Discussion
Most women can experience pain, anxiety, and fatigue in childbirth, and
this situation negatively affects their comfort level and childbirth
process. Midwifery care in childbirth aims to reduce perceived pain of
the pregnant women and to provide physical and emotional comfort for
them.1,2,13 In the present study, it was determined
that ice massage applied to SP6 point at 4-5 cm, 6-7 cm, and 8-9 cm
cervical dilatations reduced perceived labor pain. Only one study was
encountered in the literature in which the effects of ice massage
applied to SP6 point in reducing labor pain were examined. Nehbandani et
al. (2019) reported that labor pain level of the intervention group who
were applied cold pressure to SP6 point was lower at minute 30 and 60
after the intervention compared to the warm massage
group.3 There are also other studies in which cold
massage was applied to Hegu (LI4) point other than SP6
point.8,12,13,19,26,27 In the studies conducted by
Dehcheshmeh and Rafiei (2015), Indumathi (2018), and Afefy (2015), it
was reported that ice massage applied to Hegu point for 29 minutes
reduced labor pain more compared to the control
group.13,26,28 In the study they conducted, Hajiamimi
et al. (2012) applied ice massage to Hegu point for 10 minutes in
2-minute rotations, followed by a 15-minute break. As a result, they
found that ice massage applied decreased labor pain immediately after
the intervention, 30 minutes later, and one hour
later.12 Mirzaee et al. (2021) and Kaviani et al.
(2012) determined in their studies that acupressure and ice massage
applied to Hegu (LI4) point for 30 minutes reduced labor
pain.8,27 Yildirim et al. (2018) reported that ice
massage applied to Hegu point decreased pain level at the
80th minute of the intervention with respect to the
control group. Continuous arousal of acupressure points in labor can
increase vital energy flow in the meridians and thus can provide more
considerable therapeutic effects.19 In similar studies
to the present study, in which acupressure was applied to SP6 point, it
was reported that labor pain level of the intervention group was lower
compared to that of the control group.7,11,15-18Reduced labor pain will lead to positive childbirth emotion, mother’s
participation in labor, and natural childbirth. However, applying
acupressure during labor can be tiring for midwives. Ice application
does not affect labor negatively and has no risks such as side effects
or allergy, as well as being harmless for the fetus and the mother. The
effect of cold on pain is created by slowing down direct peripheral
nerve transmission, decrease in mediators that lead to nociceptive
stimulation related to indirect inflammatory response, or the loosening
of the pressure on the nerves in the region applied by the
edema.29 Therefore, ice application to acupressure
points can be used in labor as a safe midwifery intervention. Yet, more
research is needed in order to confirm this proposition.
In the present study, ice massage applied to SP6 point was found to have
no effect on labor duration. No study was encountered in the literature
in which the effect of ice massage applied to SP6 point on labor
duration was analyzed. However, in their studies in which they examined
the effect of ice massage applied to different points (Hegu point) on
labor duration, Yildirim et al. (2018), Fawaz and El-Sharkawy (2016),
Afefy (2015), and Kaviani et al. (2012) found that ice massage shortened
the duration of the first labor stage.19,27,28,30 It
is thought that as ice massage was applied to Hegu point in these
studies differently from the present study, it may have had a shortening
effect on labor duration. In the literature, it has been reported that
acupressure application to SP6 point reduced the duration of
labor.7,15,16,17,31 Acupressure stimulates oxytocin
secretion from the pituitary gland, and this regulates uterine
contractions and shortens labor contraction.7,18,31 It
is thought that since pressure is not applied to SP6 point in ice
massage as much as it is applied in acupressure, oxytocin secretion from
the pituitary gland is not stimulated. In addition, oxytocin induction,
which is routinely applied in the hospital, was applied to both groups
in the study. Therefore, it is believed that ice application did not
have any effect on labor duration.
Comfort ensures emotions such as relaxation, safety, welfare, hope, and
expectation.2 Pain relief has been defined as a
significant comfort and support source for delivering
women.32 In the study, it was determined that the
total level of comfort and relaxation achieved by ice massage applied to
SP6 point at 8-9 cm cervical dilatation was higher compared to the
control group. However, in the study, no difference was found between
the groups in terms of physical, psychospiritual, and sociocultural
comfort levels and state anxiety level. Similarly, in their study,
Mirzaee et al. (2021) reported that acupressure and ice massage applied
to Hegu (LI4) point for 30 minutes did not have an effect on anxiety
level.8 This situation can be explained by the placebo
effect of the equal amount of interest and support provided to the
pregnant women in both groups. As no study was encountered in the
literature which examined the effect of ice massage applied to SP6 point
on childbirth comfort, comparisons were made with studies that
investigated the effects of various non-pharmacological methods on
comfort in childbirth.1,2,33,34 Turkmen and Oran
(2021) reported that warm application to sacral region in childbirth had
positive effects on the total comfort and relaxation levels determined
at 8-9 cm cervical dilatation.2 Akin et al. (2022)
reported in their study that labor dance at 8 cm cervical dilatation had
positive effects on the total comfort and relaxation
levels.33 Turkmen et al. (2021) determined that the
pregnant women who focused on Maryam’s flower during stage I of labor
had higher total comfort levels at 8-9 cm cervical dilatation compared
to the control group.1 Bolanthakodi et al. (2018)
found that practicing yoga in the prenatal period increased the pregnant
women’s labor comfort.34 Non-pharmacological methods
such as cold application, warm application, labor dance, yoga, and
focusing can ensure active participation of pregnant women in labor and
reduce perceived pain. It is thought that active participation of the
pregnant women in labor and consequent decrease in their pain level
evoked a positive childbirth emotion and thus positively affected
comfort level and childbirth comfort.