Ethics code: IR.LUMS.REC.1402.096
Clinical trials code: IRCT20230610058445N1
1- Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
2- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Social Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
2- Department of Midwifery and Reproductive Health, Faculty of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Social Medicine, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Abstract: (15 Views)
Objective(s): Childbirth pain is one of the most severe pains, and the use of pain relief methods is one of the important factors in increasing maternal satisfaction with the childbirth process. Considering the importance of reducing labor pain and performing natural childbirth, this study was conducted with the aim of comparing the effect of Entonox gas and back massage on labor pain in pregnant women.
Methods: This randomized controlled clinical trial study was conducted on 84 pregnant women in Al-Hadi Shushtar maternity hospital in 2023. People were randomly divided into three groups: Entonox (Intermittent use during contractions by the mother), Back massage (stroking method during contractions from the T10 to S4 vertebra, by the researcher in 3 times of 15 minutes) and control (usual method in the maternity hospital). Pain intensity was assessed using the VAS scale. Data analysis was done using SPSS 22 statistical analysis software, one-way ANOVA, paired t-tests and Tukey's post hoc tests, and P less than 0.05 was considered significant.
Results: Comparing the mean pain score before the intervention, there was no significant difference between the three groups (P= 0.551), but after the intervention, the mean pain score in dilatations of 4-5, 6-7 and 8-9 cm in The Entonox method and back massage were significantly lower than the control group (P= 0.001), but there was no statistically significant difference between the two methods of Entonox and back massage.
Conclusion: Considering the same positive effect of Entonox and back massage on labor pain, we can use back massage as a non-medicinal method available, without complications and cheap compared to Entonox as a medicinal method with more cost and limited access in order to reduce pain and pleasure of childbirth used.
Methods: This randomized controlled clinical trial study was conducted on 84 pregnant women in Al-Hadi Shushtar maternity hospital in 2023. People were randomly divided into three groups: Entonox (Intermittent use during contractions by the mother), Back massage (stroking method during contractions from the T10 to S4 vertebra, by the researcher in 3 times of 15 minutes) and control (usual method in the maternity hospital). Pain intensity was assessed using the VAS scale. Data analysis was done using SPSS 22 statistical analysis software, one-way ANOVA, paired t-tests and Tukey's post hoc tests, and P less than 0.05 was considered significant.
Results: Comparing the mean pain score before the intervention, there was no significant difference between the three groups (P= 0.551), but after the intervention, the mean pain score in dilatations of 4-5, 6-7 and 8-9 cm in The Entonox method and back massage were significantly lower than the control group (P= 0.001), but there was no statistically significant difference between the two methods of Entonox and back massage.
Conclusion: Considering the same positive effect of Entonox and back massage on labor pain, we can use back massage as a non-medicinal method available, without complications and cheap compared to Entonox as a medicinal method with more cost and limited access in order to reduce pain and pleasure of childbirth used.
type of study: Clinical Trial |
Subject:
Reproductive Health
Received: 2025/05/29 | Accepted: 2026/07/1 | ePublished ahead of print: 2026/09/16
Received: 2025/05/29 | Accepted: 2026/07/1 | ePublished ahead of print: 2026/09/16
References
1. Valipour NS, Kheirkhah M, Amirkhanzadeh-Barandouzi Z, Neistani Samani L. Comparison of the efficacy of aromatherapy and foot spa bath on labor pain in primiparous women: A randomized controlled trial. Koomesh 2020;22:60-6 [in Persian] [DOI:10.29252/koomesh.22.1.60]
2. Srivastava A, Avan BI, Rajbangshi P, Bhattacharyya S. Determinants of women's satisfaction with maternal health care: A review of literature from developing countries. BMC Pregnancy and Childbirth 2015;15:1-12 [DOI:10.1186/s12884-015-0525-0]
