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Article

The Effects of Virtual Reality During Labour on Perceived Pain, Use of Pain Relief and Duration of Labour: A Pilot Matched Case–Control Study in Belgium

by
Luka Van Leugenhaege
1,2,3,*,
Natacha Van de Craen
1,
Leen Vanden Bergh
1,
Sarah Van Vlierberghe
4,
Barbara Elizabeth Luten
5,
Eveline Mestdagh
1,2 and
Yvonne Jacoba Kuipers
1,2,6
1
Department of Health and Science, AP University of Applied Sciences and Arts, Noorderplaats 2, 2000 Antwerp, Belgium
2
Centre for Research and Innovation in Care (CRIC), Faculty of Medicine, University of Antwerp, Campus Drie Eiken, 2610 Antwerp, Belgium
3
Immersive Lab, Department of Science and Technology, AP University of Applied Sciences and Arts, Ellermanstraat 33, 2060 Antwerp, Belgium
4
Maternity and Labour Ward, Sint-Vincentius Hospital, Ziekenhuis aan de Stroom (ZAS), Sint-Vincentiusstraat 20, 2018 Antwerp, Belgium
5
Maternity and Labour Ward, Middelheim Hospital, Ziekenhuis aan de Stroom (ZAS), Lindendreef 1, 2020 Antwerp, Belgium
6
School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh EH11 4BN, UK
*
Author to whom correspondence should be addressed.
Virtual Worlds 2025, 4(4), 43; https://doi.org/10.3390/virtualworlds4040043
Submission received: 20 August 2025 / Revised: 18 September 2025 / Accepted: 22 September 2025 / Published: 23 September 2025
Versions Notes

Abstract

Background: Virtual reality has been shown to reduce pain during labour. We aimed to determine whether virtual reality reduces analgesia use and shortens labour duration. Methods: A non-randomised pilot study was conducted, using a matched case–control design (1:2 ratio). Cases were women who voluntarily used virtual reality alongside standard intrapartum pain management, including non-pharmacological methods and/or epidural analgesia. Controls received standard intrapartum pain management. Results: A total of 108 women were included for analysis (36 cases vs. 72 controls). Perceived pain scores before and after virtual reality use did not differ significantly (p = 0.43, p = 0.73), suggesting a limited immediate analgesic effect under current conditions. Epidural analgesia rates and cervical dilation at initiation of analgesia did not show significant differences between cases and controls (p = 0.13, p = 0.42). After adjusting for induction of labour and cervical dilation at admission, there were no significant differences for duration of epidural analgesia (p = 0.86, p = 0.56), duration of labour (p = 0.64, p = 0.55), or vaginal birth (p = 0.23). Adjusted models indicated a non-significant trend toward shorter durations of labour, birth, and epidural exposure for cases. Conclusions: Our pilot study did not reveal a decrease in perceived pain or epidural analgesia use or an effect on duration of labour and vaginal birth.

1. Introduction

Labour pain is widely recognised as one of the most intense forms of pain experienced [1,2,3]. In Western countries, various pharmacological and non-pharmacological methods are available for women to alleviate or cope with labour pain, varying in functionality, effect, and impact on women’s perceived pain and maternal satisfaction with the overall birth experience and pain relief methods [4,5,6].
Pharmacological options for intrapartum pain relief include epidural analgesia (EA), spinal or combined spinal-epidural analgesia, intravenous opioids, and nitrous oxide inhalation. Although EA is frequently regarded as the most effective and satisfying method for managing labour pain, it is associated with a risk of several adverse effects, such as hypotension, postdural puncture headache, motor block, prolonged labour, pruritus, shivering, and sedation [4,7,8]. Furthermore, EA requires the presence of an anaesthesiologist, which may result in delays in administration and contribute to higher healthcare costs [4,9]. A notable discrepancy has been observed between the number of women who, antenatally, intend to avoid EA and the actual number of those who give birth without receiving it [10,11,12]. This might be due to a lack of access to sufficient non-pharmacological options that align with women’s preferences and expectations of pain management.
Virtual reality (VR) is increasingly recognised as a promising non-invasive, non-pharmacological modality for intrapartum pain management. It aims to distract users from pain through immersive, multisensory experiences and leads to reduced labour pain, improved birth satisfaction, and decreased anxiety during labour [13,14,15,16,17,18,19]. However, previous studies have not promoted labouring women to control the timing, duration, or frequency of VR use, which contradicts the principles of woman-centred care in maternity services [20].
Research on VR during labour has primarily focused on pain intensity rather than its influence on pharmacological analgesia and its impact on the progression of labour [18]. A study by Wu et al. (2020), however, suggests that VR reduces the amount of patient-controlled administration of analgesics [21]. Given that other non-pharmacological methods of intrapartum pain relief can delay or reduce the use of EA and shorten the duration of labour [22], we hypothesised that VR might similarly affect these outcomes. Specifically, if VR proves effective in reducing perceived pain, it could contribute to decreased or delayed use of EA, with fewer associated side effects, and a shorter labour duration. Therefore, the present study aimed to explore the effect of VR on perceived labour pain, use of EA, and duration of labour within a childbearing population.

