women (during stage 1 and 2): a randomized controlled trial	The Effect of Virtual Reality on Pain in Primiparity Women	The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial	Virtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial	The Effect of Showing Images of the Foetus with the Virtual Reality Glass During Labour Process on Labour Pain, Birth Perception and Anxiety	Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial	Virtual Reality, Fear of Pain and Labor Pain Intensity: A Randomized Controlled Trial	Immersive virtual reality on childbirth experience for women: a randomized controlled trial	Virtual reality is beneficial in decreasing pain in labouring women: A preliminary study	Virtual Reality Analgesia in Labor: The VRAIL Pilot Study—A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women
Authors	Narges Momenyan, Ali Asghar Safaei, Sedighe Hantoushzadeh	Intan Gumilang Pratiw, Farid Husin, Ahmad Rizal Ganiem, Hadi Susiarno, Achmad Arifin, Firman Wirahkusuma	Elif Yagmur Gür, Serap Ejder Apay	Melissa S. Wong, MD, MHDS, Brennan M.R. Spiegel, MD, MSHS, Kimberly D. Gregory, MD, MPH	Bihter Akin, Mine Yilmaz Kocak, Zehra Küçükaydın, Kübra Güzel	Atefeh Ebrahimian, Roghaieh Rahmani Bilandi, Mohammad Reza Rahmani Bilandi, Zahra Sabzeh	Halimeh Mohammadi, Javad Rasti, Elham Ebrahimi	Elif Gizem Carus, Nazli Albayrak, Halit Mert Bildirici, Selen Gur Ozmen	Lorna Massov, Brian Robinson, Edgar Rodriguez-Ramirez, Robyn Maude	David P. Frey, DO, Melissa E. Bauer, DO, Carrie L. Bell, MD, Lisa Kane Low, PhD, CNM, Afton L. Hassett, PsyD, Ruth B. Cassidy, MA, Katherine D. Boyer, BS, Sam R. Sharar, MD
Year of publication	2021	2017	2020	2020	2021	2022	2023	2022	2023	2019
Country of study	Iran	Indonesia	Turkey	United States	Turkey	Iran	Iran	Turkey	New Zealand	United States
Study design	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial	Randomized controlled trial with Cross-over	Randomized controlled trial with Cross-over
Sample size	52	60	273	40	100 (50 intervention group, 50 control group)	93 (31 in each group)	130	42 (21 in each group)	14	28 (27 completed)
Inclusion criteria	Healthy Iranian women, age 18–45, first-time giving birth after 38 weeks, no desire for pharmacologic pain intervention, low-risk pregnancy, anticipated vaginal delivery	Indonesian national, low risk of pregnancy without obstetric complication, came to health public services on latent phase	Not having visual or auditory impairment, admitted to the delivery room for vaginal delivery, term pregnancy (38–40 weeks), active phase of labor (5–7 cm dilatation), no obstetric risks, not receiving oxytocin, carrying a live fetus	Nulliparous, term women in labor with pain scores of 4 to 7, having regular contractions at least every 5 minutes, ≥ 18 years old, English-speaking, able to give informed consent	In the 28th week of pregnancy, primiparous, head presentation, no risks regarding the pregnant woman and foetus, over the age of 18, agreed to participate in the study	Consent to participate, gravida 1 or 2, singleton pregnancy, live embryo, active phase of childbirth, maternal age 18–35 years, pregnancy stage 37–41 weeks, no medical or mental illness, no abnormal embryos, cephalic presentations, low risk pregnancy	Healthy pregnant women, 37–41 weeks gestation, singleton pregnancy, vertex presentation, no chronic medical conditions or pregnancy complications	Women between 18–42 years of age, 37–41 weeks gestation, singleton pregnancy, vertex presentation, no history of chronic medical conditions, no pregnancy complications	Women at ≥ 35 weeks gestation, nulliparous or multiparous in active first stage of labour, pain score > 8, three contractions in ten minutes lasting 60–90 seconds	Healthy women at ≥ 32 weeks’ gestation giving birth for the first time, in the first stage of labor with anticipated vaginal delivery
Exclusion criteria	High-risk pregnancy, need for other analgesia methods, fetal or placental anomaly, inability to assess pain, hearing or vision impairment, mental disorders, seizure history, motion sickness predisposition, undesirable VR content memory	Parturient rejects the VR intervention, came in active phase of labor before intervention, did not receive complete intervention, obstetric complication	Visual or auditory impairment, not meeting other inclusion criteria, refusal to participate	Use of any medications for pain relief prior to intervention, preterm gestation, pain not due to contractions, pain scores outside of the intended range, risk for seizures, sensitivity to flashing light/motion, medical condition predisposing to nausea/dizziness, injury to eyes/face/neck or arms	Elective caesarean, got pregnant with assisted