3. Geranmayeh M, Rezaeipour A, Haghani H, Akhoondzadeh E. The impact of training on the application of palliative methods for labor pain reduction. Journal of Hayat 2006;12:13-21 [in Persian]
4. Sedighi Darijani T, Mehni S, Dastyar N, Amirian A, Mehralizadeh A. The effect of knee-chest position on labor pain and duration of labor in nulliparous women: A randomized clinical trial. The Iranian Journal of Obstetrics, Gynecology and Infertility 2022;25:18-26 [in Persian]
5. Steel A, Adams J, Sibbritt D, Broom A, Gallois C, Frawley J. Managing the pain of labour: Factors associated with the use of labour pain management for pregnant Australian women. Health Expectations 2015;18:1633-44 [DOI:10.1111/hex.12155]
6. Mędrzycka-Dabrowska W, Czyż-Szypenbejl K, Pietrzak J. A review of randomized trials comparisons of epidural with parenteral forms of pain relief during labour and its impact on operative and cesarean delivery rate. Ginekologia Polska 2018;89:460-7 [DOI:10.5603/GP.a2018.0079]
7. Pirdadeh Beiranvand S, Behboodi Moghaddam Z, Hasani M, Beiranvand S, Beygizadeh A. Fear of natural childbirth and its related factors among primigravid women: A mixed-methods study. The Iranian Journal of Obstetrics, Gynecology and Infertility 2024;27:21-36 [in Persian]
8. Ranjbaran M, Khorsandi M, Matourypour P, Shamsi M. Effect of massage therapy on labor pain reduction in primiparous women: A systematic review and meta-analysis of randomized controlled clinical trials in Iran. Iranian Journal of Nursing and Midwifery Research 2017;22:257-61 [DOI:10.4103/ijnmr.IJNMR_109_16]
9. Mirzaiinajmabadi K, Makvandi S, Mirteimoori M, Sadeghi R. An update on the effect of massage and inhalation aromatherapy with lavender on labor pain relief: A systematic review and meta-analysis. Journal of Obstetrics, Gynecology and Cancer Research 2018;3:29-37 [DOI:10.21859/joqcr.3.1.29]
10. Pourshirazi M, Heidarzadeh M, Taheri M, Esmaily H, Babaey F, Talkhi N, et al. Cesarean delivery in Iran: A population based analysis using the Robson classification system. BMC Pregnancy and Childbirth 2022;22:1-9 [DOI:10.1186/s12884-022-04517-1]
11. Haseli A, Eghdampour F, Ghiasi A. Impact of massage therapy and breathing techniques on the satisfaction of primiparous women with childbirth. The Iranian Journal of Obstetrics, Gynecology and Infertility 2018;21:18-26 [in Persian]
12. Asefi F, Mottaghi B, Rafiee VL, Delaram M. Comparison between effect of Entonox and controlled breathing technique for pain management in labor. Iranian Journal of Surgery 2017;25:89-97 [in Persian]
13. Rahimi M, Hirmanpour A, Keimasi M. Comparison of the mean duration of active phase of labor using Entonox inhalation and placebo. Journal of Isfahan Medical School 2019;36:1616-21 [in Persian]
14. Mukhopadhyay I, Raj VP, Aggarwal R. A randomized controlled trial of Entonox and oxygen in labor analgesia. Journal of South Asian Federation of Obstetrics and Gynaecology 2021;13:101-5 [DOI:10.5005/jp-journals-10006-1868]
15. Jahani Shoorab N, Mirzakhani K, Hasanzadeh M. The effect of Entonox on labor pain in women referring to Torbat Heidariyyeh maternity hospital in 2004. Journal of Sabzevar University of Medical Sciences 2004;12:27-31 [in Persian]
16. Kulkarni S, Sia ST. Hazards of labour pain and the role of non-neuraxial labour analgesia. Trends in Anaesthesia and Critical Care 2014;4:109-14 [DOI:10.1016/j.tacc.2014.04.009]
17. Bolbol-Haghighi N, Masoumi SZ, Kazemi F. Effect of massage therapy on duration of labour: A randomized controlled trial. Journal of Clinical and Diagnostic Research 2016;10:QC12-15 [in Persian] [DOI:10.7860/JCDR/2016/17447.7688]
18. Fraser J, Kerr JR. Psychophysiological effects of back massage on elderly institutionalized patients. Journal of Advanced Nursing 1993;18:238-45 [DOI:10.1046/j.1365-2648.1993.18020238.x]
19. Gönenç IM, Terzioğlu F. Effects of massage and acupressure on relieving labor pain, reducing labor time, and increasing delivery satisfaction. Journal of Nursing Research 2020;28:e68 [DOI:10.1097/jnr.0000000000000344]
20. Smith CA, Levett KM, Collins CT, Dahlen HG, Ee CC, Suganuma M. Massage, reflexology and other manual methods for pain management in labour. Cochrane Database of Systematic Reviews 2018;3:CD009290 [DOI:10.1002/14651858.CD009290.pub3]
21. Fayazi S, Amerian M, Faghani Aghoozi M, Mohammadi S. Methods of labor pain relief in Iran: A review. Nursing and Midwifery Journal 2019:17:421-43