2. Materials and Methods

2.1. Design

A non-randomised pilot study was conducted employing a matched case–control design with a 1:2 ratio. Control participants were manually selected on a case-by-case basis according to predefined matching criteria, including pre-labour EA preference, parity, and maternal age, to ensure comparable distribution across groups.
We chose to match on pre-labour preference for EA because women who are determined to receive EA during labour are highly likely to receive it [10,23]. Maternal age and parity are suggested moderators for preferring pain relief during labour [24,25,26,27,28,29,30]. Parity is also correlated to length of labour, influencing pain management strategies during labour [31,32,33].

2.2. Setting

This study was conducted in the labour wards of two hospitals located in the Antwerp region, a Dutch-speaking region in Belgium. In the Belgian healthcare system, perinatal care is predominantly obstetrician-led. However, women who give birth in a hospital setting are typically supported during labour by the midwife on duty, with whom they generally have had no prior interaction. In 2021, the total number of live births in the Antwerp region was 21,432 [34]. In hospital A, 2034 women gave birth in 2021. Of all women who gave birth at this site that year, 31.4% were nulliparous, 68.6% had intrapartum EA, 31.8% had an induction of labour, and 26.8% delivered by caesarean section. The same year, hospital B, had an annual birth rate of 1821, with 42.6% nulliparous women, 53% of EA use, 20.5% having induction of labour, and 16.5% caesareans. Intrapartum use of VR was introduced at both sites for the purpose of the study.

2.3. Participants

Participants eligible for inclusion in this study were labouring women aged 18 years or older who were able to understand and communicate in Dutch and/or English and had a gestational age of 37 weeks or more. For the intervention group, inclusion required a self-expressed interest in using VR as a method to cope with labour pain. Exclusion criteria included a history or presence of conditions associated with an increased risk of (pre-) eclampsia or HELLP syndrome, pre-existing sensory impairments such as deafness or blindness, and neurological disorders, including epilepsy. Women were also excluded if they were deemed unresponsive or uncooperative during labour (as assessed by the attending midwife), experienced a panic attack, or required acute medical intervention for complications during labour. Given that this was a pilot study and VR represents a novel intervention whose effect on epidural analgesia had not previously been examined, no reliable effect size could be estimated. The study was therefore designed with an exploratory purpose, and no a priori sample size calculation was conducted.

2.4. Recruitment of Participants

Information about the study was disseminated via flyers distributed during third-trimester antenatal consultations with an obstetrician or midwife at both hospitals, as well as through the social media platforms of these hospitals. In cases where women had not been informed before their hospital admission, study details and information on the use of the VR headset were provided upon admission to the labour ward. Due to the exploratory nature of this pilot study, participants self-selected into the intervention group based on their willingness to use VR during labour.

2.5. Intervention Group (Cases)

Based on a woman-centred care perspective of self-determination and women’s perceived need of self-management, we did not standardise the intervention [35,36]. The cases comprised birthing women who voluntarily used VR to cope with labour (pain). VR could be used as a single (pain) management technique or combined with standard intrapartum pain relief. Women were free to use the VR headset at any point during the first stage of labour, for as long as they wished, but it was discontinued with the onset of the second stage of labour.
To ensure (physical) participant safety, women were instructed to establish a safety boundary, referred to as the ‘guardian’, within the virtual environment. This virtual perimeter corresponded to the physical space around them. When crossing this virtual boundary, participants would be able to see the actual physical space in order not to trip or bump into objects in the (physical) room. For participants who wished to maintain greater mobility during labour, tape markings on the floor delineated a designated safety zone, ensuring a clutter-free area. Birthing partners and healthcare staff were instructed to avoid entering or placing objects within this zone to prevent women hurting themselves or falling while being engaged in the virtual environment.

2.6. Control Group

The control group consisted of women who received standard intrapartum pain management during the study period and were offered the same pain relief options as those in the VR group, except for VR. In the two participating hospitals, standard intrapartum pain-coping methods consisted of non-pharmacological options (i.e., massage, water immersion, birthing ball, birth rope, and ambulation) or epidural analgesia as a pharmacological option, which women were free to combine according to their preferences.

