The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial

Abstract

BackgroundPain control and the stress associated with labor and delivery are among the most important issues of health care system. Use of distraction techniques during childbirth is reported to reduce pain and stress of labor. However, there is a limited publication that looked on the effect of distraction techniques on labor pain and stress. Thus, the aim of this study was to determine the effect of distraction techniques on labor pain and stress (primary outcomes), fear of childbirth, length of delivery stages, first minute Apgar score and oxytocin consumption (secondary outcomes).MethodsA randomized controlled clinical trial was conducted on 68 pregnant women. Participants were allocated into two groups (intervention and control groups) by blocked randomization. Participants in the intervention group received distraction techniques in four sessions. Questionnaires of Fear of Childbirth (W-DEQ version A) and PSS once were completed before intervention and again at the 36th week for the W-DEQ and in the active phase for the PSS through interviews. The pain was assessed through VAS during active phase per hour. The length of delivery stages was recorded in the partograph chart. Data were analyzed by independent t-test and ANCOVA.ResultsThe mean of perceived stress during labor in the intervention group was significantly less than that of the control group (AMD: -3.2; 95% CI: − 0.8 to − 6.0; P = 0.01). The mean (SD) of pain intensity during labor was less than in the intervention and control groups compare to the control group (6.2 vs 7.5; P < 0.001). There was no significant difference between the two groups in terms of fear of childbirth score (AMD: 5.3; 95% CI: 13.0 to − 6.0; P = − 2.3). Moreover, there was no statistically significant difference between the two groups in terms of the active phase of labor (P = 0.504), second stage of delivery (P = 0.928), total length of delivery (P = 0.520), Apgar score (P = 1.000) and frequency of oxytocin consumption (P = 0.622).ConclusionAccording to the results, distraction techniques can reduce the pain and stress of labor, but further studies by using the distraction techniques are needed to reach a decisive conclusion.Trial registrationIRCT2017042910324N39; Name of registry: Iranian Registry of Clinical Trials; Registered 11 September 2017. URL of registry: https://fa.irct.ir/user/trial/10814/view. Date of enrolment of the first participant to the trial: September 2017.

The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial

“…It was observed that women in the experimental group were able to cope with labor pain more effectively. Studies have shown that interventions by healthcare professionals that provide physical and emotional comfort (holding the woman's hand, massage, changing position, allowing taking a warm shower, ensuring hygiene, saying words of appreciation, encouraging, making eye contact, appreciating, helping focus on positive things, providing spiritual care, breathing and relaxation techniques, and distraction) are effective in the management of labor pain (Amiri et al, 2019;Bohren et al, 2016;Steel et al, 2015 ). Our study results are consistent with the literature.…”

Effects of non-pharmacological coping strategies for reducing labor pain: A systematic review and network meta-analysis

“…The eight studies were published between 2006 and 2019. The studies were from the United Kingdom [30], Sweden [31], Taiwan [32], Iran [33,34], Canada [35], France [36], and Turkey [37]. All the studies evaluated participants immediately after the interventions.…”

“…All the studies evaluated participants immediately after the interventions. There were six RCTs [30][31][32][33][34][35] and two quasi-experimental studies [36,37].…”

Psychometric properties of the Tilburg Pregnancy Distress Scale-Persian version (TPDS-P)

“…Pregnancy and delivery are physiological events in a woman's life that, due to changes in physical conditions, family and workplace roles, and sometimes feelings and attitudes toward motherhood; require bio-psychosocial adjustment by the pregnant woman and her family [1]. This can be due to anxiety and fear of labor pain, lack of trust in the delivery room staff and stress caused by entering the unknown space of the delivery room, which is itself a factor that increases catecholamine, cortisol and epinephrine [2]. These stresses affect the adrenal axes, pituitary-hypothalamus and sympathetic nervous system, leading to endocrine neuronal changes and as a result to cortisol and adrenocorticotropin secretion.…”

“…In addition, increased cortisol levels rapidly results in problematic fetal growth , developmental disorders and reduces fetal heart rate [3] . Decreased Apgar score, lactation problems, low birth weight, late attachment between mother and baby, and increased cesarean section rate are other problems associated with increased stress and anxiety levels in the mother [1,2,5].…”