Ice Massage for the Reduction of Labor Pain

Bette L. Waters, CNM, RN, Jeanne Raisler, CNM, DrPH, FACNM


J Midwifery Womens Health. 2003;48(5) 

In This Article

Abstract and Introduction

The current study investigated the use of ice massage of the acupressure energy meridian point large intestine 4 (LI4) to reduce labor pain during contractions. LI4 is located on the medial midpoint of the first metacarpal, within 3 to 4 mm of the web of skin between the thumb and forefinger. A one-group, pretest, posttest design was chosen, which used 100-mm Visual Analog Scales (VAS) and the McGill Pain Questionnaire (MPQ) ranked numerically and verbally to measure pain levels; the pretest served as the control. Study participants were Hispanic and white Medicaid recipients who received prenatal care at a women's clinic staffed by certified nurse-midwives and obstetricians. Participants noted a pain reduction mean on the VAS of 28.22 mm on the left hand and 11.93 mm on the right hand. The postdelivery ranked MPQ dropped from number 3 (distressing) to number 2 (discomforting). The study results suggest that ice massage is a safe, noninvasive, nonpharmacological method of reducing labor pain.

A woman's experience of labor pain is influenced by many elements including her past experiences of pain, her coping abilities, the birth environment, and psychosocial factors. The definition of pain as an unpleasant and emotional experience resulting from actual or potential tissue damage has powered the scientific study and management of pain in recent decades. Labor pain differs from other forms of pain in that no actual trauma or tissue damage occurs. Chapman[1] describes labor pain as stimuli of receptive neurons arising from contractions of the uterine muscles, which is referred to as the visceral, pelvic, and lumbar-sacral areas. To date, labor pain management studies have focused on use of drugs that affect sensory awareness of pain, which may have the additional effect of impeding women's active participation in giving birth.

McCaffery's definition, "Pain is whatever the experiencing person says it is, and happens whenever the experiencing person says it does,"[2] reflects the midwifery approach to labor management. This philosophy supports management options that include diverse methods for decreasing pain while not eliminating the source.

Even though there has been enormous growth in complementary alternative medicine (CAM) research in the past decade, few well-designed studies on the use of CAM in pregnancy or childbirth have been conducted. Some of the most interesting of the studies are those based in traditional Chinese medicine, which is a complex ancient system of healing that includes the use of acupuncture, acupressure (acupuncture without needles), moxibustion (stimulation of acupuncture points with heat from a burning herb), massage, diet, herbs, and exercise to promote health and treat disease. Within the framework of traditional Chinese medicine, the stimulation of acupuncture points by these treatments is a way of initiating, controlling, or accelerating body functions by stimulating energy channels (meridians) beneath the skin's surface and rebalancing the body's energy (Qi) to restore health.[3] Shiatsu -- a Japanese healing modality based on acupuncture -- uses massage to stimulate the energy pathways.

Despite the exponential growth of research on traditional Chinese medicine in the past decade, the mechanisms of action of acupuncture, acupressure, and moxibustion are still largely unexplained in the Western scientific model. Western research on the use of traditional Chinese medicine in obstetrics has focused on the effect of acupuncture/ acupressure on nausea and vomiting during pregnancy[4,5] and on the use of moxibustion for breech version.[6] In the 1970s and 1980s, studies on the use of acupuncture for labor induction and labor analgesia were carried out, but there were problems with the study methods, including small sample sizes, the variety of methods for assessing pain, and in some studies, the lack of a control group. However, many effective CAM therapies, including massage, therapeutic touch, hydrotherapy, music, heat, and cold, are used by midwives to reduce labor pain.[7]

The purpose of this study was to evaluate the effectiveness of the use of ice massage of the energy meridian point, large intestine 4 (LI4), during contractions to reduce the woman's perception of labor pain. The energy meridian pathway is bilateral. The LI4 point is located on both the right and the left hands. Ice massage was performed on both hands, and any differences in pain sensation were measured and compared.


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