reproductive techniques, vision and hearing problems, decided to go into labor in another institution, emergency cesarean section	Mother's unwillingness to cooperate, midwifery problems, use of Entonox and spinal and epidural anesthesia, chewing gum less than 20 min, watching virtual reality film less than 20 min	Migraine, headache, dizziness, motion sickness, epilepsy, psychiatric disorders, visual or auditory disabilities, history of cesarean section	Migraine, headache, dizziness, motion sickness, epilepsy, psychiatric disorders, visual or auditory disabilities, history of cesarean section	Use of pharmacologic analgesia, age < 18, hearing or vision deficits, psychiatric disorders, seizure history, predisposition for motion sickness, requiring an interpreter	Current use of pharmacologic analgesia, age < 18 or > 45, fetal or placental anomaly, high-risk pregnancy, fetal concerns requiring urgent delivery, inability to indicate pain intensity, requiring interpreter, hearing or vision deficits, psychiatric disorders, seizure history, predisposition for motion sickness
Health status	Healthy, low-risk pregnancy	Low risk of pregnancy without obstetric complication	Low risk of pregnancy without obstetric complication	Healthy, term pregnancy	Healthy, no risks regarding the pregnant woman and foetus	Healthy, low risk pregnancy	Healthy, no chronic medical conditions or pregnancy complications	Healthy, no chronic medical conditions or pregnancy complications	Healthy, no chronic medical conditions or pregnancy complications	Healthy, low-risk pregnancy
Intervention Details
Description of the VR intervention	Simulated environment with nature scenes and sounds, presented in 360 degrees video, each intervention lasted 10 minutes during contractions	VR distraction sequence scenery like river, beach, waterfall, lake, developed by Festivo©, presented using smartphone Lenovo K4 Note VR series. Each intervention lasted 10 minutes during labor.	Video of newborn photographs with classical music (Beethoven-Moonlight Sonata), video of newborn photograph album, introductory film of Turkey, classical music (Beethoven-Moonlight Sonata), routine hospital care	Labor protocol visualization by applied VR containing imagery of blossoming tree, ocean waves, crackling campfire with meditative auditory guidance specific to pregnancy and laboring women	Ultrasound images of the foetus recorded on the 28th week of pregnancy shown with VR glass during labor process	Virtual reality glasses containing 360-degree video with nature landscapes (Samsung Gear VR Virtual Reality Headset with Samsung Mobile S7), performed twice (4–5 cm and 7–8 cm dilatations), each intervention lasted 20 min	Samsung Gear VR Headset streaming a game with pleasant sounds (flow of water), simulating a sea shore, used from early labor (4 cm dilation) for at least 20 minutes until the end of the first stage of labor	Oculus Quest All-in-one VR Gaming Headset with Nature Treks environments, used in early labor (3 cm dilation) for 20 min and after epidural analgesia in active labor (6–7 cm dilation) for 20 min	Oculus Go headset with Ocean Rift scuba diving simulation, playful dolphins scene with accompanying dolphin sounds, breathing sounds, and classical music	Ocean Rift scuba diving simulation with manatee calls and underwater breathing sounds, additional relaxing music from Brain.fm
Type of VR equipment used	Head-mounted display powered by Samsung S3, noise reduction headphones	Smartphone Lenovo K4 Note VR series	Samsung Gear VR2 VRG	VR goggle set	VR Box 3D virtual reality glass	Samsung Gear VR Virtual Reality Headset with Samsung Mobile S7	Samsung Gear VR Headset	Oculus Quest All-in-one VR Gaming Headset	Oculus Go headset	Samsung GearVR head-mounted display, Galaxy S7 phone, noise-reducing headphones powered by parallel S5 phone
Stage(s) of labor during which VR was used	First and second stages	Latent phase (1–3 cm dilatation), Active phase (4–5 cm, 7–8 cm dilatation)	Active phase (5–7 cm dilatation)	During labor with pain scores of 4 to 7	During labor	Active phase (4–5 cm and 7–8 cm dilatations)	Early labor (4 cm dilation) until the end of the first stage of labor	Early labor (3 cm dilation) and active labor (6–7 cm dilation)	Active labor	First stage of labor during unmedicated contractions
Control group details	Usual care	Usual care	Routine hospital care	No additional intervention (usual care)	Routine procedures in the hospital	Routine maternity unit care according to national protocol	Standard care without VR intervention	Standard care without VR intervention	No VR intervention, standard care	Unmedicated labor without analgesics, alternative therapies, or systematic distraction

