Effects of acupressure at LI4, He7, SP6 and Neima points on labor anxiety in nulliparous women: randomized clinical trial

Document Type : Original Article

Authors

1 M.Sc. in Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.

2 M.Sc. in Midwifery, Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.

3 M.Sc. in Biostatistics, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran.

4 General Practitioner, Iran Scientific Association of Acupuncture, Tehran, Iran.

5 M.Sc. in Midwifery, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran

Abstract

Introduction: Childbirth is a physiologic but stressful event in women's life. Anxiety during labor can affect pregnancy outcomes and causes pain and fear of childbirth. So, reduction of anxiety during labor was strictly recommended in various studies. Acupressure, against pharmacological methods, is a simple and cost-effective method which is limitedly investigated in childbirth. This study was performed with aim to investigate the effects of acupressure at LI4, He7, SP6 and Neima points on anxiety during labor in nulliparous women.
Methods: This randomized clinical trial was conducted on 130 mothers who were hospitalized in delivery wards of Qazvin Razi hospital in 2018. They were randomly assigned to intervention and control groups. In the intervention group, stimulation of SP6 and Neima points was started in cervical dilatation of 4 cm and continued for 30 minutes, then in cervical dilatation of 8 cm, stimulation of LI4 and H7 continued by TENS until the end of delivery. Control group received routine obstetrics cares. Spielberger’s State-Trait Anxiety Inventory (STAI) was completed at the time of admission to delivery room and one hour after delivery. Data was analyzed by SPSS software (version 24) and Chi-square, independent t-test, Paired t-test. PResults: Acupressure had a significant influence on mean score of state anxiety in experimental (33.7 ± 9.5) compared to control group (40.1 ± 9.9) (P = 0.001). Difference in mean score of trait anxiety in experimental (35.5 ± 8.2) compared to control group (39.08 ± 7.7) was statically significant (p=0.04).
Conclusion: Stimulation of LI4, H7, SP6 and Neima points is effective in decreasing state and trait anxiety in nulliparous women and is recommended as one of the methods for treatment of anxiety in pregnancy and childbirth.

