The effect of massage and warm application to the labor pain and comfort

OBJECTIVE: The purpose of this study was to investigate the effects of non-pharmacological methods such like sacral massage and sacral warm application on the perception of pregnants on labor pain and comfort level. METHOD: The study was conducted between June and December 2016 as a randomized controlled experimental study in Balikesir province Atatürk State Hospital Birth Hall. In the study, 30 applications of primiparous pregnant women with 4-5 cm cervical dilatation were selected for warm application, massage and control group. Intervention groups were given to warm application, sacral massage or sacral region in 4-5 cm, 6-7 cm and 8-9 cm cervical dilatation, and the control group was only given to standard midwifery care. The data were collected using the "Introductory Information Form", "Childbirth Comfort Questionnaire (CCQ)", "Numerical Pain Assessment Scale (NPAS)" and "Massage and Warm Application Questionnaire". Mean, Standard Deviation, Frequency, Chi-square test were used in the evaluation of the data. Variance analysis was used for repeated measures in the intra-group evaluation of comfort level, and one-way analysis of variance was used for inter-group evaluation. The Friedman test was used for intra-group evaluation of pain perception level, and Kruskal-Wallis test was used for evaluation among groups. RESULTS: As the labor progressed, it was determined that pain scores increased in each group (p <0.001). Post-intervention pain average of 4-5 cm cervical dilatation of pregnants was 4.56 ± 0.67 in the warm application group, 5.03 ± 1.06 in the massage group and 5.23 ± 0.72 in the control group; average pain after cervical dilation at 6-7 cm was 6.80±0.71 in the warm application group, 7.30±0.83 in the massage group and 7.70±0.59 in the control group, and there was a statistically significant difference in cervical dilatation between groups with 4-5 cm (p <0.05) and 6-7 cm (p <0.001). The mean post-operative pain level of the pregnant women after 8-9 cm cervical dilatation was 9.20 ± 0.61 in the hot treatment group, 9.46 ± 0.50 in the massage group and 9.43 ± 0.67 in the control group. There was no statistically significant difference between the groups (p >0.05). As birth progressed, it was determined that there was a decrease in comfort scores. Total average comfort of pregnants in 4-5 cm cervical dilatation was 34.03 ± 3.47 in the warm application group, 33.06 ± 3.92 in the massage group and 33.45 ± 4.32 in the control group and there was no statistically significant difference among the groups (p> 0.05). Overall average of comfort of pregnants in 8-9 cm cervical dilatation was 31.06 ± 3.46 in the warm application group, 29.76 ± 3.74 in the massage group and 27.66 ± 3.85 in the control group and there was a statistically significant difference among the groups (p <0.05). In cervical dilatation of 8-9 cm of pregnants, a statistically significant difference was found between the warm application group and the control group in terms of physical comfort average (p <0.001), relaxation (p <0.05) and superiority average (p <0.05). The puerperas were pleased with the warm application and massage practices. They found such methods as birth pain effective at the time of birth, and suggested them to other pregnants. CONCLUSION: It was found that warm application decreased perception of pain in 4-5 cm and 6-7 cm cervical dilatation and the massage practice decreased perception of pain in 6-7 cm cervical dilatation. As birth progressed, it was determined that there was a decrease in comfort scores and there was a further decrease in the control group compared to the warm application and massage group. These results show that warm application and massage are non-pharmacologic methods that can be safely used by midwifes to reduce birth pain and provide positive comfort. KEYWORDS: Birth Pain; Comfort at Birth; Warm Application; Massage; Midwifery