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Childbearing women experience varying
levels of pain and other demanding sensations
during labor and birth. The pain associated
with the first stage of labor is unique in that it
accompanies a normal physiologic process
(Ladewig, 2006).
Moreover, pain in labor, varies from
mother to mother in the strength of uterine
contractions and degree of cervical dilatations.
The pain is more likely caused by the changing
of the shape of the uterus rather than the baby
pressing through the birth canal. This is a
natural process that women experience in
order to give life (Simkin & Bolding, 2004).
Although there is a major concern on
intrapartum pain management of pregnant
mothers in labor, their safety should not be
neglected with the use of various
pharmacologic treatments that may impose
side effects and risks to both mother and baby.
The use of these drugs are of concern due to
the known and unknown effects of the
medications on the fetus; thus, prescribing
medication for pregnant women requires
knowledge of teratogenicity and fetal and
neonatal effects that may be associated with
the drugs given (Hansen, et al., 2002).
Therefore, it is important for nurses to use non-
pharmacologic pain relieving measures such
as touch and acupressure that may be
particularly satisfactory to women in labor (Lee,
et al., 2004). Non-pharmacologic measures
may be beneficial to women in labor without
worrying that even a small amount of drug will
reach the fetus. They also allow the patient to
gain an enhanced sense of control over her
childbirth experience by feeling safe and
secure in the process (Beal, 1999).
Complementary medicine can be of
great help in alleviating pain in laboring
mothers. In this case, other non-invasive and
non-pharmacologic interventions such as
acupressure can be used to minimize pain and
anxiety. Not known to many, acupressure is a
Traditional Chinese Medicine (TCM) which
introduced several techniques that have been
effectively used not only to alleviate pain but
also to facilitate labor. Primarily, the principle of
traditional Chinese medicine is to balance and
harmonize a person¶s two conflicting energies,
Yin and Yang, to preserve health. Moreover,
TCM explains there are channels of energy
running through the body. This energy
facilitates bodily functions enhancing blood
flow and nourishing tissues. Any impediments
in these energy flows can cause disturbances
which may lead to illness (Lee et al., 2004).
It is said, that there are certain points in
our body in which Qi or vital force flows. By
manipulating these points or meridians, it is
believed that it will bring harmony and balance
to the system. One way of manipulating the
flow of Qi to the meridians is by acupressure,
which is the application of constant pressure
on certain anatomic points. Acupressure is a
non-invasive technique that returns the levels
of vital energy of the body, Qi, thus
harmonizing the free flow of Qi of women in
labor (Beal, 1998). These channels have a
great effect on pregnancy because the most
common disturbance during labor and delivery
is the obstruction of these channels (Cook and
Wilcox, 1997).
Acupressure on SP6 point may help to
induce labor and manage various
gynecological and obstetrical dysfunctions.
SP6 acupoint is located at the spleen meridian
(from above the tip of the inner malleolus to the
posterior border of the tibia) (Lian, et al., 2000).
Acupressure on the SP6 acupoint is
believed to stimulate the release of oxytocin
from the pituitary gland, which in turn
stimulates uterine contractions to enhance the
labor process or to manage labor pain (Beal,
1999).
Although there have been many reports
of acupressure having substantial effects, the
researchers have no knowledge of any existing
study done here in the Philippines. These
factors prompted the researchers to conduct
the study, which aims to determine the effects
of SP6 acupressure in pain and duration of
labor of multigravidas at selected lying-in
clinics and hospital in Metro Manila.
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The study utilized a quantitative, quasi-
experimental design. This study was
conducted in two lying-in clinics of the Manila
Health Department and one government
hospital in Metro Manila. A total of thirty (30)
subjects was obtained; wherein fifteen (15)
was assigned in the control group and fifteen
(15) for the experimental group. Probability
simple random sampling using fish bowl
technique and draw lots assignment to
experimental and control group were done.
The study utilized the Visual Analogue Scale
(VAS) which measures pain with the ratings
from 0-10 in which higher scores indicate more
pain. In addition, an interview was conducted
to further validate the pain scale score.
The Technique for SP6 Acupressure were as
follows:
1. The subjects under the experimental
group were asked to position in left
lateral.
2. Then, the doctor/midwife assessed
the dilatation of the cervix. Cervical
dilatation of 7cm signaled the start of the
initial assessment.
3. After the initial assessment, two
researchers conducted the intervention
on the experimental group. Researcher
(a) monitored the contractions while
researcher (b) applied the pressure on
the SP6 acupoint in each leg. During
periods of no contraction, researcher (b)
asked the subjects of the experimental
group if the pressure that was applied
by the researcher was able to generate
a numbing effect which was caused by
the desired pressure. Any painful
sensation felt by the subject was an
indication of too much pressure applied.
4. For the experimental group,
researcher (b) stood at the feet of
women in labor. Researcher (b)
positioned at the available side of the
subject and located the SP6 acupoint by
measuring four-finger widths (patient¶s
fingers) from above the tip of the inner
malleolus to the posterior border of the
tibia. For the application of acupressure,
researcher (b) used his/her thumb with
cupped hands in applying pressure on
the lateral side of the distal tibia.
Researcher (a) began monitoring the
subject at the start of the application of
pressure by researcher (b). For every
contraction that the researcher (a)
identified, researcher (b) increased the
depth of pressure applied. The pressure
that was applied should be enough to
generate a numbing effect. And for
every periods of no contraction,
researcher (b) lightened the application
of pressure but still with minimal
pressure. Researcher (b) continued to
apply the treatment until the thirty-
minute period has expired.
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In the initial assessment, three subjects had
a pain score of 5/10; three had a pain score of 6/10;
five had a pain score of 7/10; two had a pain score
of 8/10; one had a pain score of 9; and one had
pain score of 10/10. Fifteen minutes (15) after the
intervention, two subjects had a pain score of 6/10;
five had a pain score of 7/10; one had a pain score
of 8/10; five had a pain score of 9/10 and two had a
pain score of 10/10. Thirty minutes (30) after
intervention, four subjects had a pain score of 7/10;
three had a pain score of 8/10; three had a pain
score of 9/10; and five had a pain score of 10/10.
Most (8 out of 15) subjects experienced a gradual
increase in the labor pain scores. The gradual
increase in the labor pain scores can be
simultaneously correlated with the progression of
labor of the subjects. Upon initial assessment to 15
minutes after the intervention, level of pain that five



