Effectiveness of Counterpressure Technique With a Birth Ball on Cervical Dilatation and Reduction of Labour Pain and Uterine Contractions: A Prospective Cohort Study

Keywords: Labour pain, Obstetric labour complications, Counterpressure technique, Birth ball, Non-pharmacological pain management

Abstract


Background/Aim: Non-pharmacological interventions play a crucial role in managing labour pain and facilitating labour progression. The counterpressure technique is a commonly utilised method purported to alleviate pain and enhance cervical dilation during childbirth. However, its effectiveness remains a subject of debate, necessitating further investigation. This study aimed to evaluate the efficacy of the counterpressure technique in managing labour pain and influencing labour progression among women in labour.

Method: A randomised controlled trial was conducted involving participants in active labour. The intervention group received the counterpressure technique, while the control group received standard care. Pain levels, uterine contractions and cervical dilation were assessed and compared between the two groups.

Results: Analysis revealed no significant difference in pain levels or uterine contractions between the intervention and control groups. However, there was a significant increase in cervical dilation in the intervention group compared to the control group (p = 0.034, Cohen's d = -0.586).

Conclusion: Despite the counterpressure technique's limited impact on pain relief and uterine contractions, it significantly facilitated cervical dilation during labour. These findings contribute to understanding of non-pharmacological interventions in childbirth and underscore the importance of evidence-based approaches to labour management. Further research is warranted to elucidate the underlying mechanisms of the counterpressure technique and optimise its implementation in clinical practice.

References

Solomon ET, Kassie FY, Mekonnen DG, Mihret MS, Abate AT, Dessie AA. Knowledge, attitude, and practice towards labor pain management and associated factors among skilled birth attendants working at hospitals found in Central, West, and North Gondar zones, Northwest Ethiopia, 2019: A multicenter cross-sectional study. Pain Res Manag. 2021 May 13;2021:8835677. doi: 10.1155/2021/8835677.

Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, et al. Non-pharmacological pain management in labour: a systematic review. J Clin Med. 2023 Jan;12(23):7203. doi: 10.3390/jcm12237203.

Pietrzak J, Mędrzycka-Dąbrowska W, Wróbel A, Grzybowska ME. Women's knowledge about pharmacological and non-pharmacological methods of pain relief in labour. Healthcare. 2023 Jan;11(13):1882. doi: 10.3390/healthcare11131882.

Chang CY, Gau ML, Huang CJ, Cheng H min. Effects of non-pharmacological coping strategies for reducing labour pain: A systematic review and network meta-analysis. PLoS ONE. 2022 Jan;17(1):e0261493. doi: 10.1371/journal.pone.0261493.

Barut S, Sabancı Baransel E, Çelik OT, Uçar T. The trends and hotspots of research on non-pharmacological interventions for labour pain management: a bibliometric analysis. J Psychosom Obstet Gynecol. 2024 Dec;45(1):2322614. doi: 10.1080/0167482X.2024.2322614.

Parkies LE, Murray D, Okafor UB. Pharmacological labour pain interventions: South African midwives' perspective. BMC Nurs. 2024 Mar;23:176. doi: 10.1186/s12912-024-01844-w.

Elgzar WT, Alshahrani MS, Ibrahim HA. Non-pharmacological labour pain relive methods: utilization and associated factors among midwives and maternity nurses in Najran, Saudi Arabia. Reprod Health. 2024 Jan;21(1):11. doi: 10.1186/s12978-023-01737-2.

Mwakawanga DL, Mselle LT, Chikwala VZ, Sirili N. Use of non-pharmacological methods in managing labourpain: experiences of nurse-midwives in two selected district hospitals in eastern Tanzania. BMC Pregnancy Childbirth. 2022 Apr;22(1):376. doi: 10.1186/s12884-022-04707-x.

Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, et al. Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation. Evid-Based Complement Altern Med. 2021 Jul;2021:5924040. doi: 10.1155/2021/5924040.

Jha S, Vyas H, Nebhinani M, Singh P, T D. The effect of birthing ball exercises on labour pain and labour outcome among primigraviade parturient mothers at a tertiary care hospital. Cureus. 2023;15(3):e36088. DOI:10.7759/cureus.36088.

Grenvik JM, Rosenthal E, Wey S, Saccone G, De Vivo V, De Prisco Lcp A, et al. Birthing ball for reducing labour pain: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2022 Dec;35(25):5184-93. doi: 10.1080/14767058.2021.1875439.

Costa AC, Prata JA, Oliveira KR, Silva CRF da, Progianti JM, Mouta RJO, et al. Freedom of movement and positioning in childbirth with non-invasive technologies of nursing care. Cogitare Enferm. 2023 Mar;28:e84830. doi: 10.1590/ce.v28i0.89445.

