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

The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis Parisa Najjariasl, Kamran Dalvandi, Fateme Shabani, Hadi Zamanian, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4724968/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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 Figures Figure 1 Figure 2 Figure 3 Introduction 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., 2019 r & 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. Methods 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. Results 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., 2019 r & 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 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. Discussion 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. Conclusion 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. Declarations 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. References 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. Additional Declarations No competing interests reported. Supplementary Files Supplementary1.docx DownsandBlack.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4724968","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":328230446,"identity":"1dfaa606-e1a2-40a4-9a0f-b6189f807a75","order_by":0,"name":"Parisa Najjariasl","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Parisa","middleName":"","lastName":"Najjariasl","suffix":""},{"id":328230447,"identity":"0b8cd6b8-befc-4644-8f8a-3071fec8b32c","order_by":1,"name":"Kamran Dalvandi","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Kamran","middleName":"","lastName":"Dalvandi","suffix":""},{"id":328230448,"identity":"49aa1f1c-8a6e-4474-b726-bacda1b8d10b","order_by":2,"name":"Fateme Shabani","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fateme","middleName":"","lastName":"Shabani","suffix":""},{"id":328230450,"identity":"67c8baba-0199-4928-9f7b-dbe6d929dd8d","order_by":3,"name":"Hadi Zamanian","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hadi","middleName":"","lastName":"Zamanian","suffix":""},{"id":328230452,"identity":"f1071011-2a48-4493-9d7e-5b32506eefe9","order_by":4,"name":"Amirreza Ramezani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYFACxgYE+wMQs7GTooVxBkgLMykWMvOASQKq+KcdbvtcUbNNTr6B+dlnm1/b5PmYGRg/fMzBrUXidmLzzDPHbhszNrAZz87tu23YxszALDlzGx5rgFqAqoEkA4Mxc27PbUagFjZmXjxa5MFa/t2ub2Ng/8xs2XPbnqAWA5CWxrbbCTwMPMbMDD9uJxLUYgjWAvTCDGaeYsbehtvJbcyMzXj9Inc7/TFjw7fb8vLt7ZsZfvy5bTu/vfngh4/4vA8HoOhgbAOxkNMDYfCHFMWjYBSMglEwUgAAK+BMDWh9pXUAAAAASUVORK5CYII=","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Amirreza","middleName":"","lastName":"Ramezani","suffix":""}],"badges":[],"createdAt":"2024-07-11 14:56:39","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4724968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4724968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61866040,"identity":"bbdb2a59-c39f-41ab-bda9-6475a5288339","added_by":"auto","created_at":"2024-08-06 12:09:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65595,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA flowchart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/842e148a78490ee4526c3911.png"},{"id":61866039,"identity":"62a4697a-93d4-4354-bfb7-e055e235acb4","added_by":"auto","created_at":"2024-08-06 12:09:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":35267,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.Forestplot.png","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/8dbe1242f7c3cc956aa12d88.png"},{"id":61866041,"identity":"22ac0693-ebbf-4b6b-a942-49de849fa7ea","added_by":"auto","created_at":"2024-08-06 12:09:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFunnel plot\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.Funnelplot.png","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/178d6757612581f72bcd9054.png"},{"id":81112497,"identity":"c1c76e18-128b-4ed2-aafb-c3ca72eb1775","added_by":"auto","created_at":"2025-04-22 10:53:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1229554,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/757c1f32-f886-4466-a62e-0f275b886b8a.pdf"},{"id":61865507,"identity":"050cf4fa-1e48-4467-8c65-bf5c016127a7","added_by":"auto","created_at":"2024-08-06 12:01:57","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16436,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/d886e20757d6356fd9fe29e8.docx"},{"id":61865508,"identity":"012cd28e-9a52-4745-8096-8927fdb8591a","added_by":"auto","created_at":"2024-08-06 12:01:57","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":21278,"visible":true,"origin":"","legend":"","description":"","filename":"DownsandBlack.docx","url":"https://assets-eu.researchsquare.com/files/rs-4724968/v1/c58f1441b2b071e5fddcff2f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePregnancy and childbirth represent pivotal life experiences that can deeply influence a mother's well-being, both positively and adversely (Bastos et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). 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., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Levett et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Persson et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). 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 \u0026amp; O\u0026rsquo;Hara, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Kountanis et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). 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 \u0026amp; O\u0026rsquo;Hara, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). 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., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA 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., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Lowe, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVirtual 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., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). 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., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). 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., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). 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., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNumerous 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., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Ahmad et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Bordeleau et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ding et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Georgescu et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; L\u0026oacute;pez-Valverde et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Morris et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Tashjian et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Furthermore, select clinical trials have yielded promising outcomes about the application of VR technology during labor(Frey et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003er \u0026amp; 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 \u0026amp; Safaei, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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.