Skip to main content

Advertisement

Log in

The effect of acupressure applied to points LV4 and LI4 on perceived acute postpartum perineal pain after vaginal birth with episiotomy: a randomized controlled study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Acupressure can be used for alleviating perineal pain sustained after a vaginal birth with episiotomy. To evaluate if a 10-min acupressure application relieved perineal pain after vaginal birth with episiotomy and if the analgesic effect was maintained for up to 120 min.

Methods

A randomized controlled trial was conducted from January to May 2019 with 120 women. The participants were over 18 years old, had an episiotomy and experienced perineal pain ≥ 4, had not received anti-inflammatory medication or analgesics after childbirth, and were randomized to receive acupressure or ice-pack application on the perineum for 10 min or standard care.

Results

Immediately post-intervention, the women in the experimental groups had a significantly higher decrease in perineal pain. Within 120 min, there was a significant difference in the pain levels between the three groups. Each method (acupressure, ice package and control group) is evaluated for 30 min (VAS 3), 60 min (VAS 4) and 120 min (VAS 5). Comparing these 3 methods the acupressure has significantly reduced pain after the application (VAS 3 3.20 ± 1.28 vs. 3.77 ± 1.27 vs. 4.82 ± 0.93, respectively, VAS 4 2.65 ± 1.33 vs. 3.5 ± 1.37 vs. 4.62 ± 0.97, respectively, VAS 5 2.02 ± 1.44 vs. 3.5 ± 1.37 vs. 4.57 ± 0.93, respectively, p < 0.05)

Conclusion

Effective pain relief is achieved by applying acupressure for 10 min to the perineum and is maintained between 30, 60, and 120 min.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aasheim V, Nilsen ABV, Reinar LM, Lukasse M (2017) Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.CD006672.pub2

    Article  Google Scholar 

  2. Akbarzade M, Ghaemmaghami M, Yazdanpanahi Z, Zare N, Mohagheghzadeh A, Azizi A (2016) Comparison of the effect of dry cupping therapy and acupressure at BL23 point on intensity of postpartum perineal pain based on the short form of McGill Pain Questionnaire. J Reprod Infertil 17(1):39

    PubMed  PubMed Central  Google Scholar 

  3. Kwan WS, Li WW (2014) Effect of ear acupressure on acute postpartum perineal pain: a randomised controlled study. J Clin Nurs 23(7–8):1153–1164

    Article  PubMed  Google Scholar 

  4. Molakatalla S, Shepherd E, Grivell RM (2017) Aspirin (single dose) for perineal pain in the early postpartum period. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.CD012129.pub2

    Article  Google Scholar 

  5. Marra C, Pozzi I, Ceppi L, Sicuri M, Veneziano F, Regalia AL (2011) Wrist–ankle acupuncture as perineal pain relief after mediolateral episiotomy: a pilot study. J Altern Complement Med 17(3):239–241

    Article  PubMed  Google Scholar 

  6. Karacam Z, Eroglu K (2003) Effects of episiotomy on bonding and mother’s health. J Adv Nur 43:384–394

    Article  Google Scholar 

  7. Şenol DK, Aslan Eti F (2016) Vajinal doğum sonrası perineal soğuk uygulamanın fiziksel aktivitelere etkisi. Florence Nightingale Hemşire Derg 24(3):133–142

    Google Scholar 

  8. Amorim-Francisco A, Vasconcellos J, de Oliveira SM, Barbosa da Silva FM, Bick D, Gonzalez Riesco ML (2010) Women’s experiences of perineal pain during the immediate postnatal period: a cross-sectional study in Brazil. Midwifery 27(6):e254–e259

    Article  PubMed  Google Scholar 

  9. East CE, Sherburn M, Nagle C, Said J, Forster D (2012) Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery 28(1):93–97

    Article  PubMed  Google Scholar 

  10. Francisco AA, Kinjo MH, Bosco CS, Silva RL, Mendes EPB, Oliveira SMJV (2014) Association between perineal trauma and pain in primiparous women. Rev Esc Enferm USP. https://doi.org/10.1590/S0080-623420140000600006

    Article  PubMed  Google Scholar 

  11. Kettle C, Tohill S (2008) Perineal care. BMJ Clin Evidence1401

  12. Macarthur AJ, Macarthur C (2004) Incidence, severity, and determinants of perineal pain after vaginal delivery: a prospective cohort study. Am J Obstet Gynecol 191(4):1199–1204