2.7. Intervention: An Evidence-Informed Prototype

A VR interface prototype was developed by AP University of Applied Sciences and Arts, based on prior qualitative research [35], directing to (1) an introductory tutorial on using the VR headset (Oculus Quest 1®, Meta Platforms Inc, 1 Meta Way, Menlo park, CA, USA) and handheld controllers; (2) a calming nature scene featuring a lake and forest accompanied by voice-guided meditation; (3) a 360° immersive video of a forest; (4) a game involving the stacking of blocks paired with meditative audio guidance; and (5) an audiovisual kaleidoscopic meditation experience. Labouring women could shift between the VR experiences. Based on self-determination and self-management, our study protocol did not specify a minimum or maximum duration of VR use. Likewise, the number of sessions was not restricted.

2.8. Data Collection and Measurements

The research team developed a data collection guide, which was distributed to assist midwives in accurately collecting the necessary data. While the majority of socio-demographic (e.g., age, marital status) and obstetric (e.g., parity, gestational age) data were obtained through participants’ medical records, variables not routinely documented were additionally collected and recorded by two clinical research midwives (S.V.V. and B.E.L.). This included information such as the participant’s country of origin, highest level of education, pre-labour preference for EA (yes/no/undecided), and perceived pain intensity (pre- and post-VR use) using the numeric rating scale (NRS), a 0–10 scale, with zero representing ‘no pain’ and ten ‘worst pain imaginable’ [37].
In the participating hospitals, induction of labour was carried out using various methods: amniotomy, intravenous oxytocin, Foley catheter with Prepidil® gel (Pfizer Inc., 66 Hudson Boulevard East, New York, NY, USA), vaginal Prepidil® gel, Cook® cervical ripening balloon (Cook Medical LLC, 750 Daniels Way, Bloomington, IN, USA), and Prostin E2® (Pfizer Inc., 66 Hudson Boulevard East, New York, NY, USA) (intravenous or tablet), with the choice of method depending on each site’s induction protocols and the individual obstetric parameters of the childbearing woman. All were combined into one variable, induction (yes/no), because only data on the method to initiate induction were registered.
Midwives employed in the participating hospitals received detailed instructions on the correct use of the VR headset, including safety protocols and standardised data collection procedures. The VR prototype logged and recorded the usage of the VR headset, marking the start and end of each session. These data were made accessible to the research team via a secure, cloud-based platform. The data were collected between January and April 2021.

2.9. Data Analysis

Each participant was assigned a unique, individual identifier: for the intervention group, this was linked to the specific VR headset used; for the control group, identifiers were assigned sequentially based on the order of hospital admission. These identifiers or codes were logged separately with participants’ identifiable information. Once data were extracted from medical records into a centralised database, these logs were permanently deleted immediately after data were transferred to the researcher responsible for analysis.
Retrospective matching was performed to establish a 1:2 case–control ratio, based on parity (nulliparous or multiparous), maternal age, and pre-labour preference for EA. Matching was conducted by one researcher (L.V.L.) and validated by a second researcher (Y.J.K.) to ensure consistency. No propensity-score matching or inverse probability weighting were performed because this pilot did not include a large dataset of factors potentially influencing women’s choice to use VR as an intrapartum pain management method [38]. Retrospectively, induction of labour was too broadly defined in our data collection to use as a matching criterium.
We used descriptive statistics to summarise demographic and obstetric characteristics. Categorical variables were presented as frequencies and percentages, while continuous variables were reported as means with standard deviations (SDs). The extent of missing data for each variable was assessed by frequency tables and descriptive statistics. We observed small proportions of missing data (<5%) and therefore excluded cases test-by-test and reported absolute numbers of cases in the analyses. For NRS scores before and after VR exposure, we observed missing data for 2 participants (5.5%). We did not exclude these two participants in the comparison between cases and controls because complete information on all other variables relevant to the study was available.
Comparative analyses were performed using Pearson’s chi-squared test for categorical variables and independent sample t-tests for continuous variables with a normal distribution. The assumption of normality was evaluated using the Shapiro–Wilk test. For non-normally distributed data, the Mann–Whitney U test was employed. Analysis of covariance (ANCOVA) was used to assess adjusted estimated marginal means. Mean NRS scores were compared via paired sample t-test before and after use of VR on case level for first and second VR session. Additionally, pre–post pain scores were analysed at VR session level. Data were restructured so that each VR session formed a separate case. All participant data other than VR session data (i.e., pre- and post-NRS score, cervical dilation before VR, and session duration) were retained to allow identification of repeated sessions. Paired sample t-tests compared pre- and post-NRS scores across all sessions (n = 41). Sensitivity analyses were performed for spontaneous versus induced labour, latent versus active phase of labour, and a VR session duration for < or ≥ than 25 min. The potential impact of sessions less than or exceeding 25 min was explored by fitting a LOESS curve, with smoothing parameter = 0.5, to session-level pre–post difference scores, visualising their relationship with VR duration. Statistical significance was defined as p < 0.05. Data analysis was conducted using IBM SPSS Statistics©, Version 28.0.