Figure 1. PRISMA flowchart

Detailed Descriptions of VR Content and Its Relevance to Pain Management

The study conducted by Momenyan et al. (2020) employed a simulated environment featuring natural landscapes and ambient sounds, presented through a 360-degree video format. Each intervention had a duration of 10 minutes, coinciding with contractions. It is widely acknowledged that natural scenery can elicit relaxation and mitigate stress. The immersive encounter of being situated in a tranquil, natural milieu has the potential to redirect focus from discomfort and establish a calming atmosphere for the parturient woman.(Momenyan & Safaei, 2021)

In a study conducted by Pratiw et al. (2017), a VR distraction sequence was utilized during labor. This sequence, developed by Festivo©, incorporated serene natural landscapes such as rivers, beaches, waterfalls, and lakes, with each intervention lasting 10 minutes. It is widely acknowledged that the visual presence of water bodies and natural settings possesses calming attributes and can contribute to the reduction of anxiety levels. Furthermore, the incorporation of water sounds as part of the auditory component serves to augment the relaxation effect, thereby facilitating the management of pain.(Pratiwi et al., 2017)

In their study, Gür et al. (2020) incorporated a video presentation featuring newborn photographs set to classical music (specifically, Beethoven's Moonlight Sonata), along with an introductory film showcasing Turkey, as part of the birthing process. Although the specific durations of these elements were not disclosed, their purpose was to engage multiple senses and provide a distraction from labor pain. The combined visual and auditory stimuli are recognized for their calming effects, potentially aiding in the reduction of perceived pain.(Gür & Apay, 2020)

In 2019, Frey et al. presented a scuba diving simulation called Ocean Rift, which included manatee calls, underwater breathing sounds, and relaxing music from Brain. FM. This virtual reality content was used during labor as required. The underwater theme aimed to provide a unique and immersive distraction. The sounds of manatee calls and breathing aimed to simulate a serene environment, reducing stress and anxiety known to exacerbate pain.(Frey et al., 2019)

In the 2020 study conducted by Wong et al., a labor protocol featuring VR was employed to present imagery of blooming trees, ocean waves, and a crackling campfire complemented by meditation audio guidance tailored for pregnant women in labor. The purpose of the meditative guidance and tranquil visuals is to address the sensory and cognitive components of pain perception. Through the utilization of guided imagery, individuals in labor can effectively direct their focus away from pain and toward constructive visualization.(Wong et al., 2021)

In a study conducted by Akin et al. (2021), ultrasound imagery of the fetus at the 28th week of gestation was presented through the use of VR glasses during the labor process. The act of observing such ultrasound images has been demonstrated to foster a robust emotional bond and serve as a favorable source of diversion for the expectant mother. This emotional connection can effectively redirect the mother's attention away from discomfort and towards the imminent joy associated with the process of childbirth.(Akin et al., 2021)

Ebrahimian et al. (2022) employed VR technology, utilizing 360-degree nature landscape videos through a Samsung Gear VR Virtual Reality Headset with Samsung Mobile S7. The interventions were administered twice, at 4–5 cm and 7–8 cm dilations, each lasting 20 minutes. The immersive nature landscapes in VR facilitated visual and auditory distraction, effectively promoting relaxation and reducing anxiety, resulting in decreased pain perception.(Ebrahimian et al., 2022)

In 2023, Mohammadi et al. conducted a study wherein they utilized a Samsung Gear VR Headset to stream a game featuring soothing water sounds, simulating a seashore. This intervention was applied from the onset of early labor (4 cm dilation) for a minimum duration of 20 minutes until the conclusion of the initial stage of labor. Engaging with this virtual reality game notably contributed to the diversion from labor discomfort and imparted a calming influence through sensory immersion.(Mohammadi et al., 2023)

In their study, Carus et al. (2022) employed an Oculus Quest All-in-one VR Gaming Headset featuring Nature Treks environments. The VR technology was administered during early labor (3 cm dilation) for 20 minutes, and subsequently utilized after the application of epidural analgesia in active labor (6–7 cm dilation) for the same duration. The immersive Nature Treks environments are designed to provide a deeply engaging experience enhanced with interactive elements, effectively reducing the user's perception of pain.(Carus et al., 2022)

In a study conducted by Massov et al. (2023), an Oculus Go headset was employed to administer a scuba diving simulation from Ocean Rift, featuring a playful dolphin scene with accompanying dolphin sounds, and a background of classical music. The amalgamation of these elements was found to supply a cheerful and serene diversion, effectively mitigating discomfort by immersing the user in a positive and captivating experience.(Massov et al., 2023)

Pooled Effect Size

The meta-analysis yielded a pooled effect size of -0.7012 with a standard error (SE) of 0.0698, resulting in a z-value of -10.0466 and a p-value of less than 0.0001. The 95% confidence interval (CI) was calculated to be within the range of -0.8380 to -0.5644. These findings denote a statistically significant negative effect size, indicative of a substantial reduction in the measured outcome. Specifically, it suggests a consistent negative correlation between VR interventions and labor pain. The robustness of this conclusion is further underscored by the significance of the z-value.

