Introduction
Labor pain, anxiety, and fear can have negative effects on respiratory, circulation, and endocrine system, as well as other bodily functions. All these are associated with decreased level of comfort and increased surgical complications and risks for women. Managing labor pain, increasing comfort, and reducing anxiety are among the basic features of midwifery care, and they are the primary purpose of care in childbirth.1-6 Pharmacological methods used in order to reduce labor pain have various side effects for fetal and maternal health.3,7 Therefore, non-pharmacological methods, which have no side effects for the fetus and the mother and provide comfort, should be the primary choice in pain management. There are plenty of non-pharmacological methods that midwives can use in labor. Acupressure and cold application are among these methods. These techniques draw increasing attention in terms of decreasing childbirth-related complications such as reducing labor pain, shortening the duration of the labor, and alleviating anxiety.8,9According to the traditional Chinese medicine, vital energy of the body which regulates bodily functions flows through channels called meridians. By applying pressure to certain points on the body, the clogging of these channels can be eliminated. Arousing large intestinal (L14), spleen (SP6), and bladder 67 (BL67) points reduces labor pain and strengthens uterine contractions.7,10-13 In studies conducted in the literature, it has been determined that acupressure applied to SP6 point, which is located 3-4 fingers above the posterior malleolus bone, reduced labor pain and shortened labor duration.7,11,14-18 However, healthcare professionals have to obtain a certificate in order to apply acupressure. Therefore, it may not be possible for each midwife to use this method. Besides, it has been reported that acupressure application can be tiring for midwives.7 Thus, different methods that can be used by midwives without the need for a certificate in order for them to reduce labor pain perception by arousing acupressure points can be employed. Cold therapy is a harmless procedure for both the fetus and the mother, and it is under direct control of the mother. It does not affect childbirth negatively, and it does not have any side effects or allergy risks.19 Cold pressure application on acupressure points have various effects such as facilitating energy flow at acupressure points and relieving pain perception and muscle tension by stimulating peripheral nerve receptors.3,20 In the literature, there are studies in which ice massage was applied to Hegu point located on hands, which is one of the acupressure points, in order to reduce labor pain.12,13 Only one study was encountered in the literature which examined the effect of cold application to SP6 point on labor pain. However, in the said study, labor comfort, labor duration, and anxiety level were not determined.3 Hence, the purpose of the present study was to identify the effect of ice massage applied to SP6 point on labor pain, labor comfort, labor duration, and anxiety during labor.