3. Results

A total of 108 women (36 cases and 72 controls) were included in the analysis, with a mean age of 32.2 years (SD = 3.7). The intervention group comprised 36 participants, who used the VR headset at least once during labour. A subset of this group (19.4%, n = 7) engaged in a second VR session.
Socio-demographic characteristics showed no statistically significant differences between cases and controls. We observed a pre-labour preference for intrapartum EA of 13.9%, meaning that most women did not have a specific preference for pharmacological intrapartum pain management. Most obstetric characteristics were evenly distributed across groups, except cervical dilation at admission and induction of labour. The mean cervical dilation at hospital admission was significantly lower in the VR group (2.31 cm, SD = 1.59) compared with the control group (3.88 cm, SD = 2.28; p < 0.001). Furthermore, a significantly higher proportion of women in the VR group were induced (75.0%, n = 27), compared with the control group (27.8%, n = 20; p < 0.001).
Among cases, the mean duration of the first VR session was 25.7 min (SD = 14.1). The duration of the first VR session varied substantially between participants, ranging from 5 to 57 min. The second session showed a mean of 31.3 min (SD = 27.4). Likewise, the second VR session showed considerable variation in duration across participants, from 5 to 77 min. The mean cervical dilation at the start of the first VR session was 2.94 cm (SD = 1.59), increasing to 3.86 cm (SD = 1.07) by the onset of the second session (see Table 1).

Intrapartum Perceived Pain, Pain Management and Duration of Labour

Mean NRS pain scores before and after both the first and second VR sessions (on case level) did not demonstrate statistically significant differences (p = 0.43 and p = 0.74; see Table 2). At the VR session level, no significant pre–post differences in NRS pain scores were found (see Table 2). Nevertheless, change scores varied widely, ranging from a decreased pain score of −4 points to a pain increase of +6 points on the NRS. Small effect sizes were observed for women with induced labour (n = 31, Cohen’s d = 0.29, p = 0.12) and for sessions < 25 min (n = 21, d = 0.39, p = 0.09), and an intermediate effect for sessions during the active phase of labour (n = 7, d = 0.71, p = 0.11). These effects did not reach statistical significance, likely due to limited subgroup sample sizes.
In addition to VR, a range of intrapartum coping strategies were employed by women, including massage (26.9%, n = 29), water immersion (43.5%, n = 47), use of a birthing ball (50.0%, n = 54), use of a birth rope (6.5%, n = 7), and ambulation (5.6%, n = 6). Massage, use of a birthing ball, and use of a birth rope were significantly more prevalent among cases (41.7%, 63.9%, and 13.9%) compared with the control group (19.4%, 43.1%, and 2.8%), reaching statistical significance (p = 0.01, p = 0.04, and p = 0.03; see Table 3).
More than half of the total sample received EA during labour (56.5%, n = 61), with a mean cervical dilation of 4.47 cm (SD = 1.85). The proportion of women receiving EA, as well as the mean cervical dilation at the time of EA initiation, did not differ significantly between cases and controls (p = 0.13 and p = 0.42). Only two labouring women used VR and EA simultaneously. The total duration of EA exposure was comparable between groups, even after adjusting for induction of labour and cervical dilation at admission (p = 0.86 and p = 0.56; see Table 3).
Labour duration was significantly longer among cases compared with controls. The mean duration from admission to the start of the second stage of labour was 11.21 h and the mean total duration of labour was 11.78 h in the VR group, versus 7.40 h and 8.27 h in the control group (p = 0.003 and p = 0.007). A small effect was found for both labour duration variables (r = −0.31 and r = −0.28). However, after controlling for induction of labour and cervical dilation at admission, the difference was no longer significant (p = 0.64 and p = 0.55). The ANCOVA-model did explain 38% to 39% of the variance in labour duration (R2 = 0.39 and R2 = 0.38). Adjusted estimated marginal means indicated a trend suggesting shorter durations of labour, birth, and EA exposure among women in the VR group when controlled for induction of labour and cervical dilation at admission (see Table 3).

