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.