Table 2

Studies effect sizes and their Standard errors.
Study ID	Effect Size	SE Effect Size
Momenyan et al (1)	-0.925971	0.304709
Momenyan et al (2)	-0.169656	0.2902
Momenyan et al (3)	-0.400586	0.292554
Momenyan et al( 4)	-0.329955	0.291634
Momenyan et al (5)	-0.640297	0.296963
Momenyan et al (6)	-0.534096	0.294767
Pratiw et al (1)	-0.77658	0.267754
Pratiw et al (2)	-0.770594	0.26761
Pratiw et al (3)	-1.091674	0.276763
Pratiw et al (4)	-1.165371	0.279256
Pratiw et al (5)	-0.8318	0.269133
Pratiw et al (6)	-0.655521	0.265043
Pratiw et al (7)	-0.953162	0.272466
Pratiw et al (8)	-0.8318	0.269133
Gür et al (1)	-0.78783	0.199776
Gür et al (2)	-1.49797	0.217774
Gür et al (3)	-0.79298	0.198959
Gür et al (4)	-1.33765	0.211916
Gür et al (5)	-0.214483	0.192123
Gür et al (6)	-0.723851	0.197747
Gür et al (7)	-0.446298	0.193943
Gür et al (8)	-1.237592	0.209108
Wong et al (1)	-0.222584	0.3176
Wong et al (2)	-0.372378	0.319349
Akin et al (1)	-0.045829	0.200026
Akin et al (2)	-1.931019	0.242166
Ebrahimian et al (1)	-0.512239	0.258132
Ebrahimian et al (2)	-0.791665	0.263762
Ebrahimian et al (3)	-1.085773	0.272072
Ebrahimian et al (4)	-0.781647	0.263521
Mohammad et al (1)	-0.224071	0.175961
Mohammad et al (2)	-0.420867	0.177343
Mohammad et al (3)	-0.449528	0.177613
Mohammad et al (4)	-0.465794	0.177774
Carus et al (1)	-0.479616	0.313012
Carus et al (2)	0	0.308607
Massov et al	-0.923953	0.39762
Frey et al (1)	-0.8	1.156463
Frey et al (2)	-1	1.183673
Frey et al (3)	-1.7	1.492758

Figure 2. Forest plot

Figure 3. Funnel plot

Heterogeneity and Overall Interpretation

The random-effects model has revealed significant heterogeneity among the studies, with an I² value of 65.54% and a Q statistic of 113.2127 (p < 0.0001). These findings indicate substantial variability in the effect sizes across the studies included in the meta-analysis. It is imperative to acknowledge and account for this heterogeneity when interpreting the overall pooled effect size. The observed variability may be attributed to differences in study design, participant characteristics, or the specific nature of the VR interventions employed.

Moderators Analysis

The meta-regression analysis examined a range of moderators to gain a clearer understanding of the factors contributing to variability and the specific conditions under which VR interventions are most likely to be effective.

The stage of cervical dilation proved to be a significant moderator. Specifically, the 6–7 cm dilation stage exhibited an estimated effect size of 0.8679 (SE = 0.3746, z = 2.3168, p = 0.0205), signifying a notably larger effect size than the reference stage. The remaining stages (7–8 cm cervix dilation, 4–6 cm cervix dilation, and 10 cm cervix dilation) did not demonstrate noteworthy variances from the reference stage.

The type of measurement tool used impacted the effect sizes observed. Studies using the Numerical Rating Scale (NRS) reported significantly larger effect sizes (Estimate = 0.4031, SE = 0.1999, z = 2.0164, p = 0.0438) than the reference tool. The Visual Analog Scale (VAS) also showed significantly larger effect sizes (Estimate = 0.8653, SE = 0.2652, z = 3.2627, p = 0.0011). However, the NVPS did not significantly differ from the reference.

Blinding emerged as a significant contributing factor, as evidenced by non-blinded studies which presented notably larger effect sizes (Estimate = 0.6362, SE = 0.2557, z = 2.4884, p = 0.0128).

The R² value of 100% suggests that these moderators collectively account for all the variability in effect sizes, with no residual heterogeneity (tau² = 0) and a non-significant QE test, indicating an appropriate model fit.

Subgroup Analyses

Nulliparous Group

In the nulliparous group, the model fit indices were as follows: log-likelihood of -4.1618, deviance of 8.3235, Akaike Information Criterion (AIC) of 12.3235, Bayesian Information Criterion (BIC) of 12.9287, and corrected AIC (AICc) of 14.0378. Heterogeneity was not observed (tau² = 0, I² = 0%), and the test for heterogeneity was not significant (Q-statistic (Q) ((Degrees of freedom (df) = 10) = 5.6295, p = 0.8454). The estimated effect size was − 0.4625 (SE = 0.1051, z = -4.4016, p < 0.0001), indicating a highly significant negative effect size without heterogeneity.

Primiparous Group

In the primiparous cohort, the model fit statistics were as follows: log-likelihood of -8.6358, deviance of 17.2715, AIC of 21.2715, BIC of 22.4014, and AICc of 22.4715. Notable heterogeneity was observed (tau² = 0.1691, I² = 76.87%), supported by a significant test for heterogeneity (Q (df = 13) = 55.5043, p < 0.0001). The estimated effect size was − 0.7342 (SE = 0.1269, z = -5.7862, p < 0.0001), signifying a highly significant negative effect size with substantial heterogeneity.

Mixed Parity Group

In the context of the mixed parity group, the model fit indices indicate a log-likelihood of -5.3573, a deviance of 10.7146, an AIC of 14.7146, a BIC of 15.6844, and an AICc of 16.0479. A moderate level of heterogeneity was observed (tau² = 0.0965, I² = 65.64%) with a statistically significant test for heterogeneity (Q (df = 12) = 35.9962, p = 0.0003). The estimated effect size stands at -0.8497 (SE = 0.1078, z = -7.8848, p < 0.0001), signifying a highly significant negative effect size with moderate heterogeneity.

