مقایسه تأثیر فشار در نقاط مثانهای-GV20 و کیسه صفرا-GV20 بر توانایی مقابله با درد زایمان در زنان نخست‌زا: کارآزمایی بالینی تصادفی شده

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد مامایی، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 استادیار گروه مامایی، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 استادیار گروه طب سوزنی، دانشکده طب سنتی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 استاد گروه آمار زیستی، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

5 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

چکیده

مقدمه: درد زایمان به‌عنوان یک عامل استرس­زا، روش­های مقابله­ای ویژه خود را می­طلبد. یکی از این روش­ها که ممکن است در مقابله با درد زایمان مؤثر باشد، طب فشاری است. مطالعه حاضر با هدف مقایسه فشار در نقاط مثانه‌ای - GV20 و کیسه صفرا- GV20 بر توانایی مقابله با درد زایمان در زنان نخست­زا انجام گرفت.
روش‌کار: این مطالعه کارآزمایی بالینی یک­سور در سال 1396 بر روی 158 زن نخست­زای مراجعه­کننده به بیمارستان ام­البنین (س) مشهد انجام گرفت. افراد در سه گروه طب فشاری نقاط مثانه­ای (BL5، BL8، BL9) وGV20 (مداخله 1)، کیسه صفرا (GB8، GB16، GB17، GB18) و GV20 (مداخله 2) و کنترل قرار گرفتند. در فاز فعال مرحله اول زایمان در گروه مداخله 1، 5 سیکل فشار 4 دقیقه‌ای و در گروه مداخله 2، 4 سیکل فشار 5 دقیقه‌ای و در مرحله دوم زایمان نیز 1 سیکل فشار بر نقاط مذکور در هر دو گروه اعمال شد. گروه کنترل نیز مراقبت­های معمول را دریافت نمودند. توانایی مقابله با درد زایمان با استفاده از پرسشنامه مشاهده­ای رفتار مقابله­ای با درد زایمان قبل از مداخله و سپس هر 30 دقیقه تا اتمام مرحله دوم زایمان اندازه­گیری شد. تجزیه و تحلیل داده­ها با استفاده از نرم‌افزار آماری SPSS(نسخه 25) و آزمون­های دقیق فیشر، آنالیز واریانس یک­طرفه، توکی و ناپارامتری کروسکال والیس، دان با تصحیح بونفرونی و فریدمن انجام شد. میزان p کمتر از 05/0 معنی­دار در نظر گرفته شد.
یافته­ها:میانگین نمره توانایی مقابله با درد در مرحله اول و دوم زایمان به‌ترتیب در گروه مداخله 1 (9/1±5/16، 0/2±4/17) و مداخله 2 (1/2±9/16، 2/2±8/16) نسبت به گروه کنترل (7/2±0/12، 4/2±4/10) اختلاف آماری معنی­داری داشت (05/0>p)، اما بین دو گروه مداخله اختلاف آماری وجود نداشت (05/0<p).
نتیجه­گیری: فشار بر نقاط مثانه­ای - GV20 و کیسه صفرا - GV20، توانایی مقابله با درد مرحله اول و دوم زایمان را افزایش می­دهد، لذا به‌عنوان یک روش ساده و غیرتهاجمی در کنار سایر روش­ها پیشنهاد می­گردد.

کلیدواژه‌ها


عنوان مقاله [English]

Comparison of the effect of pressure on bladder-GV20 and gallbladder-GV20 points on the ability to cope with labor pain among the primiparous women: A randomized clinical trial

نویسندگان [English]

