INTRODUCTION:

Pregnancy is an intense time in the life of an expecting mother filled with physical and emotional changes. For many pregnant women, anticipated labour pain is a major concern during their pregnancy. Decisions they make about pain relief measures can have a profound effect on their experience and memories of labor, procedures, medications or restrictions that may become necessary for them or their baby's well-being after the birth. As the pain management by pharmacological method may affect the condition of the baby or the mother, non-pharmacological method which is safe for both was preferred by the researcher for pain relief.

Need for the Study

Pregnancy is one of the most exciting and important event in each woman's life involving many factors that should be considered in advance such as changes in diet, habits and lifestyle that may be worked out with the doctor before, during and after the pregnancy. Natural childbirth aims to maximize the innate birth physiology and laboring movement of healthy, well-nourished women. For the mother, a natural birth increases the probability of a healthier postnatal period and an easier recovery due to fewer post-intervention discomforts. A natural birth also reduces the likelihood of needing to separate the infant from its mother after birth. Thus most of the woman likes to undergo a natural child birth due to its advantages and decreased pain perception. Though there are various types of pain relief measures, the method chosen should not affect the labour, condition of the mother and the baby and should decrease pain perception. As there are various studies which give the evidence in effectiveness of acupressure during labour, the researcher has chosen scalp acupressure to provide relief from pain and promote coping for the parturient women during labour.

Statement of the Problem

An Experimental Study to Assess the Effectiveness of Scalp Acupressure upon Labour Pain among Primiparturient Women in the First Stage of Labour at St. Antony’s Hospital, Chennai.

Objectives

1. To assess the level of labour pain, coping and feto-maternal parameters before and after scalp acupressure in the control and experimental group of primiparturient women.

2. To compare the level of labour pain, coping and feto-maternal parameters before and after scalp acupressure in the control and experimental group of primiparturient women.

3. To determine the level of satisfaction upon scalp acupressure among experimental group of primiparturient women.

Assumptions

The study assumes that

Ø Pain in labour is progressive in nature.

Ø The experience of labour pain varies markedly from woman to woman.

Ø Natural childbirth aims to maximize the innate birth physiology and labouring movement of healthy well nourished women.

Ø Non-pharmacological measures are simple, safe and inexpensive which can help a woman to relax during contractions.

Ø Acupressure is a way of accessing and releasing blocked or congested energy paths in the body.

Ø Stimulation of specific labour acupressure points for pain relief increases the release of endorphins which are effective natural painkillers.

Null Hypotheses

Ho₁ There will be no significant difference in the level of labour pain, coping and feto-maternal parameters before and after scalp acupressure between the control and experimental group of primiparturient women at the level of p<0.05.

Ho₂ There will be no significant association between selected demographic variables and the level of labour pain and coping before and after scalp acupressure in the control and experimental group of primiparturient women at the level of p<0.05.

Ho₃ There will be no significant association between selected obstetric variables and the level of labour pain and coping before and after scalp acupressure in the control and experimental group of primiparturient women at the level of p<0.05.

Research Methodology

Research Approach: A true experimental approach was used.

Research Design:

Time series design with multiple institution of treatment was used in the study.

RO1 – O2, O3 – O4, O5 – O6.....................O13 – O14

RO1 X O2, O3 X O4, O5 X O6 ……….. O13 X O14

Variables

Independent variable: Scalp acupressure is the independent variable.

Dependent variable: Labour pain is the dependent variable in this study.

Extraneous variables: Demographic variables and obstetric variables were extraneous variables in this study.

Research Setting: St. Antony’s Hospital, Chennai.

Population: All the primiparturient women admitted at St. Antony’s Hospital, Chennai.

Sample: A sample of 60 primiparturient women in the first stage of labour was selected with 30 women in control group and 30 women in experimental group.

Sampling Technique: Simple random sampling was used.

Sampling Criteria

Inclusion criteria:

The study includes parturient women who were

Ø In the first stage of labour with >4cm of cervical dilatation

Ø Between 37-42 weeks of gestation

Ø Willing to participate in the study

Ø Able to understand and speak either Tamil or English

Exclusion criteria:

The study excluded

Ø Mother with any underlying diseases such as PIH, DM

Ø Mother with complicated pregnancy like obstructed labour, multiple pregnancy, preterm labour.

Ø Multigravidae

Selection and Development of Study Instruments

The instruments used in this study were demographic variable proforma, obstetric variable proforma, modified pain intensity scale, pain coping scale, modified WHO Partograph and rating scale on satisfaction of scalp acupressure upon labour pain.

Data collection procedure

The researcher was trained for one week in giving scalp acupressure and certified before data collection. Protection of human rights was maintained and the data was collected day and night from June 17 to July 30.

Scalp acupressure was provided every one hour for four minutes with 30 seconds at each point for experimental group of primiparturient women during the active and transition phase of labour. The pain level, coping level and fetomaternal parameters were assessed after each intervention for both groups with the same tools. The level of satisfaction on scalp acupressure was assessed in the experimental group of primiparturient women using rating scale after delivery.

Major findings of the study

Level of Labour Pain
Group	n	Before therapy		After therapy		Paired 't' value
Group	n	Mean	SD	Mean	SD	Paired 't' value
Control Group	30	7.4	0.51	8.95	0.51	6.66 ***
Experimental Group	30	7.86	0.34	5.63	0.66	14.6 ***

Ø The mean and standard deviation of level of labour pain was higher after therapy (M=8.95, SD=0.83) when compared with labour pain before therapy (M=7.4, SD=0.51) in the control group, whereas the mean and standard deviation of the level of labour pain was lower after therapy (M=5.63, SD=0.66) when compared with labour pain before therapy (M=7.86, SD=0.34) in the experimental group (p<0.001 level of confidence).

