Delivery Pain and Postpartum Comfort

Study Overview
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Brief Summary
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In this study was aimed that acupressure applied on the BL32 point and shower application reduced the intensity of labor pain experienced by the pregnant women in the active phase of labor and increased their postpartum comfort

Detailed Description
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Acupressure and shower are methods that can help reduce pain severity. This study thus aims to determine the effects of acupressure and shower on labour pain and postpartum comfort. This study was a randomized controlled trial (RCT). This study was the control group consisted of 40 pregnant women, while the experimental groups (acupressure and shower) consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4-5, 6-7 and 8-10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale for Pain (VASP) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data. CONSORT checklist was used to report the current study.

Official Title
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Effects of Acupressure and Shower Applied in the Delivery on the Intensity of Labor Pain and Postpartum Comfort

Conditions
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Labor Pain, Hydrotherapy, Acupressure, Postpartum Period

Intervention / Treatment
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* Other: Acupressure
* Other: Shower


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The inclusion criteria were being 20-40 years of age; Having a foetus in vertex presentation Having a foetus weighing 2.5-4 kg, as determined through ultrasonography Being primiparous Being between 37 and 42 gestational weeks with a single foetus Having planned to have a spontaneous vaginal delivery Not having used nonpharmacological pain control methods previously Having a cervical dilation less than 5 cm (Dabiri et al., 2014) Not having received analgesia or anaesthesia. Exclusion Criteria: Were having a systemic disease during pregnancy (gestational diabetes, hypertension) Taking medication regularly Having a problem that prevented the woman from communicating Undergoing psychiatric treatment (pharmacotherapy or psychotherapy) Requiring an operative vaginal delivery (forceps, vacuum) Receiving pharmacological interventions for labour pain.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The randomized controlled trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Acupressure group<br>In the acupressure uterine contractions were checked before the care application began. Acupressure was applied when the women's cervical dilation reached 4-5 cm, 6-7 cm and 8-10 cm. This method was applied 18 times during uterine contractions. The application stopped at the end of each contraction and resumed once another contraction started. No application was performed between contractions. | Other: Acupressure<br>* A researcher sat behind the women to comfortably access the sacral area and be in the appropriate position. The researcher then applied deep rotational pressure on the BL32 points until her nail bed colour changed to prevent any discomfort in the participants<br>|
| Experimental: Shower Group<br>The shower group, uterine contractions were checked before the care application began. A shower was applied when the women's cervical dilation reached 4-5 cm, 6-7 cm and 8-10 cm. This method was applied 18 times during uterine contractions. The application stopped at the end of each contraction and resumed once another contraction started. No application was performed between contractions. | Other: Shower<br>* During uterine contractions, these participants took a shower while standing, with a researcher on hand to assist her (average time: 20 minutes). The water's temperature was between 22°C and 26°C.<br>|
| No Intervention: Control group<br>The women in the control group underwent routine hospital care. They were administered neither pharmacological nor nonpharmacological methods to reduce labour pain. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Reduce labor pain | The participants were applicated acupressure, and shower as for birth pain. Pain has been evaluated with VASP. | Evaluation was done until delivery (on average between 8-12 hours) | 
| Postpartum comfort levels | Postpartum comfort levels of the groups who received acupressure and shower in the postpartum period were evaluated.Postpartum comfort level has been evaluated with PPCQ. | 2 hours after birth | 
| A maternal information form | This form consisted of 13 items asking for the participants' sociodemographic characteristics | before birth | 
| Visual Analog Scale for Pain (VASP) | This scale is a 0-10 cm ruler developed by Bond and Pilowsky (Hawker et al., 2011; Aslan and Öztürk, 2014; Kömürcü and Ergin, 2014; Bond and Pilowsky, 1996). VASP is a 10 cm ruler which assessment with no pain at one end and worst pain at the other end. A Turkish validity and reliability study of the VASP was performed by Aslan and Öztürk (Aslan and Öztürk, 2014; Kömürcü and Ergin, 2014; Aslan, 2004). | Evaluation was done until delivery (on average between 8-12 hours) | 
| Postpartum Comfort Questionnaire (PPCQ) | The 48-item General Comfort Scale, developed by Kolcaba (Kolcaba, 1994), was first adapted into Turkish in 2008 by Kuğuoğlu and Karabacak, who also conducted a Turkish validity and reliability study on the scale (Kuğuoğlu and Karabacak, 2008). Based on the Turkish version of the GCS, Karakaplan and Yıldız (Karakaplan and Yıldız, 2010) developed the PPCQ. The PPCQ is a 5-point questionnaire with 34 items. Participants give items between 1 (strongly agree) and 5 points (strongly disagree). The lowest score possible is 34, and the highest score is 170, with higher scores indicating higher comfort levels. | 2 hours after birth | 
| Evalution labour pain | VASP was evaluated before and after acupressure and shower applications. | Evaluation was done until delivery (on average between 8-12 hours) | 
| Evalution postpartum comfort | Postpartum Comfort levels were evaluated in the postpartum period. | 2 hours after birth | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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labor pain, shower, acupressure, midwife, postpartum comfort