Int J Clin Exp Med 2018;11(2):898-903

www.ijcem.com /ISSN:1940-5901/IJCEM0055542

Original Article
Effects of acupressure and music
therapy on reducing labor pain
Qun Wan1, Fang-Yuan Wen2
1
Department of Gynaecology and Obstetrics, West China Second University Hospital/West China Women’s
Hospital, Chengdu, China; 2Department of Outpatient, Sichuan Academy of Medical Sciences/Sichuan Provincial
People’s Hospital, Chengdu, China
Received October 21, 2016; Accepted August 9, 2017; Epub February 15, 2018; Published February 28, 2018

Abstract: Purpose: The present study aimed to assess the clinical effects of acupressure and music therapy on
alleviating the labor pain, and investigate whether the combination of both interventions exerts better nursing
outcomes for puerperas. Materials and methods: A total of 241 pregnant women were enrolled and randomized
into four groups: including acupressure group (n=60, who received acupressure), music group (n=60, who received
music therapy), combination group (n=62, who received acupressure and music therapy) and control group (n=59).
The visual analog scale (VAS) was conducted to evaluate the postpartum pain intensity and anxiety levels after the
intervention. Results: Acupressure or music therapy could reduce the labor pain significantly. Acupressure had an
advantage on decreasing the uterine pressure compared to music therapy, whereas the music therapy owned more
benefits on reducing the anxiety levels of puerperas than acupressure. Moreover, the combination therapy could
also reduce the intensity of labor pain greatly and seemed to be superior to the single therapies in some param-
eters. However, no significant difference was found between combination therapy and single therapies on relieving
pain intensity. Conclusions: Acupressure and music therapy could both reduce labor pain effectively, while music
therapy had better effects totranquilize the subjects. The combination of acupressure and music treatment could
be used as a cost-effective, safe and accessible treatment for reducing the suffering with childbirth.

Keywords: Acupressure, music, labor pain, postpartum, VAS, childbirth, pregnant

Introduction negative role in women’s health, even affecting

the maternal and infant relationship [4]. Due to
Labor pain is one of the most severe pains on the enormous pressure caused by childbirth on
human beings around the world, despite the parturient women, a more effective non-inva-
difference of individual feelings [1]. During the sive nursing method for reducing labor pain was
childbirth, the cervix and obstetric canal were thus urgently needed.
opened with severe uterine contractions, which
made the pregnant women suffered sharp pain Up to now, multiple nursing methods for reduc-
[2]. The inevitable pain remarkably affects the ing labor pain were identified, which can be
mental and physical condition of the women. It divided into pharmacological and non-pharma-
was widely believed that if the management of cological methods. Although the palliative
pain was not performed well during the child- drugs were proven to be much effective on
birth, the tolerance threshold of parturient reducing labor pain, the side effects were also
women will decrease promptly. Furthermore, found in mothers and infants, including fatal
the labor pain could not only alter the stress debilitation of the central nervous system [5,
state of women, studies also reported that a 6]. Currently, the most effective method is intra-
series of plasma inflammatory cytokines were thecal labor analgesia; however, the optimal
associated with labor pain [3]. Considering the agent and dose adopted in this method remains
intensity, duration and individual characteris- divergent [7-9]. Besides, various complementa-
tics, various degree of hypertension, and ry and alternative approaches for pain mana-
increasing of heart rate could probably serve a gement in labor were performed in clinical,
 Comparison of different methods on reducing labor pain