The article presents a systematic review and meta-analysis that aims to assess the efficacy of VR in the management of labor pain. The findings from ten studies included in the analysis suggest that VR interventions significantly mitigate labor pain, offering a promising non-pharmacological approach. This discussion will delve into the implications of these findings, address potential constraints, and propose avenues for further research.

Implications of VR in Labor Pain Management

(Carus et al., 2022; Logan et al., 2023; Moreau et al., 2024; Nori et al., 2023; Wong et al., 2021) The immersive nature of VR effectively diverts the user's attention from physical pain by engaging multiple sensory inputs, in line with the gate control theory of pain(Naef et al., 2022). According to this theory, non-painful stimuli can effectively close the "gates" to painful input, thereby impeding the transmission of pain sensation to the central nervous system.(Melzack, 1996) The demonstrated efficacy of VR in managing labor pain lends support to this theoretical framework.

In addition, VR presents a non-pharmacological alternative that can be particularly advantageous for patients for whom certain medications are contraindicated or who prefer to refrain from pharmacological interventions.(Kassim et al., 2023) This holds particular significance in light of concerns surrounding the adverse effects and potential complications associated with epidural analgesia and other pharmacological pain relief modalities.(Nori et al., 2023)

Variability in VR Content and Its Effects

The included studies encompassed a diverse array of VR content, encompassing natural landscapes, underwater environments, guided meditations, and fetal ultrasound images. This diversity suggests that varying forms of VR content may effectively mitigate pain, plausibly attributable to the shared quality of immersive distraction.(Moreau et al., 2024; Pourmand et al., 2018; Teh et al., 2024) Nonetheless, the optimal category of VR content for the management of labor pain remains ambiguous and necessitates further examination.

For example, natural landscapes and underwater scenes were frequently employed and appeared to yield notable pain alleviation. These settings are likely to elicit sentiments of tranquility and relaxation, which can be advantageous during the demanding and distressing phases of childbirth(Getu et al., 2020). Moreover, the utilization of fetal ultrasound imagery, fostering emotional attachment, also demonstrated efficacy, underscoring the significance of emotional involvement in pain mitigation.(Araki et al., 2010; Branjerdporn et al., 2021)

Moderators of VR Effectiveness

The meta-regression analysis revealed various moderators influencing the efficacy of VR in mitigating labor pain. Notably, the stage of cervical dilation emerged as a significant determinant, indicating that VR interventions exhibit maximum effectiveness during the 6–7 cm dilation stage. This phase, synonymous with the active labor stage marked by intense contractions and notable pain, underscores the heightened utility of VR, likely attributed to the pronounced demand for distraction and pain alleviation during this critical period.(Carus et al., 2022; Mujiyani & Latifah, 2022)

Furthermore, the choice of pain assessment tool utilized in the studies had a substantial impact on the reported effect sizes. Studies that leveraged the NRS and VAS indicated larger effect sizes in comparison to those utilizing alternative tools. This distinction may be attributable to the inherent subjectivity of these scales, which potentially enables a more comprehensive capturing of the psychological benefits associated with VR.(Byrom et al., 2022; Olsen et al., 2017; Safikhani et al., 2018)

Heterogeneity Among Studies

The notable heterogeneity observed across the encompassed studies underscores the variability in study designs, participant characteristics, and VR interventions. This diversity accentuates the necessity for standardized protocols in forthcoming research endeavors to guarantee more uniform and comparable outcomes. Standardizing factors such as the nature of VR content, duration of exposure, and timing of intervention is imperative to diminish heterogeneity(Botella et al., 2017).

Subgroup Analyses

The results of subgroup analyses indicate that VR interventions were effective across various parity groups, albeit with varying effect sizes. Nulliparous women demonstrated a notable reduction in pain with minimal heterogeneity, suggesting a consistent effect of VR within this group. In contrast, both primiparous and mixed parity groups exhibited substantial heterogeneity, signaling diverse responses to VR interventions.

The variance in response to VR as a means of pain relief during childbirth may stem from disparities in pain sensitivity and adaptive mechanisms among primiparous and multiparous women. Primiparous individuals may exhibit heightened anxiety and apprehension due to unfamiliarity, rendering them more receptive to the tranquillizing impacts of VR. In contrast, multiparous women may have developed coping strategies from previous childbirth experiences, consequently shaping their responsiveness to VR.(Carus et al., 2022; Huang et al., 2024; Shakarami et al., 2021)

Future Research Directions

Subsequent research should prioritize several paramount areas to expand upon the conclusions drawn from this systematic review. Firstly, there is a necessity for large-scale randomized controlled trials incorporating standardized VR protocols to authenticate the efficacy of VR in pain management during labor. These studies should encompass diverse demographic groups to ensure widespread applicability and to explore the impact of various types of VR content.

Secondly, research must delve into the optimal timing and duration of VR interventions. Gaining insights into the most suitable timing for introducing VR during labor and the ideal duration for maintaining the intervention could significantly enhance its overall effectiveness. Furthermore, there is a need to thoroughly examine the potential long-term effects of VR usage during labor, including its influence on postpartum recovery and mental health.