Keywords


  1. Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. J Adv Nurs 2004; 46(2):212-9.
  2. Cheung W, Ip WY, Chan D. Maternal anxiety and feelings of control during labour: a study of Chinese first-time pregnant women. Midwifery 2007; 23(2):123-30.
  3. Jokić-Begić N, Žigić L, Nakić Radoš S. Anxiety and anxiety sensitivity as predictors of fear of childbirth: different patterns for nulliparous and parous women. J Psychosom Obstet Gynaecol 2014; 35(1):22-8.
  4. Geissbühler V, Zimmermann K, Eberhard J. Fear of childbirth during pregnancy-ongoing observational study. Geburtshilfe Frauenheilkd 2005; 65(9):873-80.
  5. Curzik D, Jokic-Begic N. Anxiety sensitivity and anxiety as correlates of expected, experienced and recalled labor pain. J Psychosom Obstet Gynaecol 2011; 32(4):198-203.
  6. Vogl S, Worda C, Egarter C, Bieglmayer C, Szekeres T, Huber J, et al. Mode of delivery is associated with maternal and fetal endocrine stress response. BJOG 2006; 113(4):441-5.
  7. Stocche RM, Klamt JG, Garcia LV, Moreira AC. Effects of intrathecal sufentanil on plasma oxytocin and cortisol concentrations in women during the first stage of labor. Reg Anesth Pain Med 2001; 26(6):545-50.
  8. 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. SSU J 2012; 20(2):220-8. (Persian).
  9. Reck C, Zimmer K, Dubber S, Zipser B, Schlehe B, Gawlik S. The influence of general anxiety and childbirth-specific anxiety on birth outcome. Arch Women Ment Health 2013; 16(5):363-9.
  10. Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Abnormal labor. Williams obstetrics. 23rded. New York: McGraw-Hill; 2010. P. 452.
  11. Cicek S, Basar F. The effects of breathing techniques training on the duration of labor and anxiety levels of pregnant women. Complement Ther Clin Pract 2017; 29:213-9.
  12. Namazi M, Amir Ali Akbari S, Mojab F, Talebi A, Alavi Majd H, Jannesari S. Aromatherapy with citrus aurantium oil and anxiety during the first stage of labor. Iran Red Crescent Med J 2014; 16(6):e18371.
  13. Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first‐time mothers. J Clin Nurs 2010; 19(7‐8):1065-72.
  14. Kheirkhah M, Vali Pour NS, Nisani L, Haghani H. Comparing the effects of aromatherapy with rose oils and warm foot bath on anxiety in the first stage of labor in nulliparous women. Iran Red Crescent Med J 2014; 16(9):e14455.
  15. Mortazavi SH, Khaki S, Moradi R, Heidari K, Vasegh Rahimparvar SF. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet 2012; 286(1):19-23.
  16. Asadi N, Maharlouei N, Khalili A, Darabi Y, Davoodi S, Shahraki HR, et al. Effects of LI-4 and SP-6 acupuncture on labor pain, cortisol level and duration of labor. J Acupunct Meridian Stud 2015; 8(5):249-54.
  17. Mucuk S, Baser M, Ozkan T. Effects of noninvasive electroacupuncture on labor pain, adrenocorticotropic hormone, and cortisol. Altern Ther Health Med 2013; 19(3):26-30.
  18. Rajai N, Choopani N, Pishgoei SA, Sharififar S. The effect of acupressure on Patient's anxiety who candidate for coronary angiography. Mil Caring Sci J 2015; 2(1):6-13.
  19. McKinney ES, James SR, Murray SS, Nelson K, Ashwill J. PART-sherpath 4-color loose leaf for maternal newborn and pediatric nursing combined (McKinney Version). New York: Elsevier Health Sciences; 2017.
  20. Chaillet N, Belaid L, Crochetière C, Roy L, Gagné GP, Moutquin JM, et al. Nonpharmacologic approaches for pain management during labor compared with usual care: a meta-analysis. Birth 2014; 41(2):122-37.
  21. Sharifi Rizi M, Shamsalinia A, Ghaffari F, Keyhanian S, Nabi BN. The effect of acupressure on pain, anxiety, and the physiological indexes of patients with cancer undergoing bone marrow biopsy. Complement Ther Clin Pract 2017; 29:136-41.
  22. Mojalli M, Abbasi P, Kianmehr M, Zamani S. Effect of acupressure on fecal impaction in hemodialysis patients. J Mazandaran Univ Med Sci 2016; 26(136):18-25. (Persian).
  23. Adib-Hajbaghery M, Etri M, Hosseinian M. The effect of acupressure on the Pericardium 6 point on pain, nausea and vomiting after appendectomy. Complement Med J Facul Nurs Midwifery 2012; 2(2):171-82.
  24. Stux G, Pomeranz B. Acupuncture. NewYork: Springer; 1987. P. 38.
