بررسی تأثیر وضعیت سجده بر شدت درد و پیشرفت زایمان در زنان نخست‌زا :یک کارآزمایی بالینی تصادفی شده

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی جیرفت، جیرفت، ایران.

2 کارشناس ارشد مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی جیرفت، جیرفت، ایران.

3 دکتری آمار، دانشکده پزشکی، دانشگاه علوم پزشکی جیرفت، جیرفت، ایران.

چکیده

مقدمه: زایمان برای عده­ای از زنان رضایت‌بخش نبوده و با درد، ترس و رنج همراه است. مطالعه حاضر با هدف بررسی تأثیر وضعیت سجده بر شدت درد و طول مدت زایمان در زنان نخست‌زا انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی شده در سال 1399 بر روی 100 نفر از زنان نخست‌زای بستری در بخش زایمان در جنوب استان کرمان انجام شد. افراد به‌صورت تصادفی در دو گروه 50 نفره وضعیت معمول و سجده قرار گرفتند. برای زنان وضعیت سجده، در ابتدای فاز فعال (دیلاتاسیون 4 سانتی‌متر)، به‌طور متناوب (هر یک ساعت، به‌مدت 15 دقیقه) تا پایان دیلاتاسیون کامل دهانه رحم در وضعیت سجده قرار گرفتند. گردآوری داده‌ها با استفاده از پرسشنامه‌های اطلاعات فردی و مقیاس دیداری درد و فرم پیشرفت زایمان (پارتوگراف) انجام شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزارآماری SPSS ( نسخه 26) و آزمون‌های تی مستقل، کای دو و آزمون دقیق فیشر انجام شد. میزان p کمتر از 05/0 معنی­دار در نظر گرفته شد.
یافته‌ها: بر اساس نتایج آزمون آماری، میانگین شدت درد در گروه مداخله در مقایسه با گروه کنترل به‌طور معنی­داری کمتر بود (001/0>p). پیشرفت زایمان در مادران گروه مداخله در مقایسه با گروه کنترل به‌طور معنی‌داری سریع‌تر بود که مدت زمان زایمان در گروه مداخله و کنترل به‌ترتیب 04/1±48/4 و 7/1±16/7 بود (001/0>p). میزان رضایت مادران از وضعیت قرار‌گیری در پروسه زایمان در گروه مداخله بیشتر از گروه کنترل بود (001/0>p).
نتیجه‌گیری: وضعیت سجده در زنان نخست‌زا در طول فاز فعال زایمان در کاهش شدت درد و تسریع پیشرفت زایمان سودمند است، لذا توصیه می­شود که از این وضعیت به‌عنوان یک مراقبت معمول غیردارویی در بخش‌های زایمانی استفاده شود.

کلیدواژه‌ها

عنوان مقاله [English]

The effect of Knee- chest position on labor pain and Duration of labor in nulliparous women: a randomized clinical trial

نویسندگان [English]

  • Tayebeh Sedighi Darijani 1
  • Sareh Mehni 2
  • Neda Dastyar 2
  • Azam Amirian 2
  • Akbar MehrAlizadeh 3
1 Assistant professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran .
2 M.Sc. of Midwifery, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran.
3 PhD of Statistics, Faculty of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran.
چکیده [English]

