MASSAGE AND HOT APPLICATION ON LABOR
Condition: Labor Pain
MeSH terms: Labor Pain
Study type: Interventional

Summary: 
      Aim: This study aimed to examine the effects of sacral massage and hot application on labor
      pain and comfort level perceptions in pregnant women.

      Methods: This randomized controlled experimental study included hot application, massage and
      control groups, each having 30 primiparous pregnant women whose cervix was dilated to 4-5 cm.
      The intervention groups were given a sacral massage or sacral hot application, whereas the
      control group was given only standard midwifery care during 4-5, 6-7, and 8-9 cm cervical
      dilation. The data were collected using the Introductory Information Form, the Childbirth
      Comfort Questionnaire (CCQ), and the Numerical Rating Scale (NRS).
    

Detailed description: 
      This randomized controlled experimental study was carried out between June and December 2016
      in the delivery room of Public Hospital in Turkey.The sample size was determined using power
      calculations G*Power 3 with taking into account previous studies in which a effects massage
      and hot application on labor pain. Estimates of effects were derived from the findings of
      previous studies. The sample size was calculated at the 5% level of significance and a power
      of 95% based on previous studies (n = 30 in each group). The study sample consisted of
      primiparous pregnant women with vaginal delivery expectancy, term pregnancy, single healthy
      fetus, and active labor stage (4-5 cm dilation). A total of 98 primiparous pregnant women
      were included in the study, but 8 of them were excluded because of delivery by cesarean
      section. Thus, three research groups were formed as follows: massage, hot application, and
      control groups (n =30 in each group). Sacral massage and sacral hot application were applied
      to the intervention groups, and only standard midwifery care was given to the control group.
      Randomization was performed when each pregnant woman who was admitted to the hospital during
      labor and met the inclusion criteria. Randomization was provided with the collection of data
      on Mondays, Wednesdays, and Fridays of each week during the study period. Sacral massage was
      applied on Mondays, sacral hot application was performed on Wednesdays, and data of the
      control group were collected on Fridays. Cervical dilation and effacement, contraction, fetal
      heartbeat rate, and vital findings were followed in the standard midwifery care. Midwives
      informed pregnant women about breathing and evacuation techniques. In addition, all pregnant
      women in labor process received induction application. Each study group was given a
      descriptive information form, Childbirth Comfort Questionnaire (CCQ), and Numerical Rating
      Scale (NRS) in the active stage of labor (4-5 cm cervical dilation). Standard midwifery care
      was given to each group, and intervention groups were interfered three times in total, during
      4-5, 6-7, and 8-9 cm cervical dilation. Immediately after each intervention, NRS was
      administered between contractions. CCQ was also applied between contractions after the last
      intervention made during 8-9 cm cervical dilation. Pregnant women in the control group filled
      NRS during 4-5 and 6-7 cm cervical dilation, and CCQ during 8-9 cm cervical dilation. NRS was
      applied for the last time in all three groups 5 min after the third stage of labor.

      Childbirth Comfort Questionnaire-CCQ: This scale was developed by Schuling and Sampselle
      (2003), and the Turkish validity and reliability study of the scale was carried out by Potur
      et al (2015). Potur et al. (2015) showed that the sociocultural subscale had item total score
      correlation coefficient less than 0.30, and the items showing the relief level were extracted
      from the scale. The CCQ consisted of physical, environmental, and psychospiritual subscales
      and a specific sense of relief and transcendence. It was a 5-point Likert-type scale with
      nine items. Each item scored between strongly disagree (1 point) to strongly agree (5
      points). It is possible to score from 9 to 45 when all questions on the scale are answered.
      High score referred to high comfort and vice versa. In the present study, CCQ was applied two
      times in total, one before the intervention during 4-5 cm cervical dilation and one
      immediately after the intervention during 8-9 cm cervical dilation.

      Numerical Rating Scale (NRS): This scale was used to evaluate pain levels.Subjects were asked
      to rate the level of their pain using the numbers from 0 (no pain) to 10 (worst imaginable
      pain) on this scale. In the present study, NRS was applied five times in total, one before
      the intervention, three times immediately after interventions (during 4-5, 6-7, and 8-9 cm
      cervical dilations) and one after delivery
    

Intervention name(s): HOT APPLICATION; MASSAGE
Intervention type(s): Other; Other
Intervention description(s): HOT APPLICATION
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: comfort at labor; labor pain; hot application; massage