Title of the paper:-

EFFECTIVENESS OF ACUPRESSURE ON LEVEL OF PAIN

AND DURATION OF LABOUR AMONG PRIMIGRAVIDA
MOTHERS

ROJLIN TIGGA*,M.sc Nursing, Sumandeep Vidyapeeth University, Sumandeep

Nursing College, Piparia, Waghodia, Vadodara, INDIA 391760
Phone: 9409390901
e-mail address : rosyrose8686@gamil.com

Mrs. Rita Thapa, Associate professor, Sumandeep Vidyapeeth University Sumandeep

Nursing College, Piparia, Waghodia, Vadodara, INDIA 391760
phone number: 9624628047
e-mail address- trita12flying@gmail.com

 Departmental Affiliations: Sumandeep Vidyapeeth University, Sumandeep Nursing

College

ABSTRACT
“A study to assess the effectiveness of acupressure on level of pain and duration of
labour among primigravida mothers during first stage of labour in selected hospitals of
Vadodara”.

Background : labour pain has been reported to be the most severe pain that a woman
experiences in her lifetime. Many non-pharmacological method may be helpful for women
during labour to achieve an effective coping level for their labour experience. For those
women who prefer to avoid or minimize the use of medical analgesia, acupressure is a safe,
effective, drug-free alternative. Objective: The aims of this study is to assess the pain and
duration of labour and to evaluate the effectiveness of acupressure in experimental and
control group. Material and Method: An evaluatory research approach with quasi
experimental- Non-equivalent control group post-test design was used. The sampling
technique was Non-probability convenience sampling. The participants were primigravida
mothers admitted to delivery ward of selected hospitals of Vadodara in their latent phase.
When the women who had agreed to participate in the study, experienced regular uterine
contractions, they were taken to the delivery room. Participants were examined for their
cervical dilation status, and status of the intact membranes. A total of 60 participants equally
divided to either the experimental (SP6)( N = 30) or control (N=30) group. For the purpose of
gathering pertinent and reliable data. Participants were assessed in terms of inclusion criteria.
After SP6 acupressure intervention in experimental group; whereas pre-determined numbers
of uterine contractions in control group; subjective pain was measured using standard Visual
Analogue Scale (VAS) with rating from 1-10; a higher score indicated more pain. The VAS
was recorded for each woman three times and scores calculated. Researcher gave the
participants of both groups equal care throughout the labour, except acupressure practice in
control group. No problems were detected in the women or fetuses during acupressure
application. Results There were significant differences in mean pain score between the
experimental and control group “ t” test result of VAS-1 (5.52* ), VAS-2 (20.59* ) and VAS-
3 (8.60*) which is more than the table value (1.96) and duration of first stage of labour ‘t’
(12.86*) also found to be statistically significant in favour of the acqupressure groups.
Interpretation and Conclusion It concluded that acupressure is an effective non-
pharmacological method to bring comfort to the women in times of labour agony. Hence
acupressure could be used in clinical practice in order to improve the quality of care in
labour.

Key words: duration of labour, effectiveness, first stage of labour, level of pain, primigravida
mothers,

INTRODUCTION
 Labour pain is a universal experience which differs from women to women. Labour pain is
among the most severe pain human beings experience and compares in its intensity to severe
cancer pain or pain from the amputation of a digit. Acupressure is a simple, safe and effective
hands-on technique originated in China .Involves the manual stimulation of specific points,
known as Acupoints .

NEED FOR THE STUDY

Labour pain does not result from tissue trauma or damage; rather, it is a part of a unique
physiological process. The main factors in delivery pain are cervical dilatation and uterine
contractions. Severe labour pain leads to the mother’s emotional turmoil and disturbs her
mental health. It also has several negative effects on maternal and fetal physiological status as
well as the delivery progress. Thus, reduction of delivery pain is of great importance for
decreasing the negative effects of the physiological processes which occur due to the
mother’s pain and anxiety and lead to maternal and fetal damages. Acupressure is a natural
and holistic approach in bringing on the labour and delivery. It has absolutely no adverse
effect on the baby as no pharmaceuticals are being introduced into the body. It's safe for the
mother, as well, because it only helps the body to function better.