    Article  PubMed  Google Scholar 

  13. Macleod M, Goyder K, Howarth L, Bahl R, Strachan B, Murphy DJ (2013) Morbidity experienced by women before and after operative vaginal delivery: prospective cohort study nested within a two-centre randomised controlled trial of restrictive versus routine use of episiotomy. Br J Obstet Gynaecol 120(8):1020–1026

    Article  CAS  Google Scholar 

  14. Erbaba H, Pınar G (2016) Postpartum Perineal Travmanın Önlenmesi ve Yönetimine İlişkin Güncel Yaklaşımlar. Koç Üniversitesi Hemşirelikte Eğitim ve Araştırma Dergisi (HEAD) 13(3):272–281

    Google Scholar 

  15. Wuytack F, Smith V, Cleary BJ (2016) Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period. Cochrane Datab Syst Rev. https://doi.org/10.1002/14651858.CD011352.pub2

    Article  Google Scholar 

  16. Francisco AA, De Oliveira SMJV, Steen M, Nobre MRC, De Souza EV (2018) Ice pack induced perineal analgesia after spontaneous vaginal birth: randomized controlled trial. Women Birth 31(5):e334–340

    Article  PubMed  Google Scholar 

  17. Hamlacı Y, Yazici S (2017) The effect of acupressure applied to point LI4 on perceived labor pains. Holist Nurs Pract 31(3):167–176

    Article  PubMed  Google Scholar 

  18. Bleakley CM, McDonough SM, MacAuley DC, Bjordal J (2006) Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. Br J Sports Med 40(8):700–705

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Knight KL (2000) Cryotherapy in sport injury management. Manole, São Paulo

    Google Scholar 

  20. Navvabi S, Abedian Z, Steen-Greaves M (2009) Effectiveness of cooling gel pads and ice packs on perineal pain. Br J Midwifery 17(11):724–729

    Article  Google Scholar 

  21. Oliveira SMJV, Silva FMB, Riesco MLG, Latorre MR, Nobre MRC (2012) Comparison of application times for ice packs used to relieve perineal pain after normal birth: randomised clinical trial. J Clin Nurs 21(23–24):3382–3391

    Article  PubMed  Google Scholar 

  22. Dibble SL, Chapman J, Mack KA, Shih AS (2000) Acupressure for nausea: results of a pilot study. Oncol Nurs Forum 27(1):41–47

    CAS  PubMed  Google Scholar 

  23. Gao D (1997) The encyclopedia of Chinese medicine. Carlton Books, Spain

    Google Scholar 

  24. Mirbagher-Ajorpaz N, Adib-Hajbaghery M, Mosaebi F (2011) The effects of acupressure on primary dysmenorrhea: a randomized controlled trial. Complement Ther Clin Pract 17(1):33–36

    Article  PubMed  Google Scholar 

  25. Schlaeger JM, Gabzdyl EM, Bussell JL, Takakura N, Yajima H, Takayama M, Wilkie DJ (2017) Acupuncture and acupressure in labor. J Midwifery Women's Health 62(1):12–28

    Article  Google Scholar 

  26. Liechti E (1998) The complete ıllustrated guide to shıatsu. The Japanese healing art of touch for health and fitness. Element Books, Rockport

    Google Scholar 

  27. Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160

    Article  PubMed  Google Scholar 

  28. Esteban BMM, Calvo JAS, Morcillo CT, Espeja JJD, Hinojosa JG, Goñi ÁZ (2019) Retrospective case review of combined local mepivacaine and steroid injections into vaginal trigger points for the management of moderate-to-severe perineal pain after childbirth. Arch Gynecol Obstet 299(2):501–505

    Article  CAS  Google Scholar 

  29. Vaziri F, Shiravani M, Najib FS, Pourahmad S, Salehi A, Yazdanpanahi Z (2017) Effect of lavender oil aroma in the early hours of postpartum period on maternal pains, fatigue, and mood: a randomized clinical trial. Int J Prev Med. https://doi.org/10.4103/ijpvm.ijpvm_137_16

    Article  PubMed  PubMed Central  Google Scholar 

  30. Aslan FE, Öztürk KZ (2014) Ağrı ölçümü ve değerlendirilmesi. In: Eti FA (ed) Ağrı Doğası ve Kontrolü. Akademisyen Tıp kitapevleri, Ankara, pp 67–100

    Google Scholar 

  31. Kömürcü N, Ergin AB (2014) Doğum Ağrısı ve Yönetimi. In: Kömürcü N (ed) Bölüm3: Doğum Ağrısının Değerlendirilmesi., Bölüm4: Doğum Ağrısının (Dalgalarının), 2nd edn. Yönetimi Nobel Tıp Kitabevleri, Istanbul, pp 39–46