22. Bayrami R, Baghaei R. Exploring the barriers to pregnant women's engagement in the childbirth process from Iranian midwives' point of view: A qualitative study. Proceedings of Singapore Healthcare 2022:31:20101058221089990 [DOI:10.1177/20101058221089990]
23. Ingram MA, Brady S, Peacock AS. The barriers to offering non-pharmacological pain management as an initial option for laboring women: A review of the literature. European Journal of Midwifery 2022:10:37 [DOI:10.18332/ejm/149244]
24. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Validity of four pain intensity rating scales. Pain® 2011;152:2399-404 [DOI:10.1016/j.pain.2011.07.005]
25. Lamadah SM, Nomani I. The effect of aromatherapy massage using lavender oil on the level of pain and anxiety during labour among primigravida women. American Journal of Nursing Science 2016;5:37-44 [DOI:10.11648/j.ajns.20160502.11]
26. Karcioglu O, Topacoglu H, Dikme O, Dikme O. A systematic review of the pain scales in adults: Which to use? The American Journal of Emergency Medicine 2018;36:707-14 [DOI:10.1016/j.ajem.2018.01.008]
27. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine 2001:8:1153-7 [DOI:10.1111/j.1553-2712.2001.tb01132.x]
28. Mahmoudjanlou M, Ahadi H, Nazarpour S, Kraskian Moujembari A. The effectiveness of reducing the fear of labor pain in the way of the reality therapy on the choice of vaginal delivery in pregnant women. Journal of Research in Behavioral Sciences 2019;17:68-76 [in Persian] [DOI:10.52547/rbs.17.1.68]
29. Roozbahani N, Attarha M, Akbari Torkestani N, Amiri Farahani L, Heidari T. The effect of rose water aromatherapy on reducing labor pain in primiparous women. Complementary Medicine Journal 2015;5:1042-53
30. Saghiri M, Satarzadeh N, Tabrizi N, Pezeshki Z. A comparative study on the severity of labor pain with or without Entonox and its effects on the new-borns of primiparas. Scientific Research Journal of Ardabil University of Medical Sciences 2008;8:62-7 [in Persian]
31. Rashtchi V, Maryami N, Molaei B. Comparison of Entonox and transcutaneous electrical nerve stimulation (TENS) in labor pain: A randomized clinical trial study. The Journal of Maternal-Fetal & Neonatal Medicine 2022;35:3124-8 [DOI:10.1080/14767058.2020.1813706]
32. Mardani Hamouleh M, Heydari H, Ashraf K. Comparing the effect of Entonox and pure oxygen on pain intensity of delivery. Iranian Journal of Critical Care Nursing 2009;2:105-8 [in Persian]
33. Parashi S. Comparison between Entonox and oxygen on lowering labor pain and the progress of labor. Razi Journal of Medical Sciences 2013;20:45-52 [in Persian]
34. Chantrasiri R, Wanapirak C, Tongsong T. Entonox versus pethidine in labor pain relief: A randomized controlled trial. International Journal of Environmental Research and Public Health 2021;18:12571 [DOI:10.3390/ijerph182312571]
35. Minowski P, Swiatkowska-Freund M, Preis K. Influence of Entonox (mixture of 50% nitrous oxide and 50% oxygen) on physiological labor and neonatal outcome in own material. Ginekologia Polska 2023;94:315-9 [DOI:10.5603/GP.a2022.0039]
36. Kohzad Z, Golian Tehrani S, Hosseinkhani A, Bayat F, Keshavarz Afshar M. The effect of hot water bag, effleurage massage and routine care on the intensity of active labor pain in primiparous women- A randomized clinical trial study. The Iranian Journal of Obstetrics, Gynecology and Infertility 2023;26:44-53 [in Persian]
37. Lighaei S, Hosseini SE. Comparing effects of massage and aromatherapy with lavender and almond oil on labor time and pain and serum level of beta-endorphin in primiparous women. The Quartrely Journal of Animal Physiology and Development 2019;12:81-95 [in Persian]
38. Erdogan SU, Yanikkerem E, Goker A. Effects of low back massage on perceived birth pain and satisfaction. Complementary Therapies in Clinical Practice 2017;28:169-75 [DOI:10.1016/j.ctcp.2017.05.016]
39. Amini M, Shokohinia M, Mansourjozan Z. Effects of different massage methods on the severity of labor pain in primipara females with infertility. Middle Eastern Journal of Disability Studies 2021;11:1-6
40. Chang MY, Wang SY, Chen CH. Effects of massage on pain and anxiety during labour: A randomized controlled trial in Taiwan. Journal of Advanced Nursing 2002;38:68-73 [DOI:10.1046/j.1365-2648.2002.02147.x]
41. Field T, Hemandez-Reif M, Taylor S, Quintino O, Burman I. Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics & Gynecology 1997;18:286-91 [DOI:10.3109/01674829709080701]
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |