الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Undoubtedly delivery is a painful experience for all women except for few. Effective labor pain control can be achieved through a combination of pharmacological and non-pharmacological therapies. Massage and warm application .are widely used as a complementary alternative therapy in nursing practice. Effleurage massage and warm application have the potential to relief pain.
Aim of the present study is: to determine the effect of lumbo-sacral massage versus warm application on pain intensity during the active phase of the first stage of labor.
To fulfill the study aim:a comparative non randomized controlled clinical trial research design was utilized.
This study was conducted at the labor and delivery unit in the El-shatby Maternity University Hospital in Alexandria.
Subjects
The study subjects were selected by using the non-probability sampling technique where a Convenience sample of 80 parturients from the above mentioned setting were recruited. The inclusion criteria included: primigravida with normal course of pregnancy, full-term and have a single viable fetus in cephalic presentation, spontaneous normal labor, in the latent phase of the first stage of labor (0 – 3 cm, free from any medical or obstetric risk factors, do not receive any pharmacological pain relief medications and willing to participate in the study.
The study subjects were equally divided into two groups as follows:
Study group 1: Which comprised 40 women upon whom lumbo-sacral effleurage was applied by the researcher throughout the active phase of labor. It started when cervical dilation was 4 cm. The rhythmic massage was done for a total of 30 intermittent minutes, with each uterine contraction until the dilation of the cervix reached 7 cm.
Study group 2: Which comprised 40 women upon whom warm water bag (38-40ºϲ) was applied on the lumbo- sacral area throughout the active phase of labor. It started when cervical dilation was 4 cm. The warm bag was applied for a total of 30 intermittent minutes, with each uterine contraction until the dilation of the cervix reached 7 cm.
Tools of the study:
Four tools were used for data collection. Tool I: socio-demographic and clinical data structured interview schedule: this tool was developed and used by the researcher to collect the basic data. Tool II: visual Analog Scale (VAS) which was used to measure the intensity of labor pain. The scale line ranges from 0 denoting ’’no pain’’; to 10, denoting ’’unbearable pain. Tool III: A Physiological and Behavioral Response to Pain (PBRPS). It included two parts/ part I physiological pain response which was used to measure the physiological response to pain. Part II Behavioral pain response (A Modified Version of Chamber Price Pain Rating Scale (CPPR), which was used to measure the behavioral response to pain. Tool IV: A modified Version of Johansson Pain –O-Meter Scale (JPOM) which was used to measure the intensity of sensory and affective components of pain (pain quality) after being translated & modified to suit the Egyptian culture. A scoring system was developed & used by the researcher to denote pain intensity.
Tools reliability was tested by using Cronbach’s Alpha test (internal consistency). Its result was satisfactory.
Using tool II, III and IV pain intensity was assessed for lumbo-sacral massage and warm bottle application groups two times: once before applying the massage and warm bottle and the 2nd time immediately after intervention.
The two groups were compaired to determine which intervention had induced less labor intensity during the active phase of the first stage of labor than the other.
Pilot study was carried out on 10 women (who were excluded from the main study sample) to ascertain clarity, relevance and the applicability of the tools, to detect any problem peculiar to the tools and to estimate the time needed to complete the sheet.
Collection of data
Collection of data covered a period of 7 months (from the first June to the end of December 2016. Statistical analysis was done by the researcher after collection of data by using statistical package for social science (SPSS version 20) program. The collected data was revised, categorized, coded, computerized, tabulated and analyzed. A descriptive and analytical statistics were used as frequency distribution tables, percentages, means and standard deviations. Chi-square-test, Fisher Exact test, T-test and One –Way ANOVA test at 0.05 levels to find out the statistical significant difference of the results.
The main findings of the study were:
General characteristics:
Socio-demographic data:
• The mean age was almost the same among the lumbo-sacral and warm application groups (24.28±4.32 and 25.03±3.99) respectively.
• Forty percent and 25% of the lumbo-sacral massage and warm application groups respectively were illiterate or just read and write.
• The majority (90%, 92.5%) of the lumbo-sacral massage and warm application groups respectively were housewives.
• A sizable proportion (65.0% and 52.5%) of the lumbo-sacral massage and warm application groups respectively were rural dwellers.
• All women of the lumbo-sacral and warm application groups were married.
• No statistically significant difference was found between the two groups in relation to their socio-demographic characteristics.
Assessment of current labor and labor pain profile
• No significant difference was found between lumbo-sacral massage and warm application groups in relation to the average number of uterine contractions per ten minutes, mean duration of uterine contraction and mean interval between contractions in minutes where p=(0.617, 0.063,058)
• No significant difference was observed among the two groups in relation to intact membrane and presence of show where p=0.021, p=0.152 respectively.
• No significant difference was observed among the two groups in relation to site and character of pain where p=0.33, p=0.361 respectively.