Objectives of the study

 To assess the level of pain and duration of labour in experimental group and control
group.
 To evaluate the effectiveness of acupressure between experimental and control group.
 To associate the demographic variables of experimental and control groups with level
of pain and duration of labour.

Hypothesis

 H1: There will be significant difference in level of pain and duration of labour in
experimental group and control group.
 H2: There will be significant association in level of pain, duration of labour with
selected demographic variables.

Conceptual framework

Theoretical framework selected in this study was based on Callista Roy’s model
( 1989). According to her person or mother is a bio-psycho-social being. During the uterine
contractions she is in constant interaction with a changing environment. To cope with a
changing world, she uses both innate and acquired mechanisms which are biological,
psychological and social in origin.
 ENVIRONMENTAL STIMULI COPING PROCESSESS EFFECTOR ADAPTION

Adaptive behavior
Interdependence
Focal Stimuli - Relaxes
Relationship - Cooperates
- Level of pain Physiological Self –Concept of mother - Follows instructions
- Duration of Mother remains relax May have reduce with - Improved comfort
labour and comfortable pain researcher - Reduced intensity of
and support pain and duration of
Co-operate with Delivery process persons labour
Contextual Stimuli situation will be shorten
without
- Uterine contractions complication Role Function
- Age and gender Mother have reduce
- Fear and anxiety pain perception
Acceptance of acu.for OR
- Unknown
surroundings Coping mechanisms motherhood in the aspects
of reducing the level of
- Social support
pain and duration of
Cognator Regulatorlabour in the first stagr of
Residual Stimuli labour. Non –adaptive
Information about Neural pathway Behavior
- Pain threshold acupressure and its Reduced level of pain and
- Socio-cultural benefit chemical changes
duration of labour with - In Pain
orientation the help of acupressure - Restlessness
- Contact with health Constant Endocrine changes - Non-cooperative
care professionals psychological - Irritability
- No past experience support - Physical discomfort
- No hospitalization
physical support given
by
Monitoring Partograph
and need based care FEEDBACK

- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - - - - - - - - - - - - - - - -- - - -
Fig. 2 : MODIFIED CALLISTA ROYS’ ADAPTION MODEL ( Dotted line not in the study)
REVIEW OF LITERATURE

The relevant literature is presented under the following heading:

 Section A: Literature related to pain perception during first stage of labour.

 Section B: Literature related to level of pain and duration of labour among
primigravida mothers.
 Section C: Literature related to effectiveness of acupressure during first stage of
labour.

METHODOLOGY

 Research approach:- Evaluatory approach

 Research design:-Quasi-experimental non- equivalent control group post-test design.
 Variables :- Independent variables: acupressure
Dependent variable: pain and duration of labour, primigravida mothers, first stage of
labour.
 Setting:- labour room of selected hospital of vadodara.
 Sample size & sample technique- 60 primigravida mothers, (30 mothers placed in
experimental group and 30 in control group) the sampling technique – non probability
convenient sampling technique.
 Population:- Primigravida mothers who all are in first stage of labour admitted at
selected hospital of vadodara, GJ

Criteria For Sample Selection

Inclusion criteria- primigravida mothers :

 Who completed 37weeks of gestation

 Singleton pregnancy
 Who are undergoing normal vaginal delivery
 Who are in the first stage of labour with intact membranes
 Has no neurological disorder
 Cases approved and allowed by gynecologist
 Has no bruises or existing pain at SP6 point

Exclusion criteria- Primigravida mothers,

 High risk cases

 Who are going for elective LSCS
 Who all have received analgesic for pain reduction

Development of tools

Section A:- Baseline data includes age, religion, type of family, income of family,
Qualification, duration of marriage, ANC Visit and fear of labour pain.
Section-B: Universal pain assessment scale to assess the level of pain

Scoring:-
Mild labour pain 1-2
Moderate labour pain 3-6
Severe labour pain 7-8
Worst labour pain 9-10

Section-C :-Partograph -The duration of labour is measured from the participants’ partograph
charts: from establishment of regular and rhythmic uterine contractions to full cervical
dilation. Scoring system (Duration of first stage of labour)

7- 10 hrs 1
10 -13 hrs 2
13-16 hrs 3
Validity of Tool

On the basis of critical literature analysis and panel of experts’ recommendation suitable
standard tool is adopted to collect data was universal pain scale and partograph.

Reliabity of the tool

In this study standard tool was used for 6 mothers from a nursing home and found suitable.

Pilot Study

In this study after obtaining the administrative approval pilot study was conducted in labour
room of Matritwa Nursing Home, Makrpura and uday clinic at Uma char rasta between 15th
july to 30th july. 6 Mothers were selected by non probability convenience sampling technique.
The subject for pilot study possessed same characteristics as that of sample for the main
study.

Data Collection
Formal permission obtained, The data process began from 10th August to 25th september
2015. Selected 60 primigravida women, Informed consent obtained, Every day approximately
2-4 samples were taken. SP6 acupoint was anatomically located and during uterine
contractions acupressure was given. The first VAS evaluation (VAS-1) in the latent phase.
The second VAS-2 in the early active phase of labour. The third VAS-3 was took place at
the late active phase of labour. The duration of labour is measured from the participants’
partograph charts: from establishment of regular and rhythmic uterine contractions to full
cervical dilation.

ANALYSIS AND INTERPRETATION OF DATA

The data is analyzed and presented under the following sections:

 SECTION 1: Description of demographic characteristics of participants.

  SECTION 2: Overall and aspect wise VAS level among experimental and control
groups
 SECTION 3: Association between variables and VAS level among Experimental and
control groups.

SECTION 1: Description of demographic characteristics of participants.

TABLE NO. – I Classification of Respondents by Demographic Characteristics

Characteristics Category Experimental (n=30) Control (n=30)

N % N %
Age group (years) 18-22 15 50.0 11 36.7
23-26 11 36.7 15 50.0
27-30 4 13.3 4 13.3
Religion Hindu 21 70.0 18 60.0
Muslim 9 30.0 9 30.0
Christian 0 0.0 3 10.0
Type of family Nuclear 7 23.3 6 20.0
Joint 23 76.7 24 80.0
Family Rs.3.000-8,000 12 40.0 16 53.3
income/month Rs.8,001-13,000 11 36.7 9 30.0
Rs.13.001 7 above 7 23.3 5 16.7
Educational level Illiterate 10 33.3 13 43.3
Primary & Secondary 13 43.3 10 33.3
Higher secondary 2 6.7 3 10.0
Graduate & PG 5 16.7 4 13.4
Duration of One 19 63.3 17 56.7
Marriage (years) Two 11 36.7 13 43.3

TABLE – II Classification of Respondents by Related Characteristics

Characteristics Category Experimental (n=30) Control (n=30) X2

Value
N % N %
Antenatal Clinical Yes 30 100.0 30 100.0 0.00 NS
Visits No 0 0.0 0 0.0
Fear of Labor pain Yes 24 80.0 26 86.7 0.48 NS
No 6 20.0 4 13.3
Duration of first 7-10 hrs 14 46.7 0 0.0 29.08*
stage of labor 10-13 hrs 16 53.3 15 50.0
13-16 hrs 0 0.0 15 50.0
*Significant at 5% level, NS : Non-significant
 SECTION 2-

TABLE NO.III Overall and aspect wise pain score in both experimental and control groups