4. Discussion

This study found no significant differences in pre- and post-VR pain scores, EA rate, duration of EA use, or duration of labour between women who used VR as part of their intrapartum pain management and those who received standard care.
To our knowledge, this is the first study on VR during labour to adopt a case–control study design, focusing on self-controlled timing, duration, or frequency of VR use. In contrast to other VR studies in obstetrics, we now have slightly more information on the duration or ‘dosage’ preferred by labouring women for VR experiences. To our knowledge, no previous VR studies include intrapartum use of VR for up to 77 min, as reported in our findings. The wide variation in dosage underscores the need for flexible, adaptable virtual content.
VR sessions predominantly commenced during the latent phase of labour, clinically defined as a cervical dilation of less than 5 cm. From 5 cm onwards, labour is considered to be in the active phase, with 5–6 cm dilation referred to as the acceleration phase [39,40]. Our lack of effect may be explained by prior studies that reported pain reduction during the active phase [13,16,41,42], whereas in our study, it was mainly used when pain was relatively low during the latent phase [43], potentially limiting its impact. Additionally, our finding that epidural analgesia was most often administered during the transition from the latent to the active phase of labour suggests an increased need for pain-coping methods from this stage onwards.
We observed that women in the VR group were more likely to engage with other non-pharmacological strategies for coping with labour pain. It remains unclear whether these methods were used in conjunction with VR or independently, but concurrent use is certainly possible. We are not aware of women’s perceptions of birth; it could be that cases had a more physiological mindset about birth, pursuing coping techniques rather than pain relief to cope with birth. Although these non-pharmacological coping strategies have been shown to significantly reduce the duration of labour [22,44,45,46], we did not observe a similar effect among cases, despite their higher use of such methods and/or VR, in terms of labour duration or the need for EA and duration of EA exposure. However, it could be that coping with labour in a more active and self-controlled way affects women’s satisfaction with coping with labour and labour itself [47,48].

4.1. Strengths and Weaknesses

As key intrapartum care providers, midwives can significantly shape women’s childbirth experiences through the support they provide in managing pain and the extent to which women feel cared for during the process [49]. Therefore, it was essential to the research team that the VR intervention would be implemented in a manner consistent with real-world midwifery practice, allowing labouring women the freedom to use the VR intervention at their own discretion and for as long as they wished to do so. This can be viewed as both a strength and a limitation. While it precluded complete standardisation of the intervention, it allowed the flexibility to align more closely with women’s individual needs during labour.
We applied retrospective matching to decrease confounding bias, meaning minimising the impact of clinical characteristics and personal preference on primary outcomes. The fact that researchers who were part of the data collection process were not involved in the matching process, also minimised bias by reducing the influence of prior knowledge of participants or study outcomes.
Our study has several limitations. First, the VR intervention was heterogeneous, with duration of VR use ranging from 5 to 77 min and participants selecting from various VR experiences. Second, most women chose to use VR during the latent phase, when pain scores are usually lower. The degree of self-determination and autonomy women had in using VR may have influenced its effectiveness, although our approach aligns with principles of woman-centred care, control, and self-determination of the childbearing woman [20,36]. Additionally, the methods of induction of labour used were diverse, and we lacked data on induction methods applied during the full course of labour. We observed that there are likely more unobserved confounders for VR use than currently known, suggesting the need to address this in future research.
Furthermore, midwives received instructions on the intervention and data collection, but it remains unclear how information on intrapartum pain management options was communicated by healthcare professionals. Previous research suggests that hospital policy and culture can influence how such information is presented. Despite the expectation that perinatal professionals provide unbiased, evidence-based counselling [50], how information on intrapartum pain management is communicated can significantly influence EA rates [51]. Intrapartum VR was newly introduced to the sites involved, so healthcare professionals’ inexperience with VR could have influenced the offering or discussing VR. Last, midwives may have had more opportunity to explain and facilitate the use of VR during planned inductions of labour, given that the study design did not incorporate a preparatory session for women to familiarise themselves with the VR equipment during pregnancy, as suggested in previous studies [35,42]. This could account for the unequal distribution of inductions between cases and controls.

4.2. Implications for Future Research

In our pilot study, the total duration of labour and the first stage of labour were measured from the time of hospital admission to birth, and admission to the onset of the second stage, respectively. When participants were admitted for planned induction, this may have influenced the duration of labour variables, since labour may not have yet commenced at the time of admission for these women. We also did not analyse data on timing and reasons for induction and intrapartum interventions such as augmentation or rupture of membranes, nor did we collect data on foetal health. All these factors may influence the intrapartum care pathway, which could have confounded our findings. Therefore, researchers should consider studies where intervention and control groups have similar induction rates and care pathways to better measure a true effect of VR. Our recommendation is to collect time data for every intervention (e.g., examination of cervical dilation, induction methods, non-pharmacological pain management, and EA) to ensure correct interpretation of duration of labour and concomitant interventions. Furthermore, we advise to develop a study, incorporating the option for pregnant woman to try VR beforehand during prenatal education or workshops.
Further research is needed to determine the most effective content and duration of VR interventions during labour. Our study contributes that longer VR experiences might be needed to accommodate the needs of labouring women. However, the optimal dosage of VR during labour to achieve pain reduction remains unknown. We recommend developing and testing both shorter and longer VR interventions tailored to the needs of labouring women, and examining their differential effects on pain, EA use, and labour progression.
Lastly, researchers should be aware of (pre-labour) preference for EA in their study population and the factors influencing these. We chose to match on pre-labour preference for EA because women who are determined to receive EA during labour are highly likely to receive it [10,23]. However, this study confirms the ‘intention–action gap’ between pre-labour intentions and actual use of EA for women who do not intend to use intrapartum EA, with this study also observing fewer women planning to use EA than those who ultimately received it [11,12,23,52]. The attitude towards EA during labour is shaped by culture [53] and in Flanders specifically, the belief that EA during labour is routine care, contributing to the preference to use EA during labour instead of other types of pain management [12]. Our findings may suggest that women who are more receptive to the use of coping strategies such as water immersion, birthing ball, and ambulation are also more open to incorporating VR into their pain management strategies, emphasising VR to be an additional option to cope with labour pain [35]. Personality traits and psychological factors such as pre-labour VR use, digital or technological skills and preferences, susceptibility for immersion in the virtual world, satisfaction with previous intrapartum pain management, anxiety, fear of pain, and pain catastrophizing may play a role in preferences in how to cope with labour and EA requests [54]. For future research, we recommend including these parameters, as these may be confounders affecting study outcomes when measuring the effect of VR. The inclusion of pre-labour assessments of preference of EA, personality, and psychological traits in VR research could provide valuable insights into the characteristics of women who are more likely to engage with VR during labour.