including acupuncture, audio-analgesia, acu- were signed by all patients before experiment.
pressure, aromatherapy, hypnosis, massage, The included women needed to be satisfied
and music therapy [10, 11], and these non- with the following criteria: (1) age between 20
invasive methods could help reduce suffering and 35 years; (2) gestation with 37-41 weeks,
and relieve pain in labor, indicated by the data primiparity, pregnant with single baby of ceph-
from several studies. Although these methods alic presentation who were expected to have
have obtained satisfaction from many women, natural spontaneous delivery; (3) without seve-
further studies were needed to confirm their re risk symptoms under examination. The exclu-
effectiveness. sion criteria were patients who were under
obstetric complications or had the habits of
Among several non-pharmacological methods, alcohol and smoking. The information of age,
acupressure has been proven to be effective BMI, education level and the basic characteris-
on relieving pain among populations. Many tics of participants was recorded.
cases adopted acupressure as a complemen-
tary treatment under childbirth process, for it Procedures
only required fingers and hands to press acu-
points [12, 13]. Furthermore, music was anoth- The participants were divided randomly into
er common method applied for pain relief, for four groups, acupressure group (received only
music can help people feel relax and joyful. acupressure treatment, n=60), music group
Studies also showed that listening music can (received only music treatment, n=60), combi-
reduce pain intensity levels and opioid require- nation group (received acupressure and music
ments [14]. However, Smith et al. investigated combined treatment, n=62) and control group
several relaxation techniques for labor pain (without special treatment, n=59). In the acu-
management, and considered the evidence for pressure group, the acupressure was perform-
the function of music was insufficient [15]. ed at Hegu point rotationally for 10 min, with 5
Accordingly, further studies were required to min pressure and 15 min break, which was
verify the utility of these complementary based on the previous studies [16]. In the music
treatments. group, in consistent with the protocol of Serap’s
study, music was played with a 20 min break
Although the effects of acupressure and music for every two hours [17]. The following music
therapy were discussed in previous studies, the including relaxing, soft and regular rhythmic
comparison between the two non-pharmaco- patterns was recommended to participants.
logical labor pain relief methods has not been The participants in the combination group were
well performed. Moreover, the combination of received acupressure and listening music
non-invasive treatments on alleviating labor simultaneously, while the control group did not
pain has not been investigated yet. Thus, we receive these methods. The anxiety and pain
aimed to compare the effects of acupressure level was recorded at 1, 4, 8, 16, 24 h after
and music treatment on labor pain reduction. intervention. The satisfaction to childbirth was
Besides, the study evaluate whether the combi- collected at 2 and 24 h after intervention with-
nation of acupressure and music therapy could in the postpartum period. All the interventions
provide more advantages on reducing labor were conducted during the active phase of the
pain during childbirth. first stage of labor.

Materials and methods Outcome evaluation

Participants The VAS (visual analogue scale) method was

used to evaluate the effect of intervention on
A total of 238 pregnant women hospitalized in women. The VAS-A (VAS for anxiety) indicated
West China Women’s Hospital (Chengdu, China) the anxiety level during the postpartum period,
between February 2015 and June 2016 were with 0 means no anxiety or the least possible
enrolled into the present study. This study was anxiety, 10 means severe anxiety or the worst
approved by the Research Ethics Committee possible anxiety. The survey was conducted by
of West China Women’s Hospital (Chengdu, two blinded investigators to avoid the possible
China). The study protocol was informed to of subjective intervention on reporting anxiety
each participant and the informed consents scores. The patients were required to score

899 Int J Clin Exp Med 2018;11(2):898-903

 Comparison of different methods on reducing labor pain

Table 1. The demographic characteristics of participants enrolled in this study

Characteristics Acupressure group Music group Combination group Control Value
Cases 60 60 62 59
Age 26.18±3.25 25.57±3.11 26.70±3.87 26.02±2.90 P>0.05
BMI 26.02±2.90 27.13±2.47 27.61±1.94 27.22±2.41 P>0.05
Education background
Junior High School 22 (36.7%) 20 (33.4%) 22 (35.5%) 20 (33.9%) X²=0.99
Senior High School 13 (21.7%) 14 (23.3%) 16 (25.8%) 13 (22.0%)
Collage/University 25 (41.6%) 26 (43.3%) 24 (38.7%) 27 (45.1%)
P value represents the significance level of the one-way ANOVA test. X² value represents the significance level of Chi-square
test.

