Shirdel Elham, Taghizadeh Ziba, Farnam Farnaz, Ghorbani Mahboobeh, Haghani Shima
Department of Midwifery, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.
Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran.
J Educ Health Promot. 2024 Dec 28;13:490. doi: 10.4103/jehp.jehp_1179_23. eCollection 2024.
Non-pharmaceutical method is one of the conventional methods of reducing labor pain. Acupressure is suggested as an effective method for reducing labor pain with favorable effects on the outcome of childbirth. Different acupressure methods are suggested for this purpose; the most effective one has to be investigated. Therefore, the present study compared the effect of two of the most effective acupressure methods, namely lumbar rotation in a standing position and the 6 splenic point (SP6) acupressure, in the active phase of labor on pain intensity, duration of labor, and childbirth experience among nulliparous women.
In this semi-experimental randomized clinical trial, 126 nulliparous women in Bint Al-Huda Hospital, Bojnourd, Iran, February-June 2021, were enrolled (by convenient sampling based on the inclusion criteria) and assigned to two interventions and a control group (no intervention). Baseline pain intensity was measured by VAS at a dilatation of 4 cm, immediately after intervention, and at dilation of 8 cm. Group "A" received lumbar rotation in standing position and group "B" received SP6 acupressure; once at 4 and once at 8 cm dilatation. The length of the active phase and the second stage of labor and the total duration of labor were calculated in minutes. The mothers completed the Walker Birth Experience Questionnaire within 2 h after the labor. Mean values were compared using the one-way analysis of variance (ANOVA, for three groups, with posthoc tests for significant differences) and independent samples -test (for two groups) using SPSS v.16 and considered significant at values < 0.05.
After the intervention, groups A and B had a lower mean pain intensity (5.80 ± 1.83 and 4.82 ± 2.14, respectively) than the control group (7.70 ± 1.91, < 0.001) and after the second intervention (8.06 ± 1.55, 7.68 ± 1.60, 9.92 ± 0.36 in groups A, B, and control, respectively; < 0.001). Labor duration was longer in the control group (228.11 ± 82.31 min active phase; 58.38 ± 23.86 min second stage, and 372.92 ± 114.41 min total) than group B (180.66 ± 60.68, 40.00 ± 18.56, and 310.39 ± 89.66 min, respectively, < 0.05). The mean total birth experience scores were lower in the control group (63.59 ± 6.59), compared with those in groups A and B (73.14 ± 7.95 and 72.84 ± 8.29, respectively, < 0.001), and in three dimensions of own capacity, perceived safety, and participation ( < 0.05).
Lumbar rotation in the standing position and SP6 acupressure had a positive effect on pain intensity, duration of labor, and birth experience.
非药物方法是减轻分娩疼痛的传统方法之一。穴位按压被认为是一种减轻分娩疼痛的有效方法，对分娩结局有积极影响。为此人们提出了不同的穴位按压方法；必须对最有效的方法进行研究。因此，本研究比较了两种最有效的穴位按压方法，即站立位腰椎旋转和三阴交（SP6）穴位按压，在初产妇分娩活跃期对疼痛强度、产程和分娩体验的影响。
在这项半实验性随机临床试验中，2021年2月至6月在伊朗博季努尔德的宾特·胡达医院纳入了126名初产妇（根据纳入标准采用方便抽样法），并将其分为两个干预组和一个对照组（不进行干预）。在宫颈扩张4厘米时、干预后立即以及宫颈扩张8厘米时，通过视觉模拟评分法（VAS）测量基线疼痛强度。A组接受站立位腰椎旋转，B组接受三阴交穴位按压；在宫颈扩张4厘米和8厘米时各进行一次。计算活跃期、第二产程的时长以及总产程，以分钟为单位。产妇在分娩后2小时内完成沃克分娩体验问卷。使用SPSS v.16软件进行单因素方差分析（用于三组，对显著差异进行事后检验）和独立样本t检验（用于两组）比较均值，P值<0.05被视为具有显著性。
干预后，A组和B组的平均疼痛强度（分别为5.80±1.83和4.82±2.14）低于对照组（7.70±1.91，P<0.001），第二次干预后（A组、B组和对照组分别为8.06±1.55、7.68±1.60、9.92±0.36；P<0.001）。对照组的产程更长（活跃期228.11±82.31分钟；第二产程58.38±23.86分钟，总产程372.92±114.41分钟），而B组分别为180.66±60.68、40.00±18.56和310.39±89.66分钟，P<0.05。对照组的平均总分娩体验得分（63.59±6.59）低于A组和B组（分别为73.14±7.95和72.84±8.29，P<0.001），在自身能力、感知安全性和参与度这三个维度上也是如此（P<0.05）。
站立位腰椎旋转和三阴交穴位按压对疼痛强度、产程和分娩体验有积极影响。