  • Elaheh Mansouri 1
  • Masoumeh Kordi 2
  • Shapour Badiee Aval 3
  • Mohammad Taghi Shakeri 4
  • Masoumeh Mirteimouri 5
1 M.Sc. Student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Assistant Professor, Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Assistant professor, Department of Acupuncture Medicine, Faculty of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Professor, Department of Biostatistics ,Social Determinants of Health Research Center, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Associate professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: As a stressor, labor pain requires special coping strategies. Acupressure is one of these strategies that may be effective in coping with labor pain. This study aimed to compare the effect of pressure on bladder-GV20 and gallbladder-GV20 points on the ability to cope with labor pain among the nulliparous females.
Methods: This single-blind randomized clinical trial was conducted on 158 primiparous women referring to Um Al-Benin Specialized Women Hospital, Mashhad, Iran in 2017. The subjects were randomly assigned to three groups of acupressure regarding the bladder points, namely (BL5-BL8-BL9) and GV20 (intervention 1), gallbladder (GB8-GB16–GB17-GB18) and GV20 (intervention 2), and the control group. The first stage of labor included five (4 min) and four (5 min) pressure cycles on acupressure points in bladder and gallbladder in the first and second groups, respectively. In the second stage of labor, one pressure cycle on the same points were applied. The control group only received the routine cares. The ability to cope with the labor pain was measured using the observational coping behavioral questionnaire with labor pain before the intervention and then every 30 minutes until the completion of the second stage of labor. The data were analyzed in SPSS software (version 25.0) using Fisher's exact test, one-way ANOVA, Tukey and non-parametric Kruskal Wallis test based on Dunn's approach with the Bonferroni and Friedman's correction. The P-value less than 0.05 was statistically significant.
Results: The results showed that the average scores of coping ability in the first and second stages of delivery were 16.5±1.9, 17.4±2.9 and 16.9 ± 2.2, 16.8 ± 2.2 in intervention groups one and two, respectively. There was a significant difference regarding the scores of the intervention groups and those of the control group (10.4±2.4, 12.0±2.7) (P<0.05). However, no significant difference was observed within the two intervention groups in terms of the scores of coping ability (P> 0.05).
Conclusion: According to the findings of the study, pressure on bladder-GV20 and gallbladder-GV20 points can increase the levels of labor pain coping abilities in the first and second stages of labor. Therefore, this method can be recommended as a simple, non-invasive and complementary approach in labor.

کلیدواژه‌ها [English]