5. Conclusions

Promoting women’s autonomy over the timing and duration of VR use to cope with labour pain was not associated with a significant decrease in pain perception, EA use, or the duration of first and second stages of labour. However, the findings suggest a potential benefit for a delay of EA initiation and shorter duration of both stages of labour. Further research with well-matched intervention and control groups regarding clinical characteristics and personality traits is warranted to explore these potential effects. Lastly, the most effective timing and duration of VR interventions during labour could not be determined and should be investigated further.

Author Contributions

Conceptualisation, L.V.L. and Y.J.K.; methodology, L.V.L., N.V.d.C., L.V.B., S.V.V. and B.E.L.; validation, L.V.L. and Y.J.K.; formal analysis, L.V.L.; investigation, S.V.V. and B.E.L.; resources, S.V.V., L.V.L. and B.E.L.; data curation, L.V.L.; writing—original draft preparation, L.V.L.; writing—review and editing, L.V.L., N.V.d.C., L.V.B., S.V.V., B.E.L., E.M. and Y.J.K.; visualisation, L.V.L.; supervision, E.M. and Y.J.K.; project administration, L.V.L.; funding acquisition, L.V.L., E.M. and Y.J.K. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Department of Economy, Science, and Innovation of the Flemish Government, grant number 3100R3004.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Ethics Committee of the Antwerp University Hospital (Belgian registration number B3002020000246, protocol code 20/46/609, on 11 January 2021). Additional approvals were obtained from the respective ethics committees of the two hospitals where the pilot study was conducted (protocol codes 5448 and 201204BACHEL).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

In accordance with the informed consent signed by participants, the dataset cannot be made publicly available. However, data are available upon reasonable request to interested researchers until 2041. Please contact the corresponding author, who can provide a minimal dataset supporting the central findings of this study.

Acknowledgments

We would also like to express our gratitude to all the participants in our study, who were open to new and innovative ways to alleviate labour pain. Also, we are most grateful to Sven Mariën (S.M.) for the digital support and development of the virtual reality platform which was used during this study.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
EAEpidural analgesia
VRVirtual reality
HELLPHaemolysis, elevated liver enzymes, and low platelets
NRSNumeric rating scale
ANCOVAAnalysis of covariance
EMMEstimated marginal means
SDStandard deviation
Std. ErrorStandard error