Lastly, the mechanisms underlying VR's pain-relieving effects need further elucidation. Functional MRI studies, like those mentioned in the article, can provide insights into how VR alters pain processing in the brain. This knowledge could inform the development of more targeted and effective VR interventions.

Limitations

This systematic review exhibits several limitations, primarily stemming from the noteworthy heterogeneity observed among the studies, thereby complicating the interpretation of the pooled effect size. Additionally, the reliance on self-reported pain measures introduces subjectivity, which could bias the results. The potential for publication bias also exists, as studies with negative findings are less likely to be published.

Furthermore, the omission of non-English language studies may have restricted the comprehensiveness of the review. Incorporating studies from diverse cultural contexts could yield a more comprehensive understanding of the efficacy of VR in managing labor pain.

The systematic review and meta-analysis findings demonstrate the potential of virtual reality (VR) as an effective tool for managing labor pain. It consistently shows significant pain reduction in diverse settings and among various populations. These results underscore VR's promise as a non-pharmacological intervention that can complement existing pain management strategies. Nevertheless, further research is imperative to standardize VR protocols, comprehend the mechanisms of action, and investigate the long-term effects of VR implementation during labor. Addressing these areas will optimize the integration of VR in clinical practice and contribute to improved outcomes for women in labor.

Funding

No funding was received to assist with the preparation of this manuscript.

Conflicts of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Author Contribution

Regarding the contributions of each author, Parisa Najjariasl and Amirreza Ramezani conducted the screening of the study. Kamran Dalvandi and Fateme Shabani were responsible for data extraction. Parisa Najjariasl wrote the manuscript, while Amirreza Ramezani performed the data analysis. Hadi Zamanian conceptualized the study and formulated the title.

Data Availability

Data is provided within the manuscript or supplementary information files.