  • Delivery
  • Acupressure
  • coping
  • Primiparous
  1. Valizadeh L, Bayrami R. Nulliparous women experiences the pain of natural childbirth: a qualitative study. J Tabriz Nurs Midwifery 2010; 15:25-34. (Persian).
  2. Kordi M, Rohani Mashadi S, FadaeeA, EsmailiH. Effects of SP6 acupressure on reducing the labor pain during first stage of delivery. Iran J Obestet Gynecol Infertil 2009; 12(4):7-13. (Persian).
  3. Kordi M, Firoozi M, Esmaili H. Effect of LI4 acupressure on labor pain in the first stage of labor in nuliparous women. Hayat 2011; 16(3):95-101. (Persian).
  4. Alavi N, Nemati M, Kaviani M, Tabaie MH. The effect of lavender aaromatherapy on the pain intensity perception and intarapartum outcomes in primipare. Armaghane Danesh 2010; 15(1):30-7. (Persian).
  5. Kordi M, Golmakani A, Rabiee Motlagh E, Zahedi Fard T, Badiee Aval SH. Non-pharmacological approaches of relieve labor pain. 1st ed. Mashhad: Mashhad University of Medical Sciences Publisher; 2017. (Persian).
  6. Golmakani N, Hashemi Asl M, Sadjadi A, Pourjavad M. Investigating the factors associated with labor pain and coping behavior. Iran J Obestet Gynecol Infertil 2012; 15(24):17-25. (Persian).
  7. Roberts L, Gulliver B, Fisher J, Cloyes KG. The coping with labor algorithm: an alternate pain assessment tool for the laboring woman. J Midwifery Womens Health 2010; 55(2):107-16.
  8. Ali Akbarei S, Jamalian R, Koahn S, Valaie N. Effect of childbirth preparation on reduction of pain and duration of delivery. Feyz 2000; 4(3):41-8. (Persian).
  9. Niven CA, Gijsbers K. Coping with labor pain. J Pain Symptom Manage 1996; 11(2):116-25.
  10. Tampawiboon K. Effect of childbirth preparation on fear, labor pain coping behaviors and childbirth satisfaction in primiparas. [Master Thesis]. Ramathibodi: Faculty of Medicine Ramathibodi Maternity and Newbrorn Nursing; 2005.
  11. Farzinrad B, Asgharnejad F, Yekeyazdandoost R, Habibyaskarabad M. A comparison of coping styles and personality in depressed and non-depressed students. J Behav Sci 2010; 4(1):17-21. (Persian).
  12. Abushaikha LA. Methods of coping with labor pain used by Jordanian women. J Transcult Nurs 2007; 18(1):35-40.
  13. Escott D, Spiby H, Slade P, Fraser RB. The range of coping strategies women use to manage pain and anxiety prior to and during first experience of labour. Midwifery 2004; 20(2):144-56.
  14. Van der Gucht N, Lewis K. Women׳s experiences of coping with pain during childbirth: a critical review of qualitative research. Midwifery 2015; 31(3):349-58.
  15. Lowe NK. Maternal confidence in coping with labor: a self‐efficacy concept. J Obstet Gynecol Neonat Nurs 1991; 20(6):457-63.
  16. Kulesza-Bronczyk B, Dobrzycka B, Glinska K, Terlikowski SJ. Strategies for coping with labour pain. Progr Health Sci 2013; 3(2):82.
  17. Khorsandi M, Ghofranipour F, Heidarinia A, Faghihzadeh S, Vafaee M. Perceived self-efficacy of childbirth in pregnant women. J Med Council Iran 2008; 26(1):89-95. (Persian).
  18. Rastegari L, Mohebbi P, Mazlomzadeh S. The effect of childbirth preparation training classes on perceived self-efficacy in delivery of pregnant women. J Zanjan Univ Med Sci 2013; 21(86):105-15. (Persian).
  19. Vakilian K, Karamat A, Mousavi A, Shariati M, Ajami E, Atarha M. The effect of Lavender essence via inhalation method on labor pain. J Shahrekord Univ Med Sci 2012; 14(1):34-40. (Persian).
  20. Mirghafourvand M, Sehhatie Shafaie F, Vosoughi-Niri J. The effect of non-pharmacological methods of labor pain relief on mothers’ perceived stress: a randomized controlled trial. J Ardabil Univ Med Sci 2014; 14(4):398-411. (Persian).
  21. Hamidzadeh A, Shahpourian F, Orak RJ, Montazeri AS, Khosravi A. Effects of LI4 acupressure on labor pain in the first stage of labor. J Midwifery Womens Health 2012; 57(2):133. (Persian).
  22. Akbarzadeh M, Moradi Z, Zare N, Hadiyanfard MJ, Jokar A. Comparing the effect of acupressure at two GB-21 and SP-6 points on the pain severity of active phase of delivery among primiparous women. Armaghane Danesh 2012; 16(6):498-506. (Persian).
  23. Makvandi S, Mirzaiinajmabadi K, Sadeghi R, Mahdavian M, Karimi L. Meta‐analysis of the effect of acupressure on duration of labor and mode of delivery. Int J Gynecol Obstet 2016; 135(1):5-10.
  24. Hao JJ, Hao LL. Review of clinical applications of scalp acupuncture for paralysis: an excerpt from Chinese scalp acupuncture. Global Adv Health Med 2012; 1(1):102-21.
  25. Liu Z, Guan L, Wang Y, Xie CL, Lin XM, Zheng GQ. History and mechanism for treatment of intracerebral hemorrhage with scalp acupuncture. Evid Based Complement Alternat Med 2012; 2012:895032.
  26. Gamus D, Meshulam-Atzmon V, Pintov S, Jacoby R. The effect of acupuncture therapy on pain perception and coping strategies: a preliminary report. J Acupunct Meridian Stud 2008; 1(1):51-3.
  27. Durga MK, Venkatesan L, Sonia LA. Effectiveness of scalp acupressure upon labour pain and coping among primiparturient women. Asian J Nurs Educ Res 2012; 2(3):140.
  28. Croizier RC. Traditional medicine in modern China: science, nationalism, and the tensions of cultural change. Massachusetts: Harvard University Asia Center; 1968.
  29. Golmakani N Hashemi Asl M, Sadjadi SA, Ebrahimzade S. The relationship between happiness during pregnancy, and labor pain coping behaviors. Evid Based Care J 2012; 2(2):87-95. (Persian).
  30. Rezvani M. Definition of acupuncture from the perspective of the West. J Anesthesiol Pain 2011; 2(2):85-96. (Persian).
  31. Kaviani M, Ashoori M, Azima S, Rajaei Fard A, Hadian Fard M. Comparing the effect of two methods of acupressure and ice massage on the pain, anxiety levels and labor length in the point LI-4. J Shahid Sadoughi Univ Med Sci 2012; 20(2):220-8. (Persian).
  32. Navidi A, Khedmat H, Holisaz MT, Naseri MH, Ghasemi Soleimanieh KH, Yari F. Principle of basic & clinical acupuncture. 1st ed. Tehran: Tayeb Publisher; 2002. (Persian).
  33. Khavari F. The relationship of irrational beliefs and the coping with stress behaviors with perfectionism and self-efficacy in pregnancy childbirth. [Master Thesis]. Tehran: School of Nursing and Midwifery, Iran University of Medical Science; 2016. (Persian).
  34. Smith CA, Ussher JM, Perz J, Carmady B, de Lacey S. The effect of acupuncture on psychosocial outcomes for women experiencing infertility: a pilot randomized controlled trial. J Altern Complement Med 2011; 17(10):923-30.
  35. Kovářová P, Smith CA, Turnbull DA. An exploratory study of the effect of acupuncture on self-efficacy for women seeking fertility support. Explore 2010; 6(5):330-4.