\u003c/p\u003e \u003cp\u003eThis systematic review aims to evaluate the effects of VR during labor, considering the Parity status.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Sources and Searches\u003c/h2\u003e \u003cp\u003eThe 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 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.37766/inplasy2021.10.0035\u003c/span\u003e\u003cspan address=\"10.37766/inplasy2021.10.0035\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). 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., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) was utilized for further duplicate removal and screening.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection\u003c/h2\u003e \u003cp\u003e 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Extraction and Quality Assessment\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e \u003cp\u003eThe randomized controlled trials (RCTs) were assessed using a modified Downs and Black (Downs \u0026amp; Black, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e1998\u003c/span\u003e)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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Synthesis and Analysis\u003c/h2\u003e \u003cp\u003eThe 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 I\u0026sup2; test, with a random-effects model for substantial heterogeneity (I\u0026sup2; \u0026ge; 50%) and a fixed-effects model for relatively homogeneous data (I\u0026sup2; \u0026lt; 50%). Funnel plot asymmetry tests were performed to scrutinize publication bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eModerators Analysis\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analyses\u003c/h2\u003e \u003cp\u003eSubgroup 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStudy Selection\u003c/h2\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e(El-Sayed Hussein et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e); El Sharkawy et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e(El Sharkawy et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)) 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 \u0026amp; Smitha, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) 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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Characteristics\u003c/h2\u003e \u003cp\u003eThe 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., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Carus et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ebrahimian et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Frey et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003er \u0026amp; Apay, 2020; Massov et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mohammadi et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Momenyan \u0026amp; Safaei, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Pratiwi et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Wong et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). 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\u0026ndash;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.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudy Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMomenyan et al(2020)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePratiw et al (2017)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eG\u0026uuml;r et al (2020)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWong et al (2020)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAkin et al (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEbrahimian et al (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMohammadi et al (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCarus et al (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMassov et al (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFrey et al (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTitle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImmersive virtual reality analgesia in un-medicated laboring women (during stage 1 and 2): a randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe Effect of Virtual Reality on Pain in Primiparity Women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eThe effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVirtual Reality Reduces Pain in Laboring Women: A Randomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe Effect of Showing Images of the Foetus with the Virtual Reality Glass During Labour Process on Labour Pain, Birth Perception and Anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVirtual Reality, Fear of Pain and Labor Pain Intensity: A Randomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eImmersive virtual reality on childbirth experience for women: a randomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eVirtual reality is beneficial in decreasing pain in labouring women: A preliminary study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eVirtual Reality Analgesia in Labor: The VRAIL Pilot Study\u0026mdash;A Preliminary Randomized Controlled Trial Suggesting Benefit of Immersive Virtual Reality Analgesia in Unmedicated Laboring Women\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAuthors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNarges Momenyan, Ali Asghar Safaei, Sedighe Hantoushzadeh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntan Gumilang Pratiw, Farid Husin, Ahmad Rizal Ganiem, Hadi Susiarno, Achmad Arifin, Firman Wirahkusuma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eElif Yagmur G\u0026uuml;r, Serap Ejder Apay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMelissa S. Wong, MD, MHDS, Brennan M.R. Spiegel, MD, MSHS, Kimberly D. Gregory, MD, MPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBihter Akin, Mine Yilmaz Kocak, Zehra K\u0026uuml;\u0026ccedil;\u0026uuml;kaydın, K\u0026uuml;bra G\u0026uuml;zel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAtefeh Ebrahimian, Roghaieh Rahmani Bilandi, Mohammad Reza Rahmani Bilandi, Zahra Sabzeh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHalimeh Mohammadi, Javad Rasti, Elham Ebrahimi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eElif Gizem Carus, Nazli Albayrak, Halit Mert Bildirici, Selen Gur Ozmen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLorna Massov, Brian Robinson, Edgar Rodriguez-Ramirez, Robyn Maude\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDavid 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\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear of publication\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCountry of study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndonesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNew Zealand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUnited States\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRandomized controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRandomized controlled trial with Cross-over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eRandomized controlled trial with Cross-over\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100 (50 intervention group, 50 control group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e93 (31 in each group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42 (21 in each group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e28 (27 completed)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy Iranian women, age 18\u0026ndash;45, first-time giving birth after 38 weeks, no desire for pharmacologic pain intervention, low-risk pregnancy, anticipated vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIndonesian national, low risk of pregnancy without obstetric complication, came to health public services on latent phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNot having visual or auditory impairment, admitted to the delivery room for vaginal delivery, term pregnancy (38\u0026ndash;40 weeks), active phase of labor (5\u0026ndash;7 cm dilatation), no obstetric risks, not receiving oxytocin, carrying a live fetus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNulliparous, term women in labor with pain scores of 4 to 7, having regular contractions at least every 5 minutes, \u0026ge;\u0026thinsp;18 years old, English-speaking, able to give informed consent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIn 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eConsent to participate, gravida 1 or 2, singleton pregnancy, live embryo, active phase of childbirth, maternal age 18\u0026ndash;35 years, pregnancy stage 37\u0026ndash;41 weeks, no medical or mental illness, no abnormal embryos, cephalic presentations, low risk pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealthy pregnant women, 37\u0026ndash;41 weeks gestation, singleton pregnancy, vertex presentation, no chronic medical conditions or pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eWomen between 18\u0026ndash;42 years of age, 37\u0026ndash;41 weeks gestation, singleton pregnancy, vertex presentation, no history of chronic medical conditions, no pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWomen at \u0026ge;\u0026thinsp;35 weeks gestation, nulliparous or multiparous in active first stage of labour, pain score\u0026thinsp;\u0026gt;\u0026thinsp;8, three contractions in ten minutes lasting 60\u0026ndash;90 seconds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHealthy women at \u0026ge;\u0026thinsp;32 weeks\u0026rsquo; gestation giving birth for the first time, in the first stage of labor with anticipated vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh-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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParturient rejects the VR intervention, came in active phase of labor before intervention, did not receive complete intervention, obstetric complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVisual or auditory impairment, not meeting other inclusion criteria, refusal to participate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUse 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eElective caesarean, got pregnant with assisted reproductive techniques, vision and hearing problems, decided to go into labor in another institution, emergency cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMother'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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMigraine, headache, dizziness, motion sickness, epilepsy, psychiatric disorders, visual or auditory disabilities, history of cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMigraine, headache, dizziness, motion sickness, epilepsy, psychiatric disorders, visual or auditory disabilities, history of cesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eUse of pharmacologic analgesia, age\u0026thinsp;\u0026lt;\u0026thinsp;18, hearing or vision deficits, psychiatric disorders, seizure history, predisposition for motion sickness, requiring an interpreter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eCurrent use of pharmacologic analgesia, age\u0026thinsp;\u0026lt;\u0026thinsp;18 or \u0026gt;\u0026thinsp;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\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthy, low-risk pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow risk of pregnancy without obstetric complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLow risk of pregnancy without obstetric complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHealthy, term pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eHealthy, no risks regarding the pregnant woman and foetus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHealthy, low risk pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHealthy, no chronic medical conditions or pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eHealthy, no chronic medical conditions or pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eHealthy, no chronic medical conditions or pregnancy complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHealthy, low-risk pregnancy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntervention Details\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescription of the VR intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSimulated environment with nature scenes and sounds, presented in 360 degrees video, each intervention lasted 10 minutes during contractions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVR distraction sequence scenery like river, beach, waterfall, lake, developed by Festivo\u0026copy;, presented using smartphone Lenovo K4 Note VR series. Each intervention lasted 10 minutes during labor.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVideo 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLabor protocol visualization by applied VR containing imagery of blossoming tree, ocean waves, crackling campfire with meditative auditory guidance specific to pregnancy and laboring women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUltrasound images of the foetus recorded on the 28th week of pregnancy shown with VR glass during labor process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eVirtual reality glasses containing 360-degree video with nature landscapes (Samsung Gear VR Virtual Reality Headset with Samsung Mobile S7), performed twice (4\u0026ndash;5 cm and 7\u0026ndash;8 cm dilatations), each intervention lasted 20 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSamsung 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\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOculus 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\u0026ndash;7 cm dilation) for 20 min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOculus Go headset with Ocean Rift scuba diving simulation, playful dolphins scene with accompanying dolphin sounds, breathing sounds, and classical music\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eOcean Rift scuba diving simulation with manatee calls and underwater breathing sounds, additional relaxing music from Brain.fm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of VR equipment used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead-mounted display powered by Samsung S3, noise reduction headphones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSmartphone Lenovo K4 Note VR series\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSamsung Gear VR2 VRG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVR goggle set\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eVR Box 3D virtual reality glass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSamsung Gear VR Virtual Reality Headset with Samsung Mobile S7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSamsung Gear VR Headset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOculus Quest All-in-one VR Gaming Headset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eOculus Go headset\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSamsung GearVR head-mounted display, Galaxy S7 phone, noise-reducing headphones powered by parallel S5 phone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStage(s) of labor during which VR was used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst and second stages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLatent phase (1\u0026ndash;3 cm dilatation), Active phase (4\u0026ndash;5 cm, 7\u0026ndash;8 cm dilatation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eActive phase (5\u0026ndash;7 cm dilatation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDuring labor with pain scores of 4 to 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDuring labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eActive phase (4\u0026ndash;5 cm and 7\u0026ndash;8 cm dilatations)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEarly labor (4 cm dilation) until the end of the first stage of labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEarly labor (3 cm dilation) and active labor (6\u0026ndash;7 cm dilation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eActive labor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eFirst stage of labor during unmedicated contractions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eControl group details\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUsual care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUsual care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRoutine hospital care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo additional intervention (usual care)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRoutine procedures in the hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRoutine maternity unit care according to national protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStandard care without VR intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eStandard care without VR intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNo VR intervention, standard care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUnmedicated labor without analgesics, alternative therapies, or systematic distraction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1. PRISMA flowchart\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDetailed Descriptions of VR Content and Its Relevance to Pain Management\u003c/h2\u003e \u003cp\u003eThe 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 \u0026amp; Safaei, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a study conducted by Pratiw et al. (2017), a VR distraction sequence was utilized during labor. This sequence, developed by Festivo\u0026copy;, 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., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn their study, G\u0026uuml;r 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.(G\u0026uuml;r \u0026amp; Apay, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a study conducted by Akin et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), 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., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eEbrahimian et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) 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\u0026ndash;5 cm and 7\u0026ndash;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., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn their study, Carus et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) 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\u0026ndash;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., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn a study conducted by Massov et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), 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., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePooled Effect Size\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudies effect sizes and their Standard errors.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE Effect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.925971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.304709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.169656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.2902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.400586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.292554\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al( 4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.329955\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.291634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.640297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.296963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMomenyan et al (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.534096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.294767\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.77658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.267754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.770594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.26761\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.091674\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.276763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.165371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.279256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.8318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.269133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.655521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.265043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.953162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.272466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePratiw et al (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.8318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.269133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.78783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.199776\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.49797\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.217774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.79298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.198959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.33765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.211916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.214483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.192123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.723851\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.197747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.446298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.193943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u0026uuml;r et al (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.237592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.209108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWong et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.222584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.3176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWong et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.372378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.319349\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkin et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.045829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.200026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAkin et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.931019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.242166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEbrahimian et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.512239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.258132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEbrahimian et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.791665\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.263762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEbrahimian et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.085773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.272072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEbrahimian et al (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.781647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.263521\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammad et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.224071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.175961\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammad et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.420867\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.177343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammad et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.449528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.177613\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammad et al (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.465794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.177774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarus et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.479616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.313012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarus et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.308607\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMassov et al\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.923953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.39762\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrey et al (1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.156463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrey et al (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.183673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrey et al (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.492758\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 2. Forest plot\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 3. Funnel plot\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eHeterogeneity and Overall Interpretation\u003c/h2\u003e \u003cp\u003eThe random-effects model has revealed significant heterogeneity among the studies, with an I\u0026sup2; value of 65.54% and a Q statistic of 113.2127 (p\u0026thinsp;\u0026lt;\u0026thinsp;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.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eModerators Analysis\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eThe stage of cervical dilation proved to be a significant moderator. Specifically, the 6\u0026ndash;7 cm dilation stage exhibited an estimated effect size of 0.8679 (SE\u0026thinsp;=\u0026thinsp;0.3746, z\u0026thinsp;=\u0026thinsp;2.3168, p\u0026thinsp;=\u0026thinsp;0.0205), signifying a notably larger effect size than the reference stage. The remaining stages (7\u0026ndash;8 cm cervix dilation, 4\u0026ndash;6 cm cervix dilation, and 10 cm cervix dilation) did not demonstrate noteworthy variances from the reference stage.\u003c/p\u003e \u003cp\u003eThe type of measurement tool used impacted the effect sizes observed. Studies using the Numerical Rating Scale (NRS) reported significantly larger effect sizes (Estimate\u0026thinsp;=\u0026thinsp;0.4031, SE\u0026thinsp;=\u0026thinsp;0.1999, z\u0026thinsp;=\u0026thinsp;2.0164, p\u0026thinsp;=\u0026thinsp;0.0438) than the reference tool. The Visual Analog Scale (VAS) also showed significantly larger effect sizes (Estimate\u0026thinsp;=\u0026thinsp;0.8653, SE\u0026thinsp;=\u0026thinsp;0.2652, z\u0026thinsp;=\u0026thinsp;3.2627, p\u0026thinsp;=\u0026thinsp;0.0011). However, the NVPS did not significantly differ from the reference.\u003c/p\u003e \u003cp\u003eBlinding emerged as a significant contributing factor, as evidenced by non-blinded studies which presented notably larger effect sizes (Estimate\u0026thinsp;=\u0026thinsp;0.6362, SE\u0026thinsp;=\u0026thinsp;0.2557, z\u0026thinsp;=\u0026thinsp;2.4884, p\u0026thinsp;=\u0026thinsp;0.0128).\u003c/p\u003e \u003cp\u003eThe R\u0026sup2; value of 100% suggests that these moderators collectively account for all the variability in effect sizes, with no residual heterogeneity (tau\u0026sup2; = 0) and a non-significant QE test, indicating an appropriate model fit.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analyses\u003c/h2\u003e \u003cp\u003eNulliparous Group\u003c/p\u003e \u003cp\u003eIn 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 (tau\u0026sup2; = 0, I\u0026sup2; = 0%), and the test for heterogeneity was not significant (Q-statistic (Q) ((Degrees of freedom (df)\u0026thinsp;=\u0026thinsp;10)\u0026thinsp;=\u0026thinsp;5.6295, p\u0026thinsp;=\u0026thinsp;0.8454). The estimated effect size was \u0026minus;\u0026thinsp;0.4625 (SE\u0026thinsp;=\u0026thinsp;0.1051, z = -4.4016, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), indicating a highly significant negative effect size without heterogeneity.\u003c/p\u003e \u003cp\u003ePrimiparous Group\u003c/p\u003e \u003cp\u003eIn 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 (tau\u0026sup2; = 0.1691, I\u0026sup2; = 76.87%), supported by a significant test for heterogeneity (Q (df\u0026thinsp;=\u0026thinsp;13)\u0026thinsp;=\u0026thinsp;55.5043, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The estimated effect size was \u0026minus;\u0026thinsp;0.7342 (SE\u0026thinsp;=\u0026thinsp;0.1269, z = -5.7862, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), signifying a highly significant negative effect size with substantial heterogeneity.\u003c/p\u003e \u003cp\u003eMixed Parity Group\u003c/p\u003e \u003cp\u003eIn 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 (tau\u0026sup2; = 0.0965, I\u0026sup2; = 65.64%) with a statistically significant test for heterogeneity (Q (df\u0026thinsp;=\u0026thinsp;12)\u0026thinsp;=\u0026thinsp;35.9962, p\u0026thinsp;=\u0026thinsp;0.0003). The estimated effect size stands at -0.8497 (SE\u0026thinsp;=\u0026thinsp;0.1078, z = -7.8848, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), signifying a highly significant negative effect size with moderate heterogeneity.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe 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.