their anxiety level at 1, 4, 8, 16, 24 h after inter-

vention. The result of VAS-A was compared
among the groups. The VAS-P (VAS for pain)
indicated the pain intensity during the postpar-
tum period, with 0 means no pain or the least
possible pain, 10 means severe pain or the
worst possible pain. The survey was conducted
by a blinded investigator to avoid the possible
of subjective intervention on reporting pain
scores. The patients were required to score
their pain intensity at 1, 4, 8, 16, 24 h after
Figure 1. The comparison of VAS-A scores among intervention. The result of VAS-P was compared
groups. The VAS-A indicated the anxiety level of la-
boring women. *Represented the comparison of
among the groups. The satisfaction rate with
intervention groups versus control, *P<0.05. The child birth was also assessed by VAS, with 0
VAS-A scores in music group and combination group means totally unsatisfied, 10 means totally sat-
showed significant difference than control through isfied. The survey was conducted by a blinded
all time points (all *P<0.05). # represented the com- investigator. The patients were asked to score
parison with music group, #P<0.05. The VAS-A at 1
h and 4 h of acupressure group and combination
their satisfaction level at 2, 12, 24 h after
group were significantly less than music group (all intervention.
#P<0.05).
Statistical analysis

All statistical analyses were performed using

SPSS 16.0 statistical software package (SPSS,
Chicago, IL, USA). Results from continuous
measurement data were expressed as mean ±
standard deviation (SD). The Chi-square test
was used to compare differences between
categorical variables, whereas the Student’s
t-tests and One-way ANOVA analyses were used
to compare differences between categorical
variables. A P value of <0.05 would be regarded
Figure 2. The VAS-P in different groups. *Repre- as statistically significant, with all the compari-
sented the comparison of intervention groups versus son two-tailed.
control, *P<0.05. Acupressure, music and combina-
tion groups all showed significant less VAS-P than Results
control through all time points (all *P<0.05). #repre-
sented the comparison with music group, #P<0.05.
The VAS-P at 1 h and 4 h of acupressure group and The demographic characteristics of partici-
combination group were significantly less than music pants in this study were recorded in Table 1.
group (all #P<0.05). There was no significant difference on these

