The review question and inclusion criteria were clearly defined. Relevant data sources were accessed, although the omission of articles that were unpublished, difficult to access or not in English meant that relevant studies may have been missed. It was unclear how many reviewers were involved in the review processes but it appeared that only one reviewer was involved, so the presence of reviewer error and bias could not be ruled out.
Suitable quality assessment criteria were used; the included trials were generally of high quality; a full breakdown of the results was reported. The methods of synthesis seemed appropriate, although some statistical heterogeneity between the trials was indicated. Other limitations of the evidence included a small number of trials, small sample sizes, and lack of reporting for length of labour.
The conclusion of this review reflects the evidence presented; the limitations of the sparse evidence base mean that the recommendations for clinical practice and further research were justified.