الفهرس | Only 14 pages are availabe for public view |
Abstract Postpartum afterpains represent a highly prevalent complaint. It leads to unpleasant consequences, where it gives rise to neuro-hormonal stress responses, as well as psychological problems. Additionally, it also can impede breast breastfeeding immediately after delivery and affect the breast milk flow, as well as decrease the mother’s attention to the neonate, and impair their relationship. Eventually, both women and their newborns may be deprived of the benefits of exclusive breastfeeding and forced to resort to artificial feeding as well. Afterpains management can be divided into two categories: pharmacological and nonpharmacological measures. While the pharmacological measures have side effects, nonpharmacological measures are thought to be superior than pharmacological ones because of their ease of implementation, noninvasiveness, ability to build confidence and increase women’s participation, absence of adverse effects on mothers, neonates, and leave no breastfeeding complications. Hoku point massage is an alternative modality used to relieve pain by massage between the thumbs and forefingers on the palm side of the hands where the LI4 energy meridian acupoint is present. As high prevalence of postpartum afterpains and side-effects of pharmaceutical analgesics on maternal and neonatal health, as well as there are insufficient research examining the effectiveness of Hoku point massage as a noninvasive measure to relieve afterpains intensity in Egypt. Accordingly, this study aimed to determine the effect of Hoku point massage on postpartum afterpains intensity among multiparous women. A quasi-experimental research design was conducted among 100 multiparous women at the postnatal ward of El-Shatby Maternity University Hospital. The women were equally assigned to one of two groups: a control group was receiving routine hospital care and an experimental group was receiving Hoku point massage. Each group comprised fifty multiparous women. Three tools that are used for data collection include; Socio-demographic, reproductive, and clinical profile structured interview schedule; VAS which is used for subjective estimation of women’s pain, and a modified version of CPPRS that measured pain intensity through observable behaviors. Statistical analysis was done by the researcher after the collection of data by using Statistical Package for Social Sciences (SPSS version 20) program. The collected data were categorized, coded, computerized, tabulated, and analyzed using frequency distribution tables, percentages, mean and standard deviations. The difference sample test, independent t-test, Wilcoxon test, Friedman’s test, and Chi-square test. A five percent level of significance was used to find out the statistically significant difference in the results. The study revealed the following main results: Socio-demographic characteristics The mean age was (29.04 ± 5.406, and 29.80 ± 4.686) in the experimental and control groups respectively. More than one-half (58%, 56%) of the experimental and control groups, respectively, had primary and preparatory education. Majority (90%) of the experimental group were housewives, compared to 78% of the control group The vast majority (98%, 96%) of the experimental and control groups respectively were married. More than one-half (58%, 62%) of the experimental and control groups respectively were urban dwellers No statistically significant difference was noticed between the experimental and control groups regarding socio-demographic characteristics. Reproductive history Regarding gravidity revealed that 42% and 44% of the experimental and control groups respectively stated that they got pregnant four times or more. Referring to parity, 42%, and 44% of the experimental and control groups respectively had delivered four times or more. Vaginal deliveries without episiotomy were reported by 48% and 44% of both groups respectively. The table also elucidates that 42% of the experimental and control groups had three or more living children. Almost one-half (48%) of the experimental group were in the 38th week of gestations. The mean of gestational weeks among the experimental and control groups respectively was almost the same (38.26 ± 0.876, 38.22 ± 0.954). No statistically significant difference was observed between the experimental and control group regarding their reproductive history. No statistically significant difference was observed between the experimental and control groups concerning their vital signs. No statistically significant difference was observed between the two groups regarding fundus level and fundus position. Moreover, fundus consistency displayed that the fundus was firm & hard among all experimental and control groups. Afterpains intensity as measured by )VAS( No statistically significant difference was found between the experimental and control groups regarding afterpains intensity before intervention (p= 0.461). While a highly significant difference was observed between both groups immediately after intervention (p= 0.000). Again, no statistically significant difference was noticed between the experimental and control groups in relation to their afterpains intensity one hour after intervention (p= 0.242), In the first session. In the second session, a highly statistically significant difference was found between the experimental and control groups concerning afterpains intensity before intervention (p= 0.006), immediately after intervention (p= 0.000), and one hour after intervention (p=0.000). In the first and second sessions, a highly statistically significant difference was observed among women of the experimental group in relation to their intensity of afterpains as measured by VAS before and immediately after intervention (p = 0.000), before and one hour after intervention (p = 0.000), as well as immediately after and one hour after intervention (p = 0.000). Afterpains intensity as measured by )CPPRS( No statistically significant difference was observed between the experimental and control groups in relation to their afterpains intensity before intervention (p= 0.227). While a highly significant difference was observed between both groups immediately after intervention (p=0.000), and one hour after intervention (p=0.003) in the first session. In the second session, A highly statistically significant difference was observed among women of both groups before intervention (p= 0.011), immediately after intervention (p= 0.000), and one hour after intervention (p=0.000). In the first and second sessions, a highly statistically significant difference was observed among women of the experimental group in relation to their intensity of afterpains as measured by CPPRS before and immediately after intervention (p = 0.000), before and one hour after intervention (p = 0.000), as well as immediately after and one hour after intervention (p = 0.000). Conclusion Based on the findings of the present study, it can be concluded that: The research hypotheses are accepted, where Hoku point massage was effective in the reduction of postpartum afterpains intensity among multiparous women. Furthermore, multiparous women who receive Hoku point massage showed observable behaviors indicating less afterpains intensity than those who do not receive it. Analysis of data showed that there was a significant difference between the intervention and control groups Recommendations Based on the findings of the present study, the following recommendations are suggested: Postpartum afterpains represent an indicator of uterine involution. however, it is a highly neglected complaint at hospitals. therefore, strict protocols should be established in maternity care units for a comprehensive and routine assessment of afterpains, and interventions to reduce pain should be achieved. Maternity nurses should attend training programs, implemented by the responsible authorities, to improve their knowledge and skills regarding non-pharmacological techniques, and the policies of hospitals need to be altered. Due to the simplicity, safety, and suitability of Hoku point massage as a nonpharmacological technique that is effective in elevating postpartum afterpains, without causing adverse side effects for the mother or baby, postpartum women should be educated about the importance and how to perform this technique at home. Considering the importance of health promotion, protection of women, and the high incidence and prevalence of afterpains, the results of this study trigger the conduction of high-quality clinical and non-invasive services and encourage taking a step toward improving the health and satisfaction of women in society. Further studies should be conducted with a larger sample size, a longer massage duration, and multiple sessions to verify the findings of this study. |