Introduction: Childbirth is not satisfactory for some women and is associated with pain, fear and suffering. The present study was conducted aimed to investigate the effect of Knee- chest position on pain intensity and duration of labor in nulliparous women.
Methods: This randomized clinical trial study was performed in 2020 on 100 nulliparous women admitted to the maternity ward in the south of Kerman province. Individuals were randomly divided into two groups of normal posture and Knee-chest position (n=50 in each group). For women who were in the Knee-chest position group, at the beginning of the active phase (dilatation 4cm), they were in Knee-chest position intermittently (for 15 minutes every hour) until the complete cervical dilatation. Data were collected by personal information questionnaire and pain visual scale and delivery progress form (partograph). Data were analyzed by SPSS software (version 26) and Independent t-test, chi-square and Fisher's exact test. P<0.05 was considered statistically significant.
Results: according to independent t-test, chi-square and Fisher's exact tests, the mean pain intensity in the intervention group (Knee-chest position) was significantly lower than the control group (normal position) (p <0.001). Also, the progression of labor in the mothers of the intervention group was significantly faster compared to the control group; duration of delivery in the intervention and control groups was 4.48±1.04 and 7.16±1.7, respectively (p <0.001). The level of mothers' satisfaction with the position status during delivery process was higher in the intervention group than in the control group (p<0.001).
Conclusion: The Knee-chest position in nulliparous women during the active phase of labor is beneficial in reducing labor pain and accelerating labor progression. Therefore, it is recommended that this condition be used as a routine non-pharmacological care in maternity wards.

کلیدواژه‌ها [English]

