Faris Regi RISWANA, Faris Rega RISWANA, Krisjentha Iffah AGUSTASARI
Mediterranean Nursing and Midwifery - 2026;6(4):260-266
Objective: Pregnancy and childbirth are natural processes, but labor pain is a physiological phenomenon experienced by women as they approach childbirth. This is one of the reasons for the increasing demand for cesarean delivery. Non-pharmacological pain management, including the use of a birth ball, is an important aspect of childbirth care. However, its effectiveness requires systematic evaluation and analysis. This study aimed to evaluate the effect of using the birth ball exercise during the active phase on labor pain. Methods: ScienceDirect, PubMed, and Scopus were searched from their inception to August 2025 using the following search terms: ("birth ball" OR "gym ball" OR "birthing ball") AND ("pain") AND ("labor" OR "labour" OR "delivery"), without restrictions on publication year or language. A total of 188 titles and abstracts were identified. Twelve full-text articles were assessed for eligibility, and 4 randomized controlled trials (RCTs) met the inclusion criteria. Labor pain was measured using a 10-cm Visual Analog Scale. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was performed using Review Manager, version 5.4.1. Results: Four RCTs involving 443 women were included in the systematic review and meta-analysis. The pooled analysis demonstrated that birth ball exercise during the active phase of labor significantly reduced labor pain, with a mean difference of -1.70 points (95% CI: -1.98 to -1.41; P < .00001; I2 = 28%). Conclusion: The implementation of the birth ball exercise during the active phase could be an effective method for women to reduce labor pain. PROSPERO Registration Number: CRD420261287315