  25. Zick SM, Wyatt GK, Murphy SL, Arnedt JT, Sen A, Harris RE. Acupressure for persistent cancer-related fatigue in breast cancer survivors (AcuCrft): a study protocol for a randomized controlled trial. BMC Complem Altern Med 2012; 12:132.
  26. Akbarzadeh M, Ghaem Maghami M, Yazdan Panahi Z, Zare N, Azizi A, Mohagheghzade A. Comparative effects of dry cupping therapy and acupressure at acupoint (BL23) on postpartum anxiety in nulliparous women. Evid Based Care 2013; 3(2):37-48. 
  27. Ganji G, Keramat A, Ahmad Shiravani M. Effect of acupressure on labor pain relief: a systematic review of clinical trials. Iran J Obstet Gynecol Infertil 2014; 17(119):8-17. (Persian).
  28. Arami SE, Kazemi M, Esmaeili-nadimi A. Comparing the effect of acupressure points shenmen (HE7) with a third eye on anxiety in patients undergoing coronary angiography. Med Surg Nurs J 2015; 4(2):41-6.
  29. Abadi F, Abadi F, Fereidouni Z, Amirkhani M, Karimi S, Najafi Kalyani M. Effect of acupressure on preoperative cesarean section anxiety. J Acupunct Meridian Stud 2018; 11(6):361-6.
  30. Beikmoradi A, Najafi F, Roshanaei G, Pour Esmaeil Z, Khatibian M, Ahmadi A. Acupressure and anxiety in cancer patients. Iran Red Crescent Med 2015; 17(3):e25919.
  31. Bazarganipour F, Taghavi SA, Allan H, Beheshti F, Khalili A, Miri F, et al. The effect of applying pressure to the LIV3 and LI4 on the symptoms of premenstrual syndrome: a randomized clinical trial. Complement Ther Med 2017; 31:65-70.
  32. Moradi Z, Akbarzadeh M, Moradi P, Toosi M, Hadianfard MJ. The effect of acupressure at GB-21 and SP-6 acupoints on anxiety level and maternal-fetal attachment in primiparous women: a randomized controlled clinical trial. Nurs Midwifery Stud 2014; 3(3):e19948.
  33. Lee MK, Chang SB, Lee HS, Kim HS. Effects of treatment with San-Yin-Jian (SP-6) acupressure for labor women on labor pain, length time for delivery and anxiety: a clinical trial pilot study. Korean J Women Health Nurs 2002; 8(4):559-69.
  34. Samadi P, Alipour Z, Lamyian M. The effect of acupressure at spleen 6 acupuncture point on the anxiety level and sedative and analgesics consumption of women during labor: A randomized, single-blind clinical trial. Iran J Nurs Midwifery Res 2018; 23(2):87-92.
  35. Ding L, Xing Q, Sun J, Li Y. Analgesic effect of acupuncture at Neimadian (Extra) in postoperation of abdominal surgery. Zhongguo Zhen Jiu 2011; 31(8):738-42.
  36. Zhao XB, Xing QZ, Han XC. Observation on electroacupuncture at neimadian (extra) and neiguan (PC 6) for analgesia after thoracic surgery. Zhongguo Zhen Jiu 2013; 33(9):829-32.
  37. Akbarzadeh M, Moradi Z, Zare N, Hadianfard MJ, Jowkar A. Comparison of the effects of one-step acupressure of spleen point 6 (SP-6) and gall bladder 21 (GB-21) on the duration and type of delivery in nulliparous women referred to hospitals in Shiraz University of Medical Sciences, Iran: a randomized clinical trial. Qom Univ Med Sci J 2013; 7(3):54-61. (Persian).
  38. Mahmoudirad G, Ghaedi Mosolo M, Bahrami H. Effect of foot reflexology on anxiety of patients undergoing coronary angiography. Iran J Crit Care Nurs 2014; 6(4):235-42.
  39. Bieling PJ, Antony MM, Swinson RP. The state--trait anxiety inventory, trait version: structure and content re-examined. Behav Res Ther 1998; 36(7):777-88.
  40. Alipour M, Feizi Z, Seyedfatemi N, Hosseini F. Correlation between maternal anxiety during pregnancy and incidence of preeclampsia in primigravid women. Iran J Nurs 2006; 19(47):79-88. (Persian).
  41. Rakel B, Cooper N, Adams HJ, Messer BR, Frey Law LA, Dannen DR, et al. A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. J Pain 2010; 11(3):230-8.
  42. Choubsaz M, Amirifard N, Pourmatin S. Compare the effect of dry-cupping by stimulating the P6 and H7 point in controlling perioperative anxiety. Biomed Res 2017; 28(3):1070-4.
  43. Yeh ML, Chung YC, Hsu LC, Hung SH. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: a randomized-controlled study. Clin Nurs Res 2018; 27(4):450-66.
  44. Hossein Pour N, Kaviani M, Razeghi M. Comparison of effect of transcutaneous electrical nerve stimulation and acupressure in decreasing labor pain in primiparous women. Iran J Obstet Gynecol Infertil 2012; 15(12):27-33. (Persian).