  • Duration of labor
  • Knee-chest position
  • Labor pain
  • Nulliparous women

مراجع

  1. Pasha H, Basirat Z, Hajahmadi M, Bakhtiari A, Faramarzi M, Salmalian H. Maternal expectations and experiences of labor analgesia with nitrous oxide. Iranian Red Crescent Medical Journal 2012; 14(12):792.
  2. Parsa P, Saeedzadeh N, Roshanaei G, Shobeiri F, Hakemzadeh F. The effect of Entonox on labour pain relief among nulliparous women: a randomized controlled trial. Journal of Clinical and Diagnostic Research: JCDR 2017; 11(3):QC08.
  3. Murray SS, McKinney ES. Foundations of maternal-newborn and women's health nursing-e-book. Elsevier Health Sciences; 2014.
  4. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams Obstetrics. 23nd New York: McGraw-Hill Education; 2014.
  5. Dehcheshmeh FS, Rafiei H. Complementary and alternative therapies to relieve labor pain: A comparative study between music therapy and Hoku point ice massage. Complementary therapies in clinical practice 2015; 21(4):229-32.
  6. Shahoei R, Shahghebi S, Rezaei M, Naqshbandi S. The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial. Complementary Therapies in Clinical Practice 2017; 28:176-80.
  7. Simkin P, Hanson L, Ancheta R. The labor progress handbook: early interventions to prevent and treat dystocia. John Wiley & Sons; 2017.
  8. Zaghini F, Biagioli V, Proietti M, Badolamenti S, Fiorini J, Sili A. The role of occupational stress in the association between emotional labor and burnout in nurses: A cross-sectional study. Applied nursing research 2020; 54:151277.
  9. Chaillet N, Belaid L, Crochetiere C, Roy L, Gagné GP, Moutquin JM, et al. Nonpharmacologic approaches for pain management during labor compared with usual care: a meta‐ Birth 2014; 41(2):122-37.
  10. Valiani M, Rezaie M, Shahshahan Z. Comparative study on the influence of three delivery positions on pain intensity during the second stage of labor. Iranian journal of nursing and midwifery research 2016; 21(4):372.
  11. Haratipour H, Partash N, Ebrahimi E, Zadeh MD, Bolbolhaghighi N. Non-physiological and physiological delivery method: comparison of maternal attachment behaviors and anxiety. Journal of caring sciences 2021; 10(1):37.
  12. Mathur VA, Morris T, McNamara K. Cultural conceptions of Women's labor pain and labor pain management: A mixed-method analysis. Social Science & Medicine 2020; 261:113240.
  13. Wang E. Requests for cesarean deliveries: the politics of labor pain and pain relief in Shanghai, China. Social Science & Medicine 2017; 173:1-8.
  14. Arulkumaran S, Sivanesaratnam V, Kumar P, Chatterjee A. Essentials of gynecology. Jaypee Brothers Medical Publishers; 2019.
  15. Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: A systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iranian journal of nursing and midwifery research 2017; 22(4):257.
  16. Reitter A, Daviss BA, Bisits A, Schollenberger A, Vogl T, Herrmann E, et al. Does pregnancy and/or shifting positions create more room in a woman’s pelvis?. American journal of obstetrics and gynecology 2014; 211(6):662-e1.
  17. Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. Journal of Midwifery & Women's Health 2004; 49(6):489-504.
  18. Ricci S. Essentials of maternity, newborn, and women’s health. Lippincott Williams & Wilkins; 2020.
  19. Akhlaghi F, Pourjavad M, Jafari S. Relation between position and feeling of labor pain in active phase of labor. Iran J Obstet Gynecol Infertil 2011; 14(2):14-9.
  20. Guittier MJ, Othenin‐Girard V, De Gasquet B, Irion O, Boulvain M. Maternal positioning to correct occiput posterior fetal position during the first stage of labour: a randomised controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology 2016; 123(13):2199-207.
  21. Gizzo S, Di Gangi S, Noventa M, Bacile V, Zambon A, Nardelli GB. Women’s choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BioMed research international. 2014 Oct;2014.
  22. Desbriere R, Blanc J, Le Dû R, Renner JP, Carcopino X, Loundou A, et al. Is maternal posturing during labor efficient in preventing persistent occiput posterior position? A randomized controlled trial. American journal of obstetrics and gynecology 2013; 208(1):60-e1.
  23. Bahmaei K, Iravani M, Moosavi P, Haghighizadeh MH. Effect of Maternal Positioning with Occipito-posterior Fetal Position during Labor on Pain Intensity and Satisfaction of Mothers. Iran J Obstet Gynecol Infertil 2018; 21(5):66-73.
  24. Hosseini Amiri M, Manzari ZS, Tavoosi H. Effect of transcranial direct current stimulation on pain intensity and quality of burn dressing. Journal of Mazandaran University of Medical Sciences 2015; 24(120):75-87.
  25. Hodnett ED, Stremler R, Halpern SH, Weston J, Windrim R. Repeated hands-and-knees positioning during labour: a randomized pilot study. PeerJ 2013; 1:e25.
  26. Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane database of systematic reviews 2013(8).
  27. Thies-Lagergren L, Kvist LJ, Christensson K, Hildingsson I. Striving for scientific stringency: a re-analysis of a randomised controlled trial considering first-time mothers’ obstetric outcomes in relation to birth position. BMC pregnancy and childbirth 2012; 12(1):1-9.
  28. khavandizadeh Aghadam S, Shahbazzadegan S, Mahfoozi B. To Evaluate the effects of Maternal Elective Position during active phase on our come Labor and Delivery in the Health of Primigravida Women. J Ardabil Univ Med Sci 2009; 9(3):218-23.
  29. Desseauve D, Fradet L, Lacouture P, Pierre F. Position for labor and birth: State of knowledge and biomechanical perspectives. European Journal of Obstetrics & Gynecology and Reproductive Biology 2017; 208:46-54.
  30. Andrews CM, Andrews EC. Physical theory as a basis for successful rotation of fetal malpositions and conversion of fetal malpresentations. Biological Research for Nursing 2004; 6(2):126-40.
  31. Biancuzzo M. Six myths of maternal posture during labor. MCN: The American Journal of Maternal/Child Nursing 1993; 18(5):264-9.
  32. Zhang H, Huang S, Guo X, Zhao N, Lu Y, Chen M, et al. A randomised controlled trial in comparing maternal and neonatal outcomes between hands-and-knees delivery position and supine position in China. Midwifery 2017; 50:117-24.
  33. Mohammady M, Janani L. Randomization in randomized clinical trials: From theory to practice. Journal of hayat 2016; 22(2):102-14.
مجله زنان، مامایی و نازایی ایران
دوره 25، شماره 4
تیر 1401
صفحه 18-26

فایل ها

هم رسانی

ارجاع به این مقاله

آمار