ASPECTS VAS SCORE EXPERIMENTAL GROUP CONTROL GROUP

N % N %
Pain score at Mild (1-2) 20 66.7 3 10
latent phase
(VAS-1) Moderate 10 33.3 27 90
(3-6)
Severe ------ ------- -------- -------
(7-8)
Pain score at Mild (1-2) 0 0 0 0
early active
phase Moderate 30 100 2 6.7
(VAS-2) (3-6)
Severe ------ -------- 28 93.3
(7-8)
Pain score at late Mild (1-2) 0 0 0 0
active phase
(VAS-3) Moderate 25 83.3 0 0
(3-6)
Severe 3 10 17 56.7
(7-8)
Worse 2 6.7 13 43.3
(9-10)

TABLE NO.IV Overall and aspect wise duration of labour in both experimental and control
groups

ASPECTS SCORE EXPERIMENTAL GROUP CONTROL GROUP

N % N %
Duration of 7-10 hours 14 46.7 0 0
labour
16 53.3 15 50
10-13 hours
--- 15 50
13-16 hours
 TABLE NO.V Comparison of pain score between experimental and control group

ASPECTS EXPERIMENTAL GROUP CONTROL GROUP t-test

df

MEAN SD MEAN SD

Pain score at
latent phase 1.33 0.48 1.90 0.30 5.52*
(VAS-1)
58

Pain score at
early active 2 0.0 2.94 0.25 20.59*
phase 58
(VAS-2)
Pain score at
late active phase 2.23 0.57 3.42 0.52 8.60*
(VAS-3) 58

Significant at 5% level t (0.05)=1.96

TABLE NO. VI Comparison of duration of labour between experimental and control group

ASPECTS EXPERIMENTAL GROUP CONTROL GROUP t-test

df
MEAN SD
MEAN SD
Duration of
labour 10.2 8.7 15.7 1.0 12.86*

58

Significant at 5% level t (0.05)=1.96

SECTION – 3
Association between Demographic variables and VAS -1 level among Experimental and
Control and group
TABLE –VII Association between Demographic variables and pain level and duration of
labour among Experimental group
Demographic Category Sample VAS-1 Pain Level χ 2 Value P
Variables Mild Moderate Value
N % N %
Age group 18-22 15 11 73.3 4 26.7 1.15 NS P>0.05
(years) 23-26 11 6 54.6 5 45.4 2df=5.991
27-30 4 3 75.0 1 25.0
Religion Hindu 21 13 61.9 8 38.1 0.71 NS P>0.05
Muslim 9 7 77.8 2 22.2 2df=5.991
Christian 0
Type of family Nuclear 7 2 28.6 5 71.4 5.96* P<0.05
Joint 23 18 78.3 5 21.7 1df=3.841

Family Rs.3.000-8,000 12 9 75.0 3 25.0 1.17 NS P>0.05

income/mth 2df=5.991
Rs.8,001-13,000 11 6 54.6 5 45.4
Rs.13.001 7 7 5 71.4 2 28.6
above
Educational Illiterate 10 7 70.0 3 30.0 1.30 NS P>0.05
level Primary & 13 8 61.5 5 38.5 3df=7.815
Secondary
Higher 2 2 100.0 0 0.0
secondary
Graduate & PG 5 3 60.0 2 40.0
Duration of One 19 10 52.6 9 47.4 4.59* P<0.05
Marriage Two 11 10 90.9 1 9.1 1df=3.841
(years)
Fear of Labour Yes 24 17 70.8 7 29.2 0.94 NS P>0.05
pain No 6 3 50.0 3 50.0 1df=3.841
Duration of 7-10 hrs 14 6 42.9 8 57.1 6.70* P>0.05
first stage of 10-13 hrs 16 14 87.5 2 12.5 1df=3.841
labour
Combined 30 20 66.7 10 33.3
* Significant at 5% Level, NS : Non-Significant

TABLE – 3.2 Association between Demographic variables and VAS-1 level among Control
group
 Demographic Category Sam VAS-1 Pain Level χ 2 Value P
Variables ple Mild Moderate Value
N % N %
Age group 18-22 11 0 0.0 11 100.0 8.52* P<0.05
(years) 23-26 15 1 6.7 14 93.3 2df=
27-30 4 2 50.0 2 50.0
5.991