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Table 1. Socio-demographic and obstetric characteristics (N = 108).
Table 1. Socio-demographic and obstetric characteristics (N = 108).
CharacteristicTotal (N = 108)VR Cases (n = 36)Control Group (n = 72)p-Value
Age mean (±SD)32.32 (3.73)32.92 (3.60)32.03 (3.79)0.19 °
Origin % (n)
Belgian60.2 (65)61.1 (22)59.7 (43)0.89 ˜
Other39.8 (43)38.9 (14)40.3 (29)
Partnership (e.g., married, living together) % (n)96.3 (104)97.2 (35)95.8 (69)0.72 ˜
Highest educational degree % (n)
Primary education1 (1)0 (0)1.4 (1)0.97 ˜
Secondary education13.3 (14)11.8 (4)14.1 (10)
Post-secondary (non-tertiary) education or short-cycle tertiary education (EQF 1 level 5)21.9 (23)20.6 (7)22.5 (16)
Bachelor’s degree35.2 (37)47.1 (16)29.6 (21)
Master’s degree27.6 (29)20.6 (7)31 (22)
Doctoral degree1 (1)0 (0)1.4 (1)
Gravida mean (±SD)2.08 (1.40)2.36 (1.92)1.94 (1.03)0.60 °
Parity mean (±SD)0.68 (1.02)0.86 (1.33)0.58 (0.82)0.60 °
Nulliparous % (n)58.3 (63)53.3 (21)58.3 (42)1 ˜
Pregnancy loss mean (±SD)0.39 (0.71)0.47 (0.81)0.35 (0.65)0.43 °
Gestational age in weeks mean (±SD)38.88 (1.56)39.03 (1.34)38.81 (1.67)0.89 °
Cervical dilation at admission in centimetres mean (±SD)3.36 (2.20)2.31 (1.59)3.88 (2.28)<0.001 °
Wish for epidural before onset of labour % (n)
Yes13.9 (15)13.9 (5)13.9 (10)0.99 ˜
No59.3 (64)58.3 (21)59.7 (43)
Undecided26.9 (29)27.8 (10)26.4 (19)
Induction of labour % (n)43.5 (47)75 (27)27.8 (20)<0.001 ˜
Mode of birth % (n)
Spontaneous vaginal birth75 (81)72.2 (26)76.4 (55)0.56 ˜
Assisted vaginal/instrumental birth13 (14)11.1 (4)13.9 (10)
Emergency caesarean section12 (13)16.7 (6)9.7 (7)
Dosage VR1 (n = 36) in minutes mean (±SD)-range-25.72 (14.14)–5–57--
Dosage VR2 (n = 7) in minutes mean (±SD)-range-31.29 (27.38)–5–77--
Cervical dilation (in centimetres) when commencing first VR session mean (±SD)-2.94 (1.59)--
Cervical dilation (in centimetres) when commencing second VR session mean (±SD)-3.86 (1.07)--
1 European qualification framework and lifelong learning. ° Non-parametric Mann–Whitney test. ˜ Chi square test.
Table 2. Pain scores before and after VR use on case level (N = 36) and on VR session level (N = 41) with subgroup analyses.
Table 2. Pain scores before and after VR use on case level (N = 36) and on VR session level (N = 41) with subgroup analyses.
VariableBefore VR 1After VR 1Mean Diff.Min–Max Diff.p-Value *95% CICohen’s d [95% BI]
On case level (n = 36)
First VR session (N = 34) mean (±SD)4.09 (2.79)3.82 (2.38)−0.26 (1.96)−4–60.44 *(−0.42–0.95)0.14 [−0.20–0.47]
Second VR session (N = 7) mean (±SD)4.29 (2.36)4.14 (1.68)−0.14 (1.07)−2–10.74 *(−0.85–1.13)0.13 [−0.62–0.87]
On VR session level (N = 41)
TOTAL sessions4.12 (2.69)3.88 (2.26)−0.24 (1.83)−4–60.4(−0.33–0.82)0.13 [−0.18–0.44]
Induced labour (n = 31)3.74 (2.76)3.29 (2.13)−0.45 (1.57)−4–20.12(−0.12–1.03)0.29 [−0.07–0.65]
Spontaneous labour (n = 10)5.30 (2.21)5.70 (1.64)0.40 (2.46)−2–60.62(−2.16–1.36)−0.16 [−0.78–0.47
Session commenced during latent phase of labour (<5 cm cx dil.) (n = 34)3.76 (2.55)3.65 (2.17)−0.12 (1.92)−4–60.72(−0.55–0.79)0.061 [−0.28–0.40]
Session commenced during active phase of labour (≥5 cm cx dil.) (n = 7)5.86 (2.91)5.00 (2.52)−0.86 (1.21)−2–10.11(−0.27–1.98)0.71 [−0.15–1.52]
Duration VR session ≥ 25 min. (n = 20)3.45 (3.02)3.8 (2.63)0.35 (1.35)−2–30.26(−0.98–0.28)−0.26 [−0.7–0.19]
Duration VR session < 25 min. (n = 21)4.76 (2.23)3.95 (1.99)−0.81 (2.06)−4–60.09(−0.13–1.75)0.39 [−0.57–0.83]
* Paired sample t-test two-sided. 1 Scores on NRS: numeric rating scale–0 (no pain) to 10 (worst pain). Mean diff.: mean difference. Min–max diff.: the minimum and maximum difference between pre–post-NRS scores, with negative numbers indicating a decrease in NRS pain scores and positive numbers an increase in pain score. Cx dil.: cervical dilation in cm.
Table 3. Comparison of use of non-pharmacological pain relief methods and epidural analgesia during labour and duration of first and second stage of labour between VR cases and controls (N = 108).
Table 3. Comparison of use of non-pharmacological pain relief methods and epidural analgesia during labour and duration of first and second stage of labour between VR cases and controls (N = 108).
VariableTotal (N = 108)VR Cases (n = 36)Controls (n = 72)p-ValueZr
Epidural Analgesia (AE) % (n)56.5 (61)66.7 (24)51.4 (37)0.13 ˜--
Cervical dilation at time of epidural in cm % (n)4.47 (1.85)4.5 (1.77)4.89 (1.91)0.42 *--
Massage % (n)26.9 (29)41.7 (15)19.4 (14)0.01 ˜--
Bath/shower % (n)43.5 (47)38.9 (14)45.8 (33)0.49 ˜--
Birthing ball % (n)50 (54)63.9 (23)43.1 (31)0.04 ˜--
Birth rope % (n)6.5 (7)13.9 (5)2.8 (2)0.03 ˜--
Ambulation % (n)5.6 (6)2.8 (1)6.9 (5)0.37 ˜--
Duration (in hours) from start of EA until second stage of labour (woman starts to push/full dilation) mean (±SD) (n = 48)4.75 (3.43)5.01 (4.35)4.6 (2.84)0.89 °0.140.02
Duration (in hours) from start of EA until birth mean (±SD) (n = 47)5.86 (4.77)5.63 (4.38)6 (5.06)0.84 °0.210.03
Duration (in hours) from admission to start of second stage mean (±SD) (n = 94) 8.66 (7.34)11.21 (7.39)7.4 (7.07)0.003 °−3.00−0.31
Total duration of labour (in hours) from first and second stage until birth mean (±SD) (n = 94)9.39 (7.40)11.78 (7.54)8.27 (7.11)0.007 °−2.71−0.28
Duration (in hours) from full dilation until birth mean (±SD) (n = 94)0.73 (0.67)0.57 (0.47)0.80 (0.73)0.15 °1.430.15
Duration variables
(adjusted for induction and cervical dilation at admission) N = 95		 EMMStd. Error95% CIp-Value !Adjusted R2
Duration (in hours) from start of EA until second stage of labour (woman starts to push/full dilation)VR cases4.850.922.99–6.70.86−0.04
Controls4.640.673.28–6
Duration (in hours) from start of EA until birth VR cases5.21.282.62–7.790.56−0.57
Controls6.180.964.25–8.11
Duration (in hours) from admission to start of second stage VR cases8.171.185.3–10.530.640.39
Controls8.870.767.37–10.38
Total duration of labour (in hours) from first and second stage until birth VR cases8.761.26.37–11.140.550.38
Controls9.650.778.13–11.18
Duration (in hours) from full dilation until birth VR cases0.580.130.32–0.850.230.05
Controls0.780.090.61–0.95
˜ Chi square test. * Independent sample t-test two-sided. ° Non -parametric Mann–Whitney test—exclusion of emergency caesarean section (n = 13). ! ANCOVA controlled for induction and cervical dilation at admission—exclusion of emergency caesarean section (n = 13). EMM or estimated marginal means, adjusted for induction (binary variable) and cervical dilation at admission (continuous variable). SD or standard deviation. Std. Error or standard error of EMM—95% CI or 95% confidence interval of EMM.
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Van Leugenhaege, L.; Van de Craen, N.; Vanden Bergh, L.; Van Vlierberghe, S.; Luten, B.E.; Mestdagh, E.; Kuipers, Y.J. The Effects of Virtual Reality During Labour on Perceived Pain, Use of Pain Relief and Duration of Labour: A Pilot Matched Case–Control Study in Belgium. Virtual Worlds 2025, 4, 43. https://doi.org/10.3390/virtualworlds4040043