\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eImplications of VR in Labor Pain Management\u003c/h2\u003e \u003cp\u003e(Carus et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Logan et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Moreau et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Nori et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Wong et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) 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., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). 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, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e1996\u003c/span\u003e) The demonstrated efficacy of VR in managing labor pain lends support to this theoretical framework.\u003c/p\u003e \u003cp\u003eIn 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., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) 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., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eVariability in VR Content and Its Effects\u003c/h2\u003e \u003cp\u003eThe 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., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Pourmand et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Teh et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) Nonetheless, the optimal category of VR content for the management of labor pain remains ambiguous and necessitates further examination.\u003c/p\u003e \u003cp\u003eFor 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., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). 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., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Branjerdporn et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eModerators of VR Effectiveness\u003c/h2\u003e \u003cp\u003eThe 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\u0026ndash;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., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mujiyani \u0026amp; Latifah, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFurthermore, 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., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Olsen et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Safikhani et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2018\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eHeterogeneity Among Studies\u003c/h2\u003e \u003cp\u003eThe 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., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSubgroup Analyses\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eThe 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., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Huang et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Shakarami et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFuture Research Directions\u003c/h2\u003e \u003cp\u003eSubsequent 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.\u003c/p\u003e \u003cp\u003eSecondly, 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.\u003c/p\u003e \u003cp\u003eLastly, 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.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e \u003cp\u003eFurthermore, 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.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConflicts of interest\u003c/strong\u003e \u003cp\u003eThe authors have no conflicts of interest to declare that are relevant to the content of this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRegarding 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.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAhern, M. M., Dean, L. V, Stoddard, C. C., Agrawal, A., Kim, K., Cook, C. E., \u0026amp; Narciso Garcia, A. (2020). The effectiveness of virtual reality in patients with spinal pain: A systematic review and meta‐analysis. \u003cem\u003ePain Practice\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(6), 656\u0026ndash;675.\u003c/li\u003e\n \u003cli\u003eAhmad, M., Mohammad, E. B., \u0026amp; Anshasi, H. A. (2020). Virtual reality technology for pain and anxiety management among patients with cancer: a systematic review. \u003cem\u003ePain Management Nursing\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(6), 601\u0026ndash;607.\u003c/li\u003e\n \u003cli\u003eAkin, B., Yilmaz Kocak, M., K\u0026uuml;\u0026ccedil;\u0026uuml;kaydın, Z., \u0026amp; G\u0026uuml;zel, 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. \u003cem\u003eJournal of Clinical Nursing\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(15\u0026ndash;16), 2301\u0026ndash;2308.\u003c/li\u003e\n \u003cli\u003eAraki, M., Nishitani, S., Ushimaru, K., Masuzaki, H., Oishi, K., \u0026amp; Shinohara, K. (2010). Fetal response to induced maternal emotions. \u003cem\u003eThe Journal of Physiological Sciences\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e, 213\u0026ndash;220.\u003c/li\u003e\n \u003cli\u003eBastos, M. H., Furuta, M., Small, R., McKenzie‐McHarg, K., \u0026amp; Bick, D. (2015). Debriefing interventions for the prevention of psychological trauma in women following childbirth. \u003cem\u003eCochrane Database of Systematic Reviews\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eBordeleau, M., Stamenkovic, A., Tardif, P.-A., \u0026amp; Thomas, J. (2022). The use of virtual reality in back pain rehabilitation: a systematic review and meta-analysis. \u003cem\u003eThe Journal of Pain\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(2), 175\u0026ndash;195.\u003c/li\u003e\n \u003cli\u003eBotella, C., Fern\u0026aacute;ndez-\u0026Aacute;lvarez, J., Guill\u0026eacute;n, V., Garc\u0026iacute;a-Palacios, A., \u0026amp; Ba\u0026ntilde;os, R. (2017). Recent progress in virtual reality exposure therapy for phobias: a systematic review. \u003cem\u003eCurrent Psychiatry Reports\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e, 1\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eBranjerdporn, G., Meredith, P., Wilson, T., \u0026amp; Strong, J. (2021). Maternal\u0026ndash;fetal attachment: Associations with maternal sensory processing, adult attachment, distress and perinatal loss. \u003cem\u003eJournal of Child and Family Studies\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e, 528\u0026ndash;541.\u003c/li\u003e\n \u003cli\u003eByrom, B., Elash, C. A., Eremenco, S., Bodart, S., Muehlhausen, W., Platko, J. V, Watson, C., \u0026amp; Howry, C. (2022). Measurement comparability of electronic and paper administration of visual analogue scales: A review of published studies. \u003cem\u003eTherapeutic Innovation \u0026amp; Regulatory Science\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(3), 394\u0026ndash;404.\u003c/li\u003e\n \u003cli\u003eCarus, E. G., Albayrak, N., Bildirici, H. M., \u0026amp; Ozmen, S. G. (2022). Immersive virtual reality on childbirth experience for women: a randomized controlled trial. \u003cem\u003eBMC Pregnancy and Childbirth\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 354.\u003c/li\u003e\n \u003cli\u003eChirico, A., Lucidi, F., De Laurentiis, M., Milanese, C., Napoli, A., \u0026amp; Giordano, A. (2016). Virtual reality in health system: beyond entertainment. A mini‐review on the efficacy of VR during cancer treatment. \u003cem\u003eJournal of Cellular Physiology\u003c/em\u003e, \u003cem\u003e231\u003c/em\u003e(2), 275\u0026ndash;287.