The Effect of Distraction Techniques on Labor Pain and Stress: A Randomized, Controlled Clinical Trial

Abstract

Abstract: Introduction: Pain control and the stress associated with labor and delivery are among the most important issues of health care system. This pain is one of the most severe pain in the world and its control is one of the most important health care goals. The aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of delivery, and length of delivery stages (secondary outcomes). Methods: A randomized controlled clinical trial was conducted on 68 healthy pregnant women aged 28-32 weeks of first and second pregnancy in Khalkhal city in 2018. Samples were divided into two intervention and control groups by stratified randomized blocking method based on the number of deliveries. Participants in the intervention received distraction techniques in four sessions with one-week intervals that started at the 32nd week of gestation. Questionnaires of Fear of Childbirth (W-DEQ: Wijma Delivery Expectancy/Experience Questionnaire version A) and Perceived Stress Scale (PSS) once were completed at the first visit and again at the 36th week for the fear and in the active phase for the stress through interviews. The researcher recorded the pain after the onset of the active phase through the VAS scale (Visual Analogue Scale) per hour. The length of labor was recorded in the partogram chart in minutes. Data were analyzed by independent t-test and ANCOVA. Results: No statistically significant difference was observed between the two groups in terms of socio-demographic characteristics, basic scores of perceived stress, and fear of delivery (P>0.05). Based on ANCOVA test and with adjustment of baseline score, the mean of perceived stress during labor of the intervention group was significantly less than that of the control group (adjusted mean difference: -3.2; 95% Confidence Interval: -0.8 to -6.0; P= 0.01). The means (SD) of pain intensity during labor were 6.2 )1.4) and 7.5 (1.4) in the intervention group and the control group, respectively, which indicated a statistically significant difference between the two groups (P<0.001). Although the mean score of fear in 36th week in the intervention group (29.1) was less than of the control group (39.1), there was no statistically significant difference between the two groups (P = 0.170). The duration of the active phase (P= 0.504), the second stage (P= 0.928) and the total duration of labor (P= 0.520) were less in the intervention group, but this difference was no statistically significant. There was no statistically significant difference between the two groups in terms of the first minute Apgar score (P= 1.000) and the frequency of oxytocin (P= 0.622). Conclusion: According to the results of this study, distraction techniques can reduce the pain and stress of labor, but further studies are needed to reach a decisive conclusion.