AMA Style

Van Leugenhaege L, Van de Craen N, Vanden Bergh L, Van Vlierberghe S, Luten BE, Mestdagh E, Kuipers YJ. The Effects of Virtual Reality During Labour on Perceived Pain, Use of Pain Relief and Duration of Labour: A Pilot Matched Case–Control Study in Belgium. Virtual Worlds. 2025; 4(4):43. https://doi.org/10.3390/virtualworlds4040043

Chicago/Turabian Style

Van Leugenhaege, Luka, Natacha Van de Craen, Leen Vanden Bergh, Sarah Van Vlierberghe, Barbara Elizabeth Luten, Eveline Mestdagh, and Yvonne Jacoba Kuipers. 2025. "The Effects of Virtual Reality During Labour on Perceived Pain, Use of Pain Relief and Duration of Labour: A Pilot Matched Case–Control Study in Belgium" Virtual Worlds 4, no. 4: 43. https://doi.org/10.3390/virtualworlds4040043

APA Style

Van Leugenhaege, L., Van de Craen, N., Vanden Bergh, L., Van Vlierberghe, S., Luten, B. E., Mestdagh, E., & Kuipers, Y. J. (2025). The Effects of Virtual Reality During Labour on Perceived Pain, Use of Pain Relief and Duration of Labour: A Pilot Matched Case–Control Study in Belgium. Virtual Worlds, 4(4), 43. https://doi.org/10.3390/virtualworlds4040043

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