\u003c/li\u003e\n \u003cli\u003eDennis, C.-L., Falah-Hassani, K., \u0026amp; Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. \u003cem\u003eThe British Journal of Psychiatry\u003c/em\u003e, \u003cem\u003e210\u003c/em\u003e(5), 315\u0026ndash;323.\u003c/li\u003e\n \u003cli\u003eDing, L., Hua, H., Zhu, H., Zhu, S., Lu, J., Zhao, K., \u0026amp; Xu, Q. (2020). Effects of virtual reality on relieving postoperative pain in surgical patients: A systematic review and meta-analysis. \u003cem\u003eInternational Journal of Surgery\u003c/em\u003e, \u003cem\u003e82\u003c/em\u003e, 87\u0026ndash;94.\u003c/li\u003e\n \u003cli\u003eDowns, S. H., \u0026amp; 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. \u003cem\u003eJournal of Epidemiology \u0026amp; Community Health\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(6), 377\u0026ndash;384.\u003c/li\u003e\n \u003cli\u003eEbrahimian, A., Bilandi, R. R., Bilandī, M. R. R., \u0026amp; Sabzeh, Z. (2022). Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. \u003cem\u003eBMC Pregnancy and Childbirth\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 49.\u003c/li\u003e\n \u003cli\u003eEl Sharkawy, T. A. E.-W., Mohamed Abd-El Hady, R., Abdelhaliem Said, S., Abdel-Wahab Afifi Araby, O., \u0026amp; 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. \u003cem\u003eEgyptian Journal of Health Care\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1), 1267\u0026ndash;1284.\u003c/li\u003e\n \u003cli\u003eEl-Sayed Hussein, D., Ahmed El-Sheikh, M., Mohamed Abd-El Hady, R., \u0026amp; 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. \u003cem\u003eJournal of Nursing Science Benha University\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(1), 416\u0026ndash;431.\u003c/li\u003e\n \u003cli\u003eFrey, D. P., Bauer, M. E., Bell, C. L., Low, L. K., Hassett, A. L., Cassidy, R. B., Boyer, K. D., \u0026amp; Sharar, S. R. (2019). Virtual reality analgesia in labor: the VRAIL pilot study\u0026mdash;a preliminary randomized controlled trial suggesting benefit of immersive virtual reality analgesia in unmedicated laboring women. \u003cem\u003eAnesthesia \u0026amp; Analgesia\u003c/em\u003e, \u003cem\u003e128\u003c/em\u003e(6), e93\u0026ndash;e96.\u003c/li\u003e\n \u003cli\u003eGeorgescu, R., Fodor, L. A., Dobrean, A., \u0026amp; Cristea, I. A. (2020). Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. \u003cem\u003ePsychological Medicine\u003c/em\u003e, \u003cem\u003e50\u003c/em\u003e(11), 1795\u0026ndash;1807.\u003c/li\u003e\n \u003cli\u003eGetu, A. A., Getie, S. A., Gela, G. B., Maseresha, E. A., Feleke, B. E., \u0026amp; Muna, A. M. (2020). Non-pharmacological labor pain management and associated factor among skilled birth attendants in Amhara Regional State health institutions, Northwest Ethiopia. \u003cem\u003eReproductive Health\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(1), 183.\u003c/li\u003e\n \u003cli\u003eGrekin, R., \u0026amp; O\u0026rsquo;Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. \u003cem\u003eClinical Psychology Review\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(5), 389\u0026ndash;401.\u003c/li\u003e\n \u003cli\u003eG\u0026uuml;r, E. Y., \u0026amp; Apay, S. E. (2020). The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial. \u003cem\u003eMidwifery\u003c/em\u003e, \u003cem\u003e91\u003c/em\u003e, 102856.\u003c/li\u003e\n \u003cli\u003eHoffman, H. G., Boe, D. A., Rombokas, E., Khadra, C., LeMay, S., Meyer, W. J., Patterson, S., Ballesteros, A., \u0026amp; 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. \u003cem\u003eJournal of Hand Therapy\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(2), 254\u0026ndash;262.\u003c/li\u003e\n \u003cli\u003eHoffman, H. G., Richards, T. L., Bills, A. R., Van Oostrom, T., Magula, J., Seibel, E. J., \u0026amp; Sharar, S. R. (2006). Using FMRI to study the neural correlates of virtual reality analgesia. \u003cem\u003eCNS Spectrums\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(1), 45\u0026ndash;51.\u003c/li\u003e\n \u003cli\u003eHoffman, H. G., Seibel, E. J., Richards, T. L., Furness, T. A., Patterson, D. R., \u0026amp; Sharar, S. R. (2006). Virtual reality helmet display quality influences the magnitude of virtual reality analgesia. \u003cem\u003eThe Journal of Pain\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(11), 843\u0026ndash;850.\u003c/li\u003e\n \u003cli\u003eHuang, Y., Zhong, Y., Chen, Q., Zhou, J., Fu, B., Deng, Y., Tu, X., \u0026amp; 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. \u003cem\u003eBMC Pregnancy and Childbirth\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(1), 400.\u003c/li\u003e\n \u003cli\u003eKassim, 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., \u0026amp; Lupu, A. (2023). Non-pharmacological interventions for pain management in hemodialysis: A narrative review. \u003cem\u003eJournal of Clinical Medicine\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(16), 5390.\u003c/li\u003e\n \u003cli\u003eKountanis, J. A., Kirk, R., Handelzalts, J. E., Jester, J. M., Kirk, R., \u0026amp; Muzik, M. (2022). The associations of subjective appraisal of birth pain and provider-patient communication with postpartum-onset PTSD. \u003cem\u003eArchives of Women\u0026rsquo;s Mental Health\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(1), 171\u0026ndash;180.\u003c/li\u003e\n \u003cli\u003eKoyyalamudi, V., Sidhu, G., Cornett, E. M., Nguyen, V., Labrie-Brown, C., Fox, C. J., \u0026amp; Kaye, A. D. (2016). New labor pain treatment options. \u003cem\u003eCurrent Pain and Headache Reports\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e, 1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eLevett, K. M., Sutcliffe, K. L., \u0026amp; Betts, D. (2019). Using forbidden points in pregnancy: adverse outcomes and quality of evidence in randomized controlled trials\u0026mdash;a systematic narrative review. \u003cem\u003eMedical Acupuncture\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(6), 346\u0026ndash;360.\u003c/li\u003e\n \u003cli\u003eLogan, D. E., Khanna, K., Randall, E., O\u0026rsquo;Donnell, S., Reks, T., \u0026amp; 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. \u003cem\u003eChildren\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(10), 1644.\u003c/li\u003e\n \u003cli\u003eL\u0026oacute;pez-Valverde, N., Muriel Fernandez, J., L\u0026oacute;pez-Valverde, A., Valero Juan, L. F., Ram\u0026iacute;rez, J. M., Flores Fraile, J., Herrero Payo, J., Blanco Antona, L. A., Macedo de Sousa, B., \u0026amp; Bravo, M. (2020). RETRACTED: Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis. \u003cem\u003eJournal of Clinical Medicine\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(4), 1025.\u003c/li\u003e\n \u003cli\u003eLowe, N. K. (2002). The nature of labor pain. \u003cem\u003eAmerican Journal of Obstetrics and Gynecology\u003c/em\u003e, \u003cem\u003e186\u003c/em\u003e(5), S16\u0026ndash;S24.\u003c/li\u003e\n \u003cli\u003eMahalan, N., \u0026amp; Smitha, M. V. (2023). Effect of audio-visual therapy on pain and anxiety in labor: A randomized controlled trial. \u003cem\u003eEuropean Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology: X\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e, 100240.