Effect of Hot Pack on Labor Pain, Duration of Labor, and Satisfaction of Primigravidae Women in Saudi Arabia
Condition: Labor Pain; Duration of Labor; Satisfaction
MeSH terms: Labor Pain
Study type: Interventional

Summary: 
      The study aimed at determining the effect of hot pack on labor pain reduction and the
      duration of labor in comparison with routine care. Further, the study also aimed at
      determining the women's satisfaction with the use of hot pack and with routine care

      with hypotheses: H1: Primigravid women who received hot pack in the active phase of labor
      will have a significantly lower mean labor pain score than those who received routine care.

      H2: Primigravid women who received hot pack in the active phase of labor will have
      significantly shorter mean labor duration than those who received routine care.
    

Detailed description: 
      Childbirth pain is the severest type of pain that women experience in their life. Therefore,
      effective management of labor pain is essential. There are various methods to control
      childbirth pain: pharmacological and non-pharmacological such as Entonox and heat therapy
      respectively. In most Saudi Arabian hospitals, Entonox is used as routine care, while non-
      pharmacological agents are rarely used. Various forms of heat therapy are effective in labor
      pain reduction and shortening the duration of labor. There is a dearth for studies that
      compare the effectiveness of the hot pack with routine care that includes use of Entonox.

      Objectives

        -  To determine the effect of the hot pack on labor pain reduction among primigravid women.

        -  To determine the effect of the hot pack on the duration of labor among primigravid
           women.

        -  To determine the satisfaction of primigravid women regarding hot pack and routine care.

      Methods The study was conducted in Armed Forces Hospital Southern Region, with randomized
      sample of 91 primigravidae with normal pregnancy in active phase of first stage of labor,
      with cervical dilatation of 6 - 8 cm. This randomized controlled trial consisted of two
      groups: the experimental group (n = 45) who received hot pack. The control group (n = 46)
      received routine care including Entonox. Labor pain was assessed by Visual Analogue Scale for
      pain intensity (VAS); duration of labor was measured by the WHO modified partograph, and
      women's satisfaction was assessed using a satisfaction scale. Following eligibility
      assessment, participants were selected and allocated to the groups randomly. After obtaining
      the written informed consent, the initial assessment was done; the experimental group
      received hot pack, and the control group received routine care until delivery. The baseline
      pain score was assessed before the intervention and every 30 minutes after the intervention
      until delivery. The duration of labor was assessed using the WHO Partograph. The women
      reported satisfaction two hours post-delivery using the satisfaction scale.

      Results:

      Before the intervention, the experimental and control group did not differ statistically in
      terms of labor pain score (p = .820). Post-intervention, the labor pain score was
      significantly lower in the experimental groups (p ≤ 0.05) compared to the control group at
      30, 60, 90, 120, 150 and 210 minutes. The duration of the first, second, and third stages of
      labor was not significantly different among both groups (p ≥ 0.05). The overall mean
      satisfaction scores were significantly higher in the experimental group compared to the
      control group (p ≤ 0.05), the mean scores of two items, one on happiness with the care
      received, and the other with the delivery experience were not significantly different between
      both groups (p ≥ 0.05).

      Conclusion:

      Heat therapy, such as the hot pack is a non-pharmacological method for labor pain management.
      Heat therapy is effective in reducing labor pain. Although it has been not effective in
      shortening the duration of labor, women are satisfied with the use of hot pack. This finding
      could be useful in formulating policies regarding implementation of the non-pharmacological
      methods for labor pain management. It is essential to educate healthcare professionals
      regarding the benefits of heat therapy even before implementing a change.
    

Intervention name(s): Hot Pack
Intervention type(s): Device
Intervention description(s): It is a single-use pack filled with magnesium sulfate and water, which was squeezed between the hands to activate their warming effect. The temperature ranges between 40°C to 50°C, which is safe to use. Thus, it provided a consistent heat therapy for up to 30 minutes. They can be used directly on the skin or covered with gauze to avoid direct skin contact. Applied to the lower back area for 30 minutes, followed by 10 minutes rest between each hot pack application, then it was reapplied for another 30 minutes. This procedure was repeated till delivery.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: experimental group received who received hot pack, which was a single-use pack filled with magnesium sulfate and water, squeezed between the hands to activate the warming effect, applied to the lower back area. The control group received routine care including Entonox.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Hot pack, Labor pain, Duration of labor, Satisfaction, Primigravid women