Materials and methods
This was a quasi-experimental study including
primigravidae who referred to the clinic
and delivery room of Alzahra Hospital in Tabriz.
Considering the mean and standard
deviation obtained by the study of Chang et
al.7 and using the formula related to determine
sample size by analysis of variance
(ANOVA), the sample size for each group
was calculated as around 20 people.
First, after sufficient explanations about
the study in an obstetrics and gynecology
(OB/GYN) Clinic and also obtaining written
consents from the mothers, forty 20 to 35-
year-old mothers at 36th week of gestation
were selected. More subjects were normal
primiparous women in normal midwifery
conditions without any physical diseases or
types of paralysis. Using a table of random
numbers, they were divided into two groups
of massage therapy 1 (M1) and breathing
technique 1 (B1). In order to provide control
groups, another 42 people, selected with similar
criteria, were divided into two groups of
massage therapy 2 (M2) and breathing technique
2 (B2). Thus, if group B1 received
breathing techniques at 4 and 8 cm dilatations,
the subjects in the B2 group B2 were
considered as controls at the same dilatations
in order to determine the efficacy of the method
on the required variables.
Demographic data was obtained through
interviewing. The mothers in the breathing
technique group were trained to do practical
breathing in a class by an educated researcher
assistant (ERA) on the same day. When
mothers of the four groups referred for labor,
the ERA was also present in the labor room
and repeated the breathing training for
breathing groups. Thereafter, each group implemented
the required actions by the help of
ERA. In the B1 group, mothers used the
breathing techniques for 30 minutes at the
first or second stage of labor at 4 and 8 cm
dilatations. Subjects in the B2 group employed
the same techniques at 6 and 10 cm
dilatations. Thirty minutes after determination
of dilatation, the pain intensity was assessed
by a numerical rating scale (NRS)
which was scored from zero to 10. The NRS
could measure physiological responses to
pain (pulse rate, blood pressure and fever). In
the M1 and M2 groups, respectively at 4 and
8 cm dilatations and 6 and 10 cm dilatations,
mothers underwent massage (hypogastric,
upper thighs, sacral area, shoulders and foot)
by an ERA for 30 minutes. Pain intensity and
physiological responses to pain were measured
by the same NRS 30 minutes after determination
of dilatation. Mean differences of
pain intensity between M1 and M2, as well as
B1 and B2 were analyzed by independent t–
test. The comparison between massage and
breathing groups in terms of mean pain was
performed by Wilcoxon test. Mean differences
of physiological responses to labor pain
between M1 and M2 groups and B1 and B2
groups were compared by paired t–test,
while the massage and breathing were compared
using independent t-test.
The process of labor progression was evaluated
by the partograph. The progression
and labor results including the type of delivery
and first and fifth minute Apgar scores
were analyzed by chi-square test.