The effect of mindfulness techniques in counseling with and without acupressure on pain and childbirth experience in primiparous women: a randomized controlled clinical trial

Abstract

Abstract: Background: Labor pain is one of the most painful pains for women and is one of the factors that causes an unpleasant childbirth experience and, as a result, a reluctance to have a natural birth. Conversely, a pleasant experience can improve the birth process and increase feelings of support and control. So far, various theories have been introduced regarding the mechanism of labor pain, but a standard effective method for controlling and reducing this pain during labor has not yet been identified. The present study was designed and implemented to determine the effect of mindfulness techniques in counseling with and without acupressure on pain and the experience of childbirth. Methods and Materials: 90 pregnant women aged 32 to 34 weeks of primiparous pregnancy who referred to the specialized perinatology clinic at Al-Zahra, Taleghani, and 29 Bahman hospitals in Tabriz who met the inclusion criteria participated in this randomized controlled clinical trial and were randomly assigned to three groups (intervention 1, intervention 2, and control) with equal proportions in blocks of 9. Questionnaires on demographic and social characteristics were completed for the participants. The intervention group received 8 sessions of counseling program and the second intervention group, in addition to mindfulness, was taught acupressure point stimulation (KD1 (Kidney 1),(Special Hand-Comb Technique) in the seventh and eighth sessions, and the control group received routine care. During labor and delivery, participants in the first intervention group were encouraged to use mindfulness practices during labor. For the second intervention group, in addition to using mindfulness techniques during labor, specific pressure point stimulation was performed by the participants themselves from six centimeters of dilation. Finally, after delivery and during the first 24 hours after delivery and before discharge, the midwifery characteristics checklist, labor pain perception questionnaires, experience, and support and control in childbirth questionnaires were completed through interviews. Data analysis was performed using SPSS software ver 26. Data were analyzed using ANCOVA test. Results: Mean overall pain perception score in the mindfulness counseling group (P<0.001, -6.79 to -39.54: 95% confidence interval; -23.16: adjusted mean difference) and in the pressure conscious counseling group (P<0.001, -46.95 to -14.18: 95% confidence interval; -30.55: adjusted mean difference) was significantly lower than the control group. Mean overall childbirth experience score in the mindfulness counseling group (P<0.001, 0.89 to 0.16: 95% confidence interval; 0.53: adjusted mean difference) and in the mindfulness counseling group with acupressure (P>0.001, 0.30 to 1.03: 95% confidence interval; 0.66: adjusted mean difference) was significantly higher than the control group. Mean overall support and control score in the mindfulness counseling group (P<0.001, 33.09 to 8.71: 95% confidence interval; 20.90: adjusted mean difference) and in the mindfulness counseling group with acupressure (P<0.001, 11.11 to 35.49: 95% confidence interval; 20.30: adjusted mean difference) was significantly higher than the control group. Although the mean pain perception score in the intervention group receiving mindfulness counseling combined with acupressure was lower and the mean experience, support and control scores were higher, there was no statistically significant difference between the intervention groups (P>0.05). Conclusion: Education and counseling during pregnancy with mindfulness and acupressure approaches as easy, accessible pain reduction methods with negligible side effects can improve the perception of labor pain, the experience of labor, and the sense of greater support and control by the laboring woman. Therefore, it is recommended that health policymakers plan to provide psychological counseling approaches related to pregnancy and childbirth and the use of acupressure in health centers for women.