    Google Scholar 

  32. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res 63(S11):S240–S252

    Article  Google Scholar 

  33. Chang SR, Chen KH, Lee CN, Shyu MK, Lin MI, Lin WA (2016) Relationships between perineal pain and postpartum depressive symptoms: a prospective cohort study. Int J Nurs Stud 59:68–78

    Article  PubMed  Google Scholar 

  34. Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G (1983) Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 34(2):234–239

    Article  CAS  PubMed  Google Scholar 

  35. Stephenson NL, Herman J (2000) Pain measurement: a comparison using horizontal and vertical visual analogue scales. Appl Nurs Res 13(3):157–158

    Article  CAS  PubMed  Google Scholar 

  36. Scott J, Huskisson EC (1979) Vertical or horizontal visual analogue scales. Ann Rheum Dis 38(6):560

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. George D, Mallery M (2010) SPSS for Windows Step by Step: a simple guide and reference, 17.0 update, 10th edn. Pearson, Boston

    Google Scholar 

  38. Mafetoni RR, Shimo AKK (2016) The effects of acupressure on labor pains during child birth: randomized clinical trial. Rev Lat-Am De Enferm Aguts 8:24

    Google Scholar 

  39. Torkzahrani S, Mahmoudikohani F, Saatchi K, Sefidkar R, Banaei M (2017) The effect of acupressure on the initiation of labor: a randomized controlled trial. Women Birth 30(1):46–50

    Article  PubMed  Google Scholar 

  40. Ozgoli G, Mobarakabadi SS, Heshmat R, Majd HA, Sheikhan Z (2016) Effect of LI4 and BL32 acupressure on labor pain and delivery outcome in the first stage of labor in primiparous women: a randomized controlled trial. Complement Ther Med 29:175–180

    Article  PubMed  Google Scholar 

  41. Hashashemi M, Ghanbari Z, Movahedi M, Rafieian M, Keivani A, Haghollahi F (2018) The effect of Achillea millefolium and Hypericum perforatum ointments on episiotomy wound healing in primiparous women. J Matern-Fetal Neonatal Med 31(1):63–69

    Article  Google Scholar 

  42. Moudi Z, Edozahi M, Emami SA, Asili J, Pour MS (2018) Effects of mastic oleoresin on wound healing and episiotomy pain: a mixed methods study. J Ethnopharmacol 214:225–231

    Article  CAS  PubMed  Google Scholar 

  43. Leventhal LC, de Oliveira SMJV, Nobre MRC, da Silva FMB (2011) Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. J Midwifery Women’s Health 56(2):141–146

    Article  Google Scholar 

  44. East CE, Begg L, Henshall NE, Marchant P, Wallace K (2012) Local cooling for relieving pain from perineal trauma sustained during childbirth (review). Cochrane Database Syst Rev 5:1–146

    Google Scholar 

  45. Paiva CSB, de Oliveria SMJV, Francisco AA (2015) Length of perineal pain relief after ice pack application: a quasi experimental study. Women Birth 29(2):117–122

    Article  Google Scholar 

  46. Tsay SL, Chen ML (2003) Acupressure and quality of sleep in patients with end-stage renal disease: a randomized controlled trial. Int J Nurs Stud 40:1–7

    Article  PubMed  Google Scholar 

  47. Tsay SL (2004) Acupressure and fatigue in patients with end-stage renal disease: a randomized controlled trial. Int J Nurs Stud 41:99–106

    Article  PubMed  Google Scholar 

  48. Shahla G, Shahnaz T, Ali RA, Reza H (2012) The effects of acupressure on severity of primary dysmenorrhea. Patient Prefer Adherence 6:137–142

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

ASK: project development, data collection, manuscript writing, and data analysis. DKG: data collection, manuscript writing, and data analysis.

Corresponding author

Correspondence to Ayça Şolt Kirca.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

Approval for the study was obtained from İstanbul Medipol University Clinical Researches Ethics Committee (Reference number: 10840098-04.01.01-E.53604-758). All the procedures were performed in accordance with the rules regarding studies involving human participants by considering the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

During the data collection phase, Ozel Nisa Hospital obtained written permission and consent from the participants after explaining the purpose and objective of the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Şolt Kirca, A., Kanza Gul, D. The effect of acupressure applied to points LV4 and LI4 on perceived acute postpartum perineal pain after vaginal birth with episiotomy: a randomized controlled study. Arch Gynecol Obstet 301, 473–481 (2020). https://doi.org/10.1007/s00404-020-05439-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05439-z

Keywords

Navigation