Ø The mean and standard deviation of coping level in the control group was lower after therapy (M=2.00, SD=1.01) than before therapy (M=5.36, SD=0.23) and the mean and standard deviation of coping level in the experimental group was higher after therapy (M=6.01, SD=0.96) compared to before therapy (M=1.9, SD=0.22) at p<0.001 level of confidence.

Level of Coping
Group	n	Before therapy		After therapy		Paired 't' value
Group	n	Mean	SD	Mean	SD	Paired 't' value
Control Group	30	5.36	0.23	2	1.01	8.91***
Experimental Group	30	1.9	0.22	6.01	0.66	15.17***

Ø The mean and standard deviation of the frequency of uterine contraction in the experimental group was lower after therapy (M=3.2, SD=0.14) when compared to before therapy (M=4.14, SD=0.22) and uterine contraction duration was higher after therapy (M=49.5, SD=3.51) compared to before therapy (M=41.4, SD=3.21) at p<0.05 and p<0.001 level of significance for control and experimental group respectively.

Ø The mean cervical dilatation in the control group (M=6.49, SD=0.44) was lesser than the experimental group (M=7.44, SD=0.26). Majority of the women were highly satisfied 96.7% with scalp acupressure during the first stage of labour and none of them reported low satisfaction.

Mean Distribution of Cervical Dilatation in Control and Experimental Group of Primiparturient Women

Implications

Nursing Practice:

The parturient women of the experimental group felt less pain perception and improved coping with the use of scalp acupressure during the first stage of labour than the control group proving it to be effective to use. Many women opt to use some form of pain relieving method to help them cope during labour. Hence it becomes a necessity for the midwives to have adequate knowledge and skill about various non-pharmacological methods. Though there is availability of various non-pharmacological methods, acupressure technique is noninvasive, safe and effective. Thus nurses should use acupressure as noninvasive, safe and effective treatment modalities in their practices.

Nursing Education:

The nursing profession has a long history of viewing and caring for individuals in a holistic manner. Nurse educators should consider the inclusion of complementary and alternative therapies in nursing curricula with increasing frequency and motivation by major part of the public for the use of these therapies. Inherent in the nurse’s role is the ability to assess, intervene and evaluate preventive, supportive, and restorative functions of a patient’s physical, emotional, mental and spiritual domains. This should be emphasized to the nursing students through educating them about the various therapies that helps the patients in providing care to meet the above aspects.

Nursing Administration:

With the advent of various technologies in the field of nursing, nurses are expected to be skillful in various aspects of providing care for which student nurses has to be trained in it through their education. Thus it is the responsibility of the nurse administrators to include the concept of alternative and complementary therapies in the nursing curricula. The nursing staffs and the nursing students should be encouraged by the nurse administrators to learn various nursing modalities in caring patients and could conduct certifying courses which would help them to practice alternative and complementary therapies.

Nursing Research:

The competence of a registered nurse to perform the skills of complementary and alternative therapies begins with nursing education and ends with nursing practice which requires an evidence to give assurance that the knowledge and practice gained by the nurse are safe and provides comfort for the patients. Thus major research has to be promoted and conducted by the nurse researchers to prove the effectiveness of alternative and complementary therapies in nursing profession.

Recommendations

Ø The same study can be conducted with larger number of samples.

Ø A comparison can be made between primi and multi gravidae.

Ø A comparison can be made with different stages of labour.

Ø The same study can be conducted at different setting.

Ø A comparison can be made between different types of alternative and complementary therapies.

CONCLUSION:

The study concluded that scalp acupressure used by the researcher during the first stage of labour among primiparturient women were effective in reducing the perception of labour pain and increasing the coping level during the labour without affecting the feto-maternal parameters.

REFERENCES:

· Allendorf, K. (2010). The Quality of Family Relationships and Use of Maternal Health –care Services in India. Studies in Family Planning, 41(4), 263–276.

· Anderson, F.W., and Johnson, C.T. (2005). Complementary and alternative medicine in obstetrics. An International Journal of Obstetrics and Gynecology, 91(2):116-24.

· Bergstrom, M., Kieler, H., and Waldenstrom, U. (2010). Psychoprophylaxis during labor: associations with labor-related outcomes and experience of childbirth. Journal of Acta Obstetricia Gynecologica Scandinavica, 89(6), 794-800.

· Bo, Q.X., and Zhang, J.X. (2006). Observation on therapeutic effect of scalp acupressure analgesia on labor. Journal of Zhongguo Zhen Jiu, 26(9), 659-61.

· Borup, R.M. et al. (2009). Acupuncture as Pain Relief During Delivery: A Randomized Controlled Trial. Journal of Birth, 36(1), 5-12.

· Cho, S.H., Lee, H., and Ernst, E. (2010). Acupuncture for pain relief in labour: a systematic review and meta-analysis. An International Journal of Obstetrics and Gynecology, 117, 907–920.

· Christiaens, W., Verhaeghe, M., and Bracke, P. (2010). Pain acceptance and personal control in pain relief in two maternity care models: a cross-national comparison of Belgium and the Netherlands. Journal of BMC Health Services Research, 10, 268.

· Chung, U.L. et al. (2003). Effects of LI4 and BL 67 acupressure on labor pain and uterine contractions in the first stage of labor. Journal of Nursing Research, 11(4),251-60.

· Cunningham, c. et al. (2005). Obstetrics. (22^nd ed.). New York: McGraw-Hill Publishers.

Received on 06.06.2012 Modified on 16.07.2012

Asian J. Nur. Edu. and Research 2(3): July-Sept. 2012; Page 140-143