Effectiveness of acupressure on pain
during active phase of labour among parturient women admitted in the labour
room of Christian Medical College, Vellore
Jennifer Jothi Mary. A1,
Dr. Ruby Jose2, Mrs. Alice Augustine3, Mrs. Alice Sony4
1Lecturer, College of Nursing, SRIPMS,
Coimbatore
2 Professor and Head OG 4, CMC,
Vellore.
3HOD (Retd.), Dept.
of Obs. and Gynac. College of Nursing, CMC, Vellore
4Professor, Dept. of Obs. and Gynac.
College of Nursing, CMC, Vellore
*Corresponding
Author Email: jenniferjothimary@yahoo.co.in
ABSTRACT:
A true experimental study was done to
determine the effectiveness of acupressure on pain during the active phase of
labour among parturient women. Using simple ransom sampling method a total of
30 patients in experimental and 30 in control group were selected. The
instruments used were a Numeric rating scale, Observation check list and a pain
questionnaire to assess the pain score and pain perception in parturient women.
Data was collected and analyzed using descriptive and inferential statistics.
The study shows that there is a significant reduction in the pain scores among
the experimental group after acupressure.
KEYWORDS: Effectiveness, Acupressure, Active phase of
labour.
INTRODUCTION:
Labour pain is widely viewed as being
nothing more than the perception of unpleasant sensation. The reality, however
is much more complex ”
Labour is an important phase in the life of
a women. Going through pain and delivering the bundle of joy gives a whole lot
of satisfaction, sense of achievement and wholeness in her heart. First time
mothers are more likely to give their pain a higher rating than women who have
had babies before. Even though pain is a personal experience, it can be
analyzed by means of quantitative pain measures. Non-pharmacological
interventions help reduce the painful perceptions changing this response in
most of them.
STATEMENT OF THE PROBLEM:
A study to determine the effect of
acupressure on pain during active phase of labour among parturient women
admitted in the labour room of Christian Medical College. Vellore.
OBJECTIVES:
1. To assess the pain scores among the
parturient women in experimental group and control group
2. To compare the pain scores among
experimental and control group women.
3. To assess the perception on
effectiveness of acupressure intervention in the experimental group
4. To identify the association between pain
relief and selected demographic variables among parturient women.
Hypothesis:
There will be a significant reduction in
pain in the first stage of labour after acupressure
Assumptions
Ø Acupressure reduces labour pain
Ø Pain reduction promotes relaxation in
parturient women
LIMITATIONS
Ø Women who were willing to take part in the
study
Ø Study was limited for only 6 weeks.
Ø Study was limited to women who spoke Tamil
and English only.
Projected Outcome
Ø It helps to know the effectiveness of
acupressure in reducing labour pain
Ø This study will help health care
professionals follow acupressure in parturient mother in reducing labour pain.
METHODOLOGY:
Research Design -True experimental study design
was used.
Setting - Labour room of Christian Medical
College, Vellore.
Population - Parturient women admitted in
labour room
Sample - Primi women in active labour
Sample Size - 30 women in experimental group
and 30 in control group
Inclusion Criteria
1. Primi at or more than 37- 40 weeks of
gestation
2. Vertex presentation
3. Having 3-5 contractions every 10 minutes
4. Tamil or English speaking women
Exclusion Criteria
1.
Malpresentation
2.
Obese
patients
3.
Previous
LSCS patients
4.
Women in
Second stage of labour
5.
Gravida 2 or
more
6.
Post term
patients
7.
Women
undergoing entonox therapy
Method of sample selection
Two women fulfilling criteria were selected
by lot method. Then a coin was flipped. Experimental group women were chosen if
head appears while other women was included in control group.
Data collection procedure
Experimental group – Pain was
assessed using numeric pain rating scale and observation check list before
acupressure. After acupressure was given for 20 minutes, again at end of 20
minutes, 1 hour 20 minutes and 2 hour 20 minutes pain was assessed.
Control Group – Pain was
assessed using numeric pain rating scale and observation check list at 20
minutes, 1 hour 20 minutes and 2 hour 20 minutes.
Protection of human rights
Approval was obtained from the
dissertation committee. Permission was obtained from the heads of the maternity
department (Medicine and Nursing) and the concerned in-charges of the labour
room. The reason and procedure of acupressure was explained to the women
included in the study in detail. A written consent was obtained before
starting the intervention.
Validity and reliability of the instrument
With the guidance of experts, content
validity of the instrument was done. Score of content validity is 0.95.
Reliability of the instrument was checked by doing a pilot study.