Berta M, Lindgren H, Christensson K, Mekonnen S, Adefris M. Effect of maternal birth positions on duration of second stage of labour: systematic review and meta-analysis. BMC Pregnancy Childbirth. 2019 Dec;19(1):466. doi: 10.1186/s12884-019-2620-0.

Kamath P, Pai M, Shenoy R, Karkada S, D'souza S, Noronha J. Effectiveness of a peanut ball device during labouron maternal and neonatal outcomes: protocol for a randomised controlled trial. F1000 Research. 2022 Nov;11:717. doi: 10.12688/f1000research.109537.2.

Rosmiarti, Marlin R, Murbiah. Reduction of labour pain with back massage. Enferm Clín. 2020 Jun;30:209-12. doi: 10.1016/j.enfcli.2019.11.056.

Mohan M, Varghese L. Effect of foot reflexology on reduction of labour pain among primigravida mothers. Int J Ther Massage Bodyw. 2021 Mar;14(1):21-9. doi: 10.3822/ijtmb.v14i1.386.

Matabane SE, Musie MR, Mulaudzi MF. Childbirth preparation: knowledge of the use of non-pharmacological pain relief methods during childbirth in Tshwane District, South Africa: a cross-sectional study. Nurs Rep. 2024 Mar;14(1):1-11. doi: 10.3390/nursrep14010001.

Williams EL, Khan FM, Claydon VE. Counter pressure maneuvers for syncope prevention: A semi-systematic review and meta-analysis. Front Cardiovasc Med. 2022 Oct;9:1016420. doi: 10.3389/fcvm.2022.1016420.

Sari N, Runjati, Fatmasari D, Pujiyanto TI. Practices of counter pressure and birth ball exercise combination to increase β-endorphin hormone levels in labour pain. Dordrecht (NA): Atlantis Press; pp. 314-317. doi: 10.2991/ahsr.k.200723.079.

Zuarez-Easton S, Erez O, Zafran N, Carmeli J, Garmi G, Salim R. Pharmacologic and nonpharmacologic options for pain relief during labour: an expert review. Am J Obstet Gynecol. 2023 May;228(5, Supplement):S1246-59. doi: 10.1016/j.ajog.2023.03.003.

Wang J, Lu X, Wang C, Li X. The effectiveness of delivery ball use versus conventional nursing care during delivery of primiparae. Pak J Med Sci. 2020;36(3):550-4. doi: 10.12669/pjms.36.3.1440.

Stulz V, Dashputre A, Reilly H. Midwives' experiences using a peanut ball for women during labour: A qualitative study. Midwifery. 2023 Oct;125:103797. doi: 10.1016/j.midw.2023.103797.

Taavoni S, Abdolahian S, Haghani H, Neysani L. Effect of birth ball usage on pain in the active phase of labour: a randomized controlled trial. J Midwifery Womens Health. 2011;56(2):137-40. doi: 10.1111/j.1542-2011.2010.00013.x.

O'Brien D, Coughlan B, Thompson S, Carroll L, Sheehy L, Brosnan M, et al. Exploring midwives' experiences of implementing the Labour Hopscotch Framework: A midwifery innovation. Eur J Midwifery. 2022;6:18. doi: 10.18332/ejm/146081.

Sönmez T, Apay SE. Effect of different birth balls used at the first stage of labour on birth outcomes and maternal satisfaction: a randomized controlled trial. Clin Exp Health Sci. 2023 Sep;13(3):600-7. doi: 10.33808/clinexphealthsci.1164952.

Shen HC, Wang H, Sun B, Jiang LZ, Meng Q. Birthing ball on promoting cervical ripening and its influence on the labour process and the neonatal blood gas index. World J Clin Cases. 2021 Dec;9(36):11330-7. doi: 10.12998/wjcc.v9.i36.11330.

Anwar KK, Yustiari Y, Naningsi H, Asi M. The effect of counter pressure and birthball on the time of the first stage of labour and prevention of perineal rupture. Poltekita J Ilmu Kesehat. 2023 Nov;17(3):647-54. doi: 10.33860/jik.v17i3.3042.

Ahmed MA, Ahmed RHS, Ali AH, Salah Shalaby N, El-Shamy FF, Gaber Salem S. Effect of counter-pressure versus effleurage massages on labour pain intensity among parturient women. Egypt J Health Care. 2021;12(3):408-20. doi: 10.21608/ejhc.2021.190770.

Sriayuningtyas E, Galaupa R. The effect of counter pressure and kneading techniques on reducing the intensity of labour pain in the first stage of active phase. Int J Health Pharm. 2022;2(4):676-9. doi: 10.51601/ijhp.v2i4.86.

Wahyuni NS, Tridiyawati F. Effectiveness of rebozo technique and massage counter technique on labour pain in active phase 1 At Pmb Bd Itoh 2023. Int J Health Pharm. 2024;4(1):168-75. doi: 10.51601/ijhp.v4i1.293.

Published
2024/06/28
Section
Original article