\u003c/li\u003e\n \u003cli\u003eMassov, L., Robinson, B., Rodriguez‐Ramirez, E., \u0026amp; Maude, R. (2023). Virtual reality is beneficial in decreasing pain in labouring women: A preliminary study. \u003cem\u003eAustralian and New Zealand Journal of Obstetrics and Gynaecology\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(2), 193\u0026ndash;197.\u003c/li\u003e\n \u003cli\u003eMelzack, R. (1996). Gate control theory: On the evolution of pain concepts. \u003cem\u003ePain Forum\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(2), 128\u0026ndash;138.\u003c/li\u003e\n \u003cli\u003eMohammadi, H., Rasti, J., \u0026amp; Ebrahimi, E. (2023). Virtual reality, fear of pain and labor pain intensity: A randomized controlled trial. \u003cem\u003eAnesthesiology and Pain Medicine\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e(1).\u003c/li\u003e\n \u003cli\u003eMomenyan, N., \u0026amp; Safaei, A. A. (2021). \u003cem\u003eImmersive virtual reality analgesia in un-medicated laboring women (during stage 1 and 2): a randomized controlled trial\u003c/em\u003e.\u003c/li\u003e\n \u003cli\u003eMoreau, S., Th\u0026eacute;rond, A., Cerda, I. H., Studer, K., Pan, A., Tharpe, J., Crowther, J. E., Abd-Elsayed, A., Gilligan, C., \u0026amp; Tolba, R. (2024). Virtual reality in acute and chronic pain medicine: an updated review. \u003cem\u003eCurrent Pain and Headache Reports\u003c/em\u003e, 1\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003eMorris, L. D., Louw, Q. A., \u0026amp; Grimmer-Somers, K. (2009). The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. \u003cem\u003eThe Clinical Journal of Pain\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e(9), 815\u0026ndash;826.\u003c/li\u003e\n \u003cli\u003eMujiyani, S. A., \u0026amp; Latifah, L. (2022). Pain management in the first stage of labour using sensory stimulation. \u003cem\u003eBritish Journal of Midwifery\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(7), 396\u0026ndash;404.\u003c/li\u003e\n \u003cli\u003eNaef, A. C., Jeitziner, M.-M., Knobel, S. E. J., Exl, M. T., M\u0026uuml;ri, R. M., Jakob, S. M., Nef, T., \u0026amp; Gerber, S. M. (2022). Investigating the role of auditory and visual sensory inputs for inducing relaxation during virtual reality stimulation. \u003cem\u003eScientific Reports\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 17073.\u003c/li\u003e\n \u003cli\u003eNori, W., Kassim, M. A. K., Helmi, Z. R., Pantazi, A. C., Brezeanu, D., Brezeanu, A. M., Penciu, R. C., \u0026amp; Serbanescu, L. (2023). Non-pharmacological pain management in labor: a systematic review. \u003cem\u003eJournal of Clinical Medicine\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(23), 7203.\u003c/li\u003e\n \u003cli\u003eOlsen, M. F., Bjerre, E., Hansen, M. D., Hilden, J., Landler, N. E., Tendal, B., \u0026amp; Hr\u0026oacute;bjartsson, A. (2017). Pain relief that matters to patients: systematic review of empirical studies assessing the minimum clinically important difference in acute pain. \u003cem\u003eBMC Medicine\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e, 1\u0026ndash;18.\u003c/li\u003e\n \u003cli\u003eOuzzani, M., Hammady, H., Fedorowicz, Z., \u0026amp; Elmagarmid, A. (2016). Rayyan\u0026mdash;a web and mobile app for systematic reviews. \u003cem\u003eSystematic Reviews\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e, 1\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003ePersson, A., Lindmark, S., Petersson, K., Gabriel, E., Thorsell, M., Lindstr\u0026ouml;m, K., G\u0026ouml;ransson, M., Cardell, G., \u0026amp; Magnusson, \u0026Aring;. (2020). Potentially traumatic events, fear of childbirth and posttraumatic stress disorder during pregnancy in Stockholm, Sweden: A cross-sectional study. \u003cem\u003eSexual \u0026amp; Reproductive Healthcare\u003c/em\u003e, \u003cem\u003e25\u003c/em\u003e, 100516.\u003c/li\u003e\n \u003cli\u003ePourmand, A., Davis, S., Marchak, A., Whiteside, T., \u0026amp; Sikka, N. (2018). Virtual reality as a clinical tool for pain management. \u003cem\u003eCurrent Pain and Headache Reports\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e, 1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003ePratiwi, I. G., Husin, F., Ganiem, A. R., Susiarno, H., Arifin, A., \u0026amp; Wirakusuma, F. (2017). The effect of virtual reality on pain in primiparity women. \u003cem\u003eInternational Journal of Nursing and Health Science\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(4), 46\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eSafikhani, S., Gries, K. S., Trudeau, J. J., Reasner, D., R\u0026uuml;dell, K., Coons, S. J., Bush, E. N., Hanlon, J., Abraham, L., \u0026amp; Vernon, M. (2018). Response scale selection in adult pain measures: results from a literature review. \u003cem\u003eJournal of Patient-Reported Outcomes\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e, 1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eSantana, L. S., Gallo, R. B. S., Ferreira, C. H. J., Duarte, G., Quintana, S. M., \u0026amp; Marcolin, A. C. (2016). Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial. \u003cem\u003eJournal of Physiotherapy\u003c/em\u003e, \u003cem\u003e62\u003c/em\u003e(1), 29\u0026ndash;34.\u003c/li\u003e\n \u003cli\u003eShakarami, A., Mirghafourvand, M., Abdolalipour, S., Jafarabadi, M. A., \u0026amp; Iravani, M. (2021). Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women. \u003cem\u003eBMC Pregnancy and Childbirth\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e, 1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eTashjian, V. C., Mosadeghi, S., Howard, A. R., Lopez, M., Dupuy, T., Reid, M., Martinez, B., Ahmed, S., Dailey, F., \u0026amp; Robbins, K. (2017). Virtual reality for management of pain in hospitalized patients: results of a controlled trial. \u003cem\u003eJMIR Mental Health\u003c/em\u003e, \u003cem\u003e4\u003c/em\u003e(1), e7387.\u003c/li\u003e\n \u003cli\u003eTeh, J. J., Pascoe, D. J., Hafeji, S., Parchure, R., Koczoski, A., Rimmer, M. P., Khan, K. S., \u0026amp; Al Wattar, B. H. (2024). Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. \u003cem\u003eBMC Medicine\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 64.\u003c/li\u003e\n \u003cli\u003eWong, M. S., Spiegel, B. M. R., \u0026amp; Gregory, K. D. (2021). Virtual reality reduces pain in laboring women: a randomized controlled trial. \u003cem\u003eAmerican Journal of Perinatology\u003c/em\u003e, \u003cem\u003e38\u003c/em\u003e(S 01), e167\u0026ndash;e172.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Virtual Reality, Labor Pain, Systematic Review, Pain Management, Pregnancy, Non-Pharmacological Interventions","lastPublishedDoi":"10.21203/rs.3.rs-4724968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4724968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"The Effectiveness of Virtual Reality in Managing Labor Pain: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-06 12:01:51","doi":"10.21203/rs.3.rs-4724968/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1d0f25a8-84f7-42a8-8f0f-e6787274c589","owner":[],"postedDate":"August 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-22T10:53:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-06 12:01:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4724968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4724968","identity":"rs-4724968","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}