Instruments
v Numerical rating scale
It is a standardized rating
scale for assessing pain intensity. It is marked from 0 – 10.The patients were
asked to rate their pain by seeing the scale. It was interpreted as : 1-4
Mild pain, 5– 7 Moderate pain, 8– 10 Severe pain
v Observation check list for pain
It is a standardized Hospital
anxiety scale developed by Lorraine in 2005, modified and used for this study
to assess the non-verbal expressions of women in labour made before the start
of acupressure, then at 20 minutes, at 1hour 20 minutes and at 2 hours 20
minutes after acupressure. It was interpreted as :1 -4 Mild pain, 5- 7
Moderate pain,8-10 Severe pain, 11–12 Unbearable pain
v Questionnaire
A self -prepared interview
questionnaire was used to assess the perception of women who had undergone the
acupressure intervention on its effectiveness. It contained 6 questions
regarding the acupressure procedure and its effect in reducing labour pain.
Interview was done 2 hours after the delivery for women in the experimental
group. A score of 1 was given for responses said as “yes” and 0 was given for
responses said as “ No”. It was interpreted as : 0 – 50 % = Less effective,
51-75 % = Moderate pain, 76-100 % = Highly effective
FINDINGS:
1. 90% women in experimental group and
93.33% in control group belonged to the age group of 21-30 years. 50% women in
experimental group and 60% in control group had a graduate education. In both
groups, 86.66 % were house wives. 83.33% of women in experimental group and 90%
in control group were hindus.
2. Pain score using pain rating scale - 26
(86.66%) women in experimental group experienced moderate pain during 1 hour
and 20 mts and 19 (63.33%) during 2 hour and 20 minutes. But in the control
group, 28 (93.33% ) experienced severe pain during 1 hour and 20 minutes and 30
(100%) had severe pain at 2 hours and 20 minutes.
3. Pain score using observation check list
-30 (100%) women in the experimental group experienced moderate pain but in the
control group, 17 (56.6 %) women had severe pain at the end of 1st
observation. At 1 hr and 20 mts, 29 (96.6% ) of women in experimental group had
moderate pain while 20 (66.6%) women in control group women had severe pain.
Similarly at 2 hrs and 20 mts, 26( 86.66 %) women in experimental group
experienced moderate pain while 27 (90%) of women in control group experienced
severe pain. Unbearable pain was not experienced by any of the women in either
groups. At all observations experimental group women had moderate pain and
control group women had severe pain.
Paired ’t’ test was done to assess the
significant difference of pain scores before and after acupressure. Mean was
calculated from pain scores at various time periods. The test shows that there
was a significant reduction of pain scores after acupressure . (P <0.001)
The figure 1 highlights that among
experimental group pain score was significantly less from 7.98 to 5.9 after
acupressure assessed using numeric rating scale. Also pain scores using
observation check list shows a reduction from 7.64 to 6.28 after the
intervention. This signifies that acupressure has some association with pain relief.
The table 2 projects the mean pain scores
at different time intervals in both experimental and control group patients.
The table 2 shows a significant reduction of pain according to pain score in
the experimental group with a P value of <0.001.
v 30 (100%) women felt comfortable during the
procedure and needed acupressure continually in labour. 25 (83.3%) women said
that acupressure promoted relaxation and controlled pain. 26 (86.66%) women
verbalized that the intensity of pain was not reduced with acupressure.
v There was no statistically significant
association between the selected demographic variables with pain relief.
CONCLUSION:
In analyzing the above data it is
understood that acupressure reduces labour pain during the active phase of labour
. It supports the hypothesis also. Acupressure can be an effective nursing
management for women in labour. If nurses and care givers are taught on the
acupressure sites and technique it would make labour process an easy and a
memorable experience for the parturient women.
IMPLICATIONS:
ü Nurses need to be taught on acupressure and
its effectiveness in pain relief for labour.
ü Nurses need to be motivated and encouraged
to understand and measure pain for each woman in labour
ü Nursing education can incorporate this new
method which is gaining much popularity among the people in these days.
ü More researches need to be done in this
aspect using various methods of pain relieving non- pharmacological methods.
ü . The same study can be repeated using a large
sample and analyzed for significant results.
RECOMMENDATIONS:
Ø Nurses can undergo a formal training to
gain skills in teaching and doing acupressure
Ø This method can be adopted and practiced in
labour room for day- day practice.
Ø Continued education is needed for
acceptance by the nurses.
CONCLUSION:
It is always an important task
for the nurse to assess pain and manage pain effectively. As the parturient
women suffer in pain during labour, using acupressure would reduce their pain
to a desirable extent. As nurses we can give our best to make the women at ease
and improve a positive relationship among nurse and the care giver building a
good rapport with patients and easing their labour pain
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