Religion Hindu 18 1 5.6 17 94.4 2.22 NS P>0.05

Muslim 9 2 22.2 7 77.8 2df=
Christian 3 0 0.0 3 100.0
5.991

Type of family Nuclear 6 0 0.0 6 100.0 0.83 NS P>0.05

Joint 24 3 12.5 21 87.5 1df=
3.841
Family Rs.3.000-8,000 16 0 0.0 16 100.0 6.79* P<0.05
income/month Rs.8,001-13,000 9 1 11.1 8 88.9 2df=
Rs.13.001 7 above 5 2 40.0 3 60.0
5.991

Educational Illiterate 13 2 15.4 11 84.6 2.86 P>0.05

level Primary & 10 0 0.0 10 100.0 NS
Secondary (3df=
Higher 3 0 0.0 3 100.0 7.815)
Secondary

Graduate & PG 4 1 25.0 3 75.0

Duration of One 17 0 0.0 17 100.0 4.36* P<0.05
Marriage Two 13 3 23.1 10 76.9 1df=3.841
(years)
Fear of Labour Yes 26 3 11.5 23 88.5 0.51 NS P>0.05
pain No 4 0 0.0 4 100.0 1df=3.841

Duration of 10-13 hrs 15 3 20.0 12 80.0 3.93* P<0.05

first stage of 13-16 hrs 15 0 0.0 15 100.0 1df=3.841
labour
Combined 30 3 10.0 27 90.0
* Significant at 5% Level, NS : Non-Significant

RESULTS: There were significant differences in mean pain score between the experimental
and control group “ t” test result of VAS-1 (5.52* ), VAS-2 (20.59* ) and VAS-3 (8.60*)
which is more than the table value (1.96) and duration of first stage of labour ‘t’ (12.86*) also
found to be statistically significant in favour of the acqupressure groups. Thus H1 is highly
accepted while H2 partially accepted.
LIMITATION: Study is limited to:
1. Sample size limited to 60. 30 experimental group and 30 control group.
2. Period of 6-8 weeks.
3. Selected maternity hospitals
4. The data was collected on selected aspects.

DISCUSSION : Based on the formulated objectives of the study and hypothesis. The study
was designed to assess the effectiveness of acupressure on level of pain and duration of
labour among primigravida mothers during first stage of labour in selected hospitals of
vadodara.The findings of the study have been discussed with reference to the objectives and
hypothesis stated in results.

RECOMMADATIONS

• The similar study can be conducted on a larger group. This would provide invaluable
evidence in the area of practice.
• A study can be carried out to assess the knowledge and attitude of nurse midwives on
complementary and alternative therapies for labour pain management.
• A study can be carried out to assess the effectiveness of other nursing measures such
as music therapy, warm water bath, and labour support for effective pain management
during labour.
• Further study could be carried out to assess the effectiveness of acupressure by
adopting random sampling of primi or multigravida women.
• Other than SP6 acupoint; Li4, BL67, GB21, can be evaluated for the reduction of
labour pain.
• Acupressure can be used for relief of primary dysmenorrhea and postmenapausal
symptoms relief.

ETHICAL CONSIDERATION: ethical clearance obtained from the ethical committee of

Sumandeep Vidyapeeth and willingness obtained from the subject before data collected.

"CONFLICTS OF INTEREST" AND SOURCE OF FUNDING: The authors report no

conflict of interest and used own budget for this study, no fund had been provided by any of
the institutions.

CONCLUSION : It was determined that SP6 acupressure was effective in reducing pain and
duration of labour.

ACKNOWLEDGEMENT

First and foremost, to the Almighty Father, for His unceasing love and blessings.
It gives me great pleasure to express my sincere thanks to Co-guide Prof. (Ms.) Sijo Koshy,
Head of Department of Obstetric and Gynaecological Nursing, for her vigilant supervision,
open nature and valuable suggestions.

I am highly obligated to my Husband, Mr. Dheeraj k. Gautam, parents and friends for their
encouragement, support and for simply being there, without which I could not be able to
complete this study successfully.

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