Ahern, M. M., Dean, L. V, Stoddard, C. C., Agrawal, A., Kim, K., Cook, C. E., & Narciso Garcia, A. (2020). The effectiveness of virtual reality in patients with spinal pain: A systematic review and meta‐analysis. Pain Practice, 20(6), 656–675.
Ahmad, M., Mohammad, E. B., & Anshasi, H. A. (2020). Virtual reality technology for pain and anxiety management among patients with cancer: a systematic review. Pain Management Nursing, 21(6), 601–607.
Akin, B., Yilmaz Kocak, M., Küçükaydın, Z., & Güzel, K. (2021). The effect of showing images of the foetus with the virtual reality glass during labour process on labour pain, birth perception and anxiety. Journal of Clinical Nursing, 30(15–16), 2301–2308.
Araki, M., Nishitani, S., Ushimaru, K., Masuzaki, H., Oishi, K., & Shinohara, K. (2010). Fetal response to induced maternal emotions. The Journal of Physiological Sciences, 60, 213–220.
Bastos, M. H., Furuta, M., Small, R., McKenzie‐McHarg, K., & Bick, D. (2015). Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database of Systematic Reviews, 4.
Bordeleau, M., Stamenkovic, A., Tardif, P.-A., & Thomas, J. (2022). The use of virtual reality in back pain rehabilitation: a systematic review and meta-analysis. The Journal of Pain, 23(2), 175–195.
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent progress in virtual reality exposure therapy for phobias: a systematic review. Current Psychiatry Reports, 19, 1–13.
Branjerdporn, G., Meredith, P., Wilson, T., & Strong, J. (2021). Maternal–fetal attachment: Associations with maternal sensory processing, adult attachment, distress and perinatal loss. Journal of Child and Family Studies, 30, 528–541.
Byrom, B., Elash, C. A., Eremenco, S., Bodart, S., Muehlhausen, W., Platko, J. V, Watson, C., & Howry, C. (2022). Measurement comparability of electronic and paper administration of visual analogue scales: A review of published studies. Therapeutic Innovation & Regulatory Science, 56(3), 394–404.
Carus, E. G., Albayrak, N., Bildirici, H. M., & Ozmen, S. G. (2022). Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy and Childbirth, 22(1), 354.
Chirico, A., Lucidi, F., De Laurentiis, M., Milanese, C., Napoli, A., & Giordano, A. (2016). Virtual reality in health system: beyond entertainment. A mini‐review on the efficacy of VR during cancer treatment. Journal of Cellular Physiology, 231(2), 275–287.
Dennis, C.-L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry, 210(5), 315–323.
Ding, L., Hua, H., Zhu, H., Zhu, S., Lu, J., Zhao, K., & Xu, Q. (2020). Effects of virtual reality on relieving postoperative pain in surgical patients: A systematic review and meta-analysis. International Journal of Surgery, 82, 87–94.
Downs, S. H., & Black, N. (1998). The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Journal of Epidemiology & Community Health, 52(6), 377–384.
Ebrahimian, A., Bilandi, R. R., Bilandī, M. R. R., & Sabzeh, Z. (2022). Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy and Childbirth, 22(1), 49.
El Sharkawy, T. A. E.-W., Mohamed Abd-El Hady, R., Abdelhaliem Said, S., Abdel-Wahab Afifi Araby, O., & Taha Ahmed Abou-Elazab, R. (2022). Efficacy of virtual reality application as a distraction for primiparity women at 1st stage of labor on pain and anxiety control. Egyptian Journal of Health Care, 13(1), 1267–1284.
El-Sayed Hussein, D., Ahmed El-Sheikh, M., Mohamed Abd-El Hady, R., & Afifi, A. E.-W. (2022). Usability of virtual reality for alleviating pain and anxiety for primiparity women during 1st stage of labor and its reflection on labor outcomes. Journal of Nursing Science Benha University, 3(1), 416–431.
Frey, D. P., Bauer, M. E., Bell, C. L., Low, L. K., Hassett, A. L., Cassidy, R. B., Boyer, K. D., & Sharar, S. R. (2019). Virtual reality analgesia in labor: the VRAIL pilot study—a preliminary randomized controlled trial suggesting benefit of immersive virtual reality analgesia in unmedicated laboring women. Anesthesia & Analgesia, 128(6), e93–e96.
Georgescu, R., Fodor, L. A., Dobrean, A., & Cristea, I. A. (2020). Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. Psychological Medicine, 50(11), 1795–1807.
Getu, A. A., Getie, S. A., Gela, G. B., Maseresha, E. A., Feleke, B. E., & Muna, A. M. (2020). Non-pharmacological labor pain management and associated factor among skilled birth attendants in Amhara Regional State health institutions, Northwest Ethiopia. Reproductive Health, 17(1), 183.
Grekin, R., & O’Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clinical Psychology Review, 34(5), 389–401.
Gür, E. Y., & Apay, S. E. (2020). The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial. Midwifery, 91, 102856.
Hoffman, H. G., Boe, D. A., Rombokas, E., Khadra, C., LeMay, S., Meyer, W. J., Patterson, S., Ballesteros, A., & Pitt, S. W. (2020). Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain. Journal of Hand Therapy, 33(2), 254–262.
Hoffman, H. G., Richards, T. L., Bills, A. R., Van Oostrom, T., Magula, J., Seibel, E. J., & Sharar, S. R. (2006). Using FMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums, 11(1), 45–51.
Hoffman, H. G., Seibel, E. J., Richards, T. L., Furness, T. A., Patterson, D. R., & Sharar, S. R. (2006). Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. The Journal of Pain, 7(11), 843–850.
Huang, Y., Zhong, Y., Chen, Q., Zhou, J., Fu, B., Deng, Y., Tu, X., & Wu, Y. (2024). A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study. BMC Pregnancy and Childbirth, 24(1), 400.
Kassim, M. A. K., Pantazi, A. C., Nori, W., Tuta, L. A., Balasa, A. L., Mihai, C. M., Mihai, L., Frecus, C. E., Lupu, V. V., & Lupu, A. (2023). Non-pharmacological interventions for pain management in hemodialysis: A narrative review. Journal of Clinical Medicine, 12(16), 5390.
Kountanis, J. A., Kirk, R., Handelzalts, J. E., Jester, J. M., Kirk, R., & Muzik, M. (2022). The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. Archives of Women’s Mental Health, 25(1), 171–180.
Koyyalamudi, V., Sidhu, G., Cornett, E. M., Nguyen, V., Labrie-Brown, C., Fox, C. J., & Kaye, A. D. (2016). New labor pain treatment options. Current Pain and Headache Reports, 20, 1–9.
