The Effect of Localized Heat and Cold Therapy on Pain Intensity, Duration of Phases of Labor, and Birth Outcomes Among Primiparous Females: A Randomized, Controlled Trial

Abstract

Background: Pain is a common and unavoidable phenomenon in childbirth, and in terms of severity, childbirth pain is among the most severe pains in human. Objectives: The current study aimed at investigating the effect of localized heat and cold therapy on pain intensity, duration of phases of labor, and birth outcomes among primiparous females. Satisfaction was also compared in the two intervention groups. Methods: The current randomized, controlled trial was conducted on 120 primiparous females in three groups (heat/ cold therapy, and control) from September 2015 to January 2016. Intensity of pain, duration of phases of labor, and birth outcomes were measured before and after intervention in the three groups. Satisfaction with localized heat and cold therapy was compared in the two intervention groups. No intervention was conducted in the control group. Data were analyzed using the Fisher exact, Chi-square, the Kruskal-Wallis, and ANOVA tests with SPSS version 19. Results: After intervention, statistically significant difference was found in the average pain severity respectively among the heat therapy, cold therapy, and control groups in dilations of 5 -6 cm (3.25 ± 0.91, 3.57 ± 1.14, 4.00 ± 1.37) 7 -8 cm (4.08 ± 0.91, 4.88 ± 1.05, 4.97 ± 1.17), and 9 -10 cm (6.00 ± 1.35, 6.40 ± 1.09, 7.80 ± 1.18) in the first and second phase of the labor (6.22 ± 1.13, 7.37 ± 1.08, 7.94 ± 1.08). There was a statistically significant differences in the average duration of first phase of labor, respectively among heat therapy, cold therapy, and control groups (293.70 ± 68.97, 368.57 ± 79.82, 400.86 ± 77.43) and second phases of labor respectively among heat therapy, cold therapy, and control groups (42.85 ± 13.60, 51.71 ± 12.24, 46.85 ± 13.67), but there was no statistically significant difference among the three groups in terms of the average duration of labor in the third phase. No significant difference was observed between heat and cold therapy groups in terms of satisfaction. No significant difference was observed among the three groups in birth outcomes, including the mean first and fifth Apgar scores, time of cuddling newborn, and the first breastfeeding of newborn. Conclusions: Localized heat and cold therapy are non-pharmacological, non-invasive, satisfactory for the primiparous females, and effective methods to control and relieve pain during labor without adverse effects on maternal and fetal outcomes.

The effect of cold application to the sacral area on labor pain and labor process: A randomized controlled trial

“…In the study that used cold application for pregnant women, Shirvani and Ganji 7 reported that the labor duration in the experimental group was shorter. In their study conducted with primipara pregnant women who received cold application to the stomach, lower stomach, and low back, Yazdkhasti et al 25 found no significant differences between the groups in terms of the duration of the first stage of labor, but the duration of the second stage of labor was significantly shorter in the experimental group. 25 This study's findings regarding labor duration are in line with the other prior studies.…”

“…In their study conducted with primipara pregnant women who received cold application to the stomach, lower stomach, and low back, Yazdkhasti et al 25 found no significant differences between the groups in terms of the duration of the first stage of labor, but the duration of the second stage of labor was significantly shorter in the experimental group. 25 This study's findings regarding labor duration are in line with the other prior studies. 7,25 When the pregnant women's cervical dilation and effacement values were compared according to the groups, the participants in the experimental group were found to have higher dilation and effacement values.…”

The effect of delivery ball and warm shower on the childbirth experience of nulliparous women: a randomized controlled clinical trial

“…Given the long-term effects of childbirth experience on women’s physical and mental health and taking into account the Oxford Summit’s emphasis on the prevention of psychological birth trauma (PBT) that negatively affects childbirth experience [ 27 ], studies and interventions aimed to create a positive childbirth experience are considered effective alternatives and solutions [ 10 , 28 ]. In using warm showers, the effect of heat on the sacrum region leads to a reduction in pain intensity as well as the feelings of pleasure and comfort in women, through various mechanisms [ 29 , 30 ]. On the other hand, hydrotherapy reduces the use of drugs and interventions with side effects such as fever [ 31 ], infections caused by bladder catheterization [ 32 ], delivery with spinal anesthesia [ 33 ], and uterine tachysystole [ 34 ].…”

The Effect of Perineal Warm Application on Perineal Pain, Perineal Integrity, and Postpartum Comfort in the Second Stage of Labor: Randomized Clinical Trial

“…Therefore, the results of the study support the hypothesis that perineal pain is experienced less severely in the warm application group than in the control group. In their studies, Fahami et al [13] (2011), Ganji et al [14] (2013), Essa and Ismail [11] (2013), Ahmad and Turky [5] (2010), ­Yazdkhasti et al [18] (2018), Behmanesh et al [19] (2008), and Dahlen et al [20] (2009) reported that warm application to the perineum in the second stage of labor reduces pain levels. When the warmth is applied, the touch and temperature receptors are stimulated and this creates a pleasant feeling.…”