900 Int J Clin Exp Med 2018;11(2):898-903

 Comparison of different methods on reducing labor pain

Table 2. The satisfaction scores in groups effective management for alleviat-

Acupressure Music Combination P ing labor pain. The frequently-used
Variables Control strategies for relieving pain in la-
group group group value
VAS-S (2 h) 8.2±1.0 8.3±0.9 8.3±0.8 4.9±0.9 >0.05 bor are divided into pharmacologi-
cal and non-pharmacological me-
VAS-S (12 h) 8.4±0.7 8.6±0.6 8.9±0.9 5.7±1.0 >0.05
thods, which were largely associ-
VAS-S (24 h) 8.1±1.2 8.2±1.3 8.4±0.8 5.5±1.0 >0.05
ated with the maternal and infant
VAS-S: Visual Analog scale-Satisfaction. P value represents the significance
level of the t test versus control group.
birth outcomes [18]. The pharma-
cological method for relieving pain
was really effective and obtained
demographic characteristics among the groups high overall maternal satisfaction, such as
(all P>0.05), indicating the utility for compara- remifentanil and ropivacaine [19, 20]. However,
ble results. part of women prefer non-pharmacological
ways for pain relief rather pharm analgesics
As shown in Figure 1, the scores of VAS-A in due to cultural perspectives and the uncertain
acupressure group at 1, 4, 8 h were significant- safety of pharmacological interventions [21].
ly decreased than control (all P<0.05). Also, the Previous studies showed that non-pharmaco-
VAS-A scores in patients received music treat- logical approaches used in clinic provided sig-
ments were significantly lower than that in con- nificant benefits to parturients and their infants
trol through the therapy (all P<0.05), suggest- without additional harm, contributing to the
ing music therapy could significantly reduce development of complementary treatments for
maternal anxiety levels. Similarly, the combina- relieving labor pain [22]. However, the effective-
tion therapy group also exhibited lower VAS-A ness of non-pharmacological labor analgesic
scores than control from 1 to 24 h (all P<0.05). interventions remains to be further investigat-
It was observed that the VAS-A of music group ed [23].
at 1, 4 h were remarkably higher than acupres-
sure group and combination group (all P<0.05). Belonging to the non-invasive management of
pain relief, acupressure and music treatment
The results of VAS-P were illustrated in Figure might be effective strategies for the manage-
2. The VAS-P scores in music, acupressure, and ment of multiple pains, including low back pain,
combination group were significantly decreased chronic headache, traumatic pain, and labor
than control (all P<0.05), indicating the effects pain [14, 24]. Dabiri performed acupressure on
on relieving labor pain intensity by interven- LI4 point in the first stage of labor, while anoth-
tions. Moreover, it was found that the value of er study conducted SP6 acupressure on labor
VAS-P at 1, 4 and 8 h from acupressure and pain relief, and the results showed acupressure
combination group were statistically lower than was effective in relieving labor pain [25, 26].
the group received music treatment (all P< Moreover, other studies showed that acupres-
0.05). sure on BL32 acupoint was efficient on reduc-
ing the level of anxiety and the intensity of pain
The satisfaction rate of women during child
during labor [27, 28]. Hajiamini compared the
birth was also evaluated by VAS. The interven-
effects of Hegupoint acupressure and ice mas-
tion groups, including patients received acu-
sage on labor pain reduction, suggesting both
pressure, music and combination treatment,
techniques could reduce labor pain and ice
had significantly higher VAS-S score than con-
massage provided more persistent pain relief
trol at postpartum 2 h, 12 h and 24 h respec-
[16]. Different acupressure points could reduce
tively (all P<0.05). Furthermore, no significant
the pain during labor, and the efficacy of acu-
difference was found among acupressure treat-
pressure may be influenced by the selected
ment group, music therapy group and combina-
points. Thus, the effects of acupressure points
tion group (all P>0.05). The details of satisfac-
on relieving labor pain are required to be fur-
tion rate were listed in Table 2.
ther studied to uncover the most effective
Discussion points. Furthermore, the persistent time of acu-
pressure may also affect the pain relieving effi-
As the stress and harm brought by labor pain in cacy. Based on the same Hegu acupressure
childbirth, more and more women receive point, we found that the continuous acupres-

901 Int J Clin Exp Med 2018;11(2):898-903

 Comparison of different methods on reducing labor pain

sure during the childbirth period could notice- levels. Our study suggested that the interven-
ably decrease the VAS-P scores than control, tion that combines acupressure and listening
revealing greater labor pain intensity reduction music was an effective approach to reduce
than a previous study [16]. laboring women suffering during childbirth. The
combination intervention exerts the advantag-
Meanwhile, multiple studies investigated the es of two single methods in alleviating labor
effects of music therapy during childbirth. In a pain intensity and anxiety levels safely and
trial conducted on Taiwanese first-time moth- effectively. It could be recommended as an
ers, the authors revealed that listening music alternative therapy for pain relief and maternal
could significantly reduce labor pain and anxi- mental health in labor.
ety during the latent phase of labor [29]. Soft
music could be provided when women suffer Disclosure of conflict of interest
from labor pain and strong contractions [30].
The results from other studies implied that None.
music therapy not only reduced labor pain and Address correspondence to: Fang-Yuan Wen, Depart-
anxiety, but also increased the satisfaction dur- ment of Outpatient, Sichuan Academy of Medical
ing childbirth, affecting various maternal-fetal Sciences/Sichuan Provincial People’s Hospital,
parameters [17, 31]. However, Taghinejad et al. Chengdu, China. E-mail: wing_fy2016@163.com
found massage was more effective for reduc-
ing labor pain compared with music therapy References
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