Levett, K. M., Sutcliffe, K. L., & Betts, D. (2019). Using forbidden points in pregnancy: adverse outcomes and quality of evidence in randomized controlled trials—a systematic narrative review. Medical Acupuncture, 31(6), 346–360.
Logan, D. E., Khanna, K., Randall, E., O’Donnell, S., Reks, T., & McLennan, L. (2023). Centering Patient and Clinician Voices in Developing Tools to Address Pain Related School Impairment: A Phase I Study of a Virtual Reality School Simulation for Children and Adolescents with Chronic Pain. Children, 10(10), 1644.
López-Valverde, N., Muriel Fernandez, J., López-Valverde, A., Valero Juan, L. F., Ramírez, J. M., Flores Fraile, J., Herrero Payo, J., Blanco Antona, L. A., Macedo de Sousa, B., & Bravo, M. (2020). RETRACTED: Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 9(4), 1025.
Lowe, N. K. (2002). The nature of labor pain. American Journal of Obstetrics and Gynecology, 186(5), S16–S24.
Mahalan, N., & Smitha, M. V. (2023). Effect of audio-visual therapy on pain and anxiety in labor: A randomized controlled trial. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 20, 100240.
Massov, L., Robinson, B., Rodriguez‐Ramirez, E., & Maude, R. (2023). Virtual reality is beneficial in decreasing pain in labouring women: A preliminary study. Australian and New Zealand Journal of Obstetrics and Gynaecology, 63(2), 193–197.
Melzack, R. (1996). Gate control theory: On the evolution of pain concepts. Pain Forum, 5(2), 128–138.
Mohammadi, H., Rasti, J., & Ebrahimi, E. (2023). Virtual reality, fear of pain and labor pain intensity: A randomized controlled trial. Anesthesiology and Pain Medicine, 13(1).
Momenyan, N., & Safaei, A. A. (2021). Immersive virtual reality analgesia in un-medicated laboring women (during stage 1 and 2): a randomized controlled trial.
Moreau, S., Thérond, A., Cerda, I. H., Studer, K., Pan, A., Tharpe, J., Crowther, J. E., Abd-Elsayed, A., Gilligan, C., & Tolba, R. (2024). Virtual reality in acute and chronic pain medicine: an updated review. Current Pain and Headache Reports, 1–36.
Morris, L. D., Louw, Q. A., & Grimmer-Somers, K. (2009). The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. The Clinical Journal of Pain, 25(9), 815–826.
Mujiyani, S. A., & Latifah, L. (2022). Pain management in the first stage of labour using sensory stimulation. British Journal of Midwifery, 30(7), 396–404.
Naef, A. C., Jeitziner, M.-M., Knobel, S. E. J., Exl, M. T., Müri, R. M., Jakob, S. M., Nef, T., & Gerber, S. M. (2022). Investigating the role of auditory and visual sensory inputs for inducing relaxation during virtual reality stimulation. Scientific Reports, 12(1), 17073.
Nori, W., Kassim, M. A. K., Helmi, Z. R., Pantazi, A. C., Brezeanu, D., Brezeanu, A. M., Penciu, R. C., & Serbanescu, L. (2023). Non-pharmacological pain management in labor: a systematic review. Journal of Clinical Medicine, 12(23), 7203.
Olsen, M. F., Bjerre, E., Hansen, M. D., Hilden, J., Landler, N. E., Tendal, B., & Hróbjartsson, A. (2017). Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Medicine, 15, 1–18.
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan—a web and mobile app for systematic reviews. Systematic Reviews, 5, 1–10.
Persson, A., Lindmark, S., Petersson, K., Gabriel, E., Thorsell, M., Lindström, K., Göransson, M., Cardell, G., & Magnusson, Å. (2020). Potentially traumatic events, fear of childbirth and posttraumatic stress disorder during pregnancy in Stockholm, Sweden: A cross-sectional study. Sexual & Reproductive Healthcare, 25, 100516.
Pourmand, A., Davis, S., Marchak, A., Whiteside, T., & Sikka, N. (2018). Virtual reality as a clinical tool for pain management. Current Pain and Headache Reports, 22, 1–6.
Pratiwi, I. G., Husin, F., Ganiem, A. R., Susiarno, H., Arifin, A., & Wirakusuma, F. (2017). The effect of virtual reality on pain in primiparity women. International Journal of Nursing and Health Science, 4(4), 46–50.
Safikhani, S., Gries, K. S., Trudeau, J. J., Reasner, D., Rüdell, K., Coons, S. J., Bush, E. N., Hanlon, J., Abraham, L., & Vernon, M. (2018). Response scale selection in adult pain measures: results from a literature review. Journal of Patient-Reported Outcomes, 2, 1–9.
Santana, L. S., Gallo, R. B. S., Ferreira, C. H. J., Duarte, G., Quintana, S. M., & Marcolin, A. C. (2016). Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. Journal of Physiotherapy, 62(1), 29–34.
Shakarami, A., Mirghafourvand, M., Abdolalipour, S., Jafarabadi, M. A., & Iravani, M. (2021). Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women. BMC Pregnancy and Childbirth, 21, 1–9.
Tashjian, V. C., Mosadeghi, S., Howard, A. R., Lopez, M., Dupuy, T., Reid, M., Martinez, B., Ahmed, S., Dailey, F., & Robbins, K. (2017). Virtual reality for management of pain in hospitalized patients: results of a controlled trial. JMIR Mental Health, 4(1), e7387.
Teh, J. J., Pascoe, D. J., Hafeji, S., Parchure, R., Koczoski, A., Rimmer, M. P., Khan, K. S., & Al Wattar, B. H. (2024). Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Medicine, 22(1), 64.
Wong, M. S., Spiegel, B. M. R., & Gregory, K. D. (2021). Virtual reality reduces pain in laboring women: a randomized controlled trial. American Journal of Perinatology, 38(S 01), e167–e172.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis

Status:

Version 1

Abstract

Figures

Introduction

Methods

Data Sources and Searches

Study Selection

Data Extraction and Quality Assessment

Data Synthesis and Analysis

Moderators Analysis

Subgroup Analyses

Results

Study Selection

Study Characteristics

Detailed Descriptions of VR Content and Its Relevance to Pain Management

Pooled Effect Size

Heterogeneity and Overall Interpretation

Moderators Analysis

Subgroup Analyses

Discussion

Implications of VR in Labor Pain Management

Variability in VR Content and Its Effects

Moderators of VR Effectiveness

Heterogeneity Among Studies

Subgroup Analyses

Future Research Directions

Limitations

Conclusion

Declarations

Funding

Author Contribution

Data Availability

References

Additional Declarations

Supplementary Files

Status:

Version 1