r% 

subjects of the control group felt increased;
however, from the 15-minute mark to 30 minutes
after intervention, the level of pain remained
constant. On the other hand, upon initial
assessment to the 15-minute mark, the level of pain
that five subjects of the control group remained
constant; however, from the 15-minute mark to 30
minutes after intervention, the level of pain
increased. The last one subject had a pain score of
10 throughout the three phases. Generally, when
compared to the control group, the labor pain
scores of the experimental group were lower.
These differences in the level of pain of the
subjects can also be attributed to labor pain, as a
subjective and intricate experience resulting from
the interaction of the physiological and
psychosocial aspects of the body. Pain
experienced during labor is unique and highly
individualized (Chung, et. al, 2003).
 
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 6.87±1.46 8.00±1.36 8.60±1.24



Table 1 shows the computation for the
mean pain scores of the control group during initial
assessment, 15 minutes after the application of
acupressure and 30 minutes after the application of
acupressure. The mean pain score of the
experimental
group obtained a mean of 6.87± 1.46 during initial
assessment; 8.00 ± 1.36 45 minutes after initial
assessment and 8.60 ± 1.24 60 minutes after initial
assessment. Both attention and distraction can
influence the perception of pain. When pain
sensation is the focus attention, perceived intensity
is greater. A sensory stimulus can be a distraction
that focuses the woman¶s attention on the stimulus
rather than the pain. This explains some of the
verbalizations of the subjects that ³mas nawawala
yung sakit kapag nakapindot ka´. When the
subjects were asked if the intervention was helpful,
one subject verbalized ³Medyo nabawasan ang
hilab na nararamdaman ko sa tiyan pero
nakaramdam ako ng pamamanhid sa mga binti ko´.
According to Chan (2005), after acupressure
patients may feel hot, sore, and numb around the
 
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acupoints with some local redness, and sweating.
These are normal responses to the treatment and
need not cause concern for they will spontaneously
disappear. Moreover a study conducted by Lee. et
al. (2004) also utilized the use of SP6 acupressure
and SP6 touch to alleviate the pain of women in
labor. Their study presented a statistically
significant difference in labor pain scores between
the SP6 acupressure group and SP6 touch group
which means that SP6 acupressure according to
their study can lower the perceived pain compared
to SP6 touch.

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In the initial assessment, one subject had a
pain score of 5/10; three had a pain score of 6/10;
six had a pain score of 7/10; three had a pain score
of 8 and two had pain score of 10/10. The subjects
who scored 5/10 and 6/10 were quiet, could still
smile, and verbalized, ³Kaya ko pa naman yung
sakit.´ The two subjects who scored 10/10 at the
initial assessment were easily irritated, and were
requesting for an anesthesia and painless delivery.
Forty five minutes after the initial assessment, one
subject had a pain score of 6/10; one had a pain
score of 7/10; seven had a pain score of 8/10; four
had a pain score of 9/10 and two had a pain score
of 10/10. The subjects who scored 6/10 and 7/10
displayed face grimacing only during uterine
contraction. While the subjects who scored 10/10
still continued to be irritable and persisted on
having a painless vaginal delivery. Sixty minutes
after initial assessment, four subjects had a pain
score of 8/10; five had a pain score of 9/10 and six
had a pain score of 10/10. Subjects who had a pain
score of 10/10 manifested facial grimacing,
frequent shouting and moaning. A subject with the
same score verbalized, ³I-cesarean niyo na ko. Di
ko na kaya!´ Eleven out of 15 subjects experienced
a gradual increase in the labor pain scores. The
gradual increase in the labor pain scores can be
simultaneously correlated with the progression of
labor of the subjects (Ladewig, 2006). Niven (2000)
suggested that women do not completely forget
labor pain, and recall is often vivid but not always
entirely accurate. The level of pain that two
subjects of the control group felt increased 45
minutes after the initial assessment; however, from
the 45-minute mark to 60 minutes after initial
assessment, the level of pain remained constant.
The remaining two subjects had a pain score of 10
throughout the three phases.


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 7.27±1.39 8.33±1.05 9.13±0.83
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The mean pain score of the control group
obtained a mean of 7.27± 1.39 during initial
assessment; 8.33 ± 1.05 45 minutes after initial
assessment and 9.13 ± 0.83 60 minutes after initial
assessment. It can be seen on the table that there
is a gradual increase in the labor pain scores of the
subjects. According to Ladewig (2006), the gradual
increase in the labor pain scores can be
simultaneously correlated with the progression of
labor of the subjects. Moreover, childbearing
women experience varying levels of pain and other
demanding sensations during labor and birth
(Ladewig, 2006). Although the perception of pain
varies among the subjects, there is a physiologic


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basis for this. Pain in the first stage of labor is
primarily attributed to the dilatation of the cervix,
other secondary sources of pain are stretching of
the lower uterine segment, pressure on the
adjacent tissues and hypoxia of uterine muscles
during contraction (Blackburn, 2003).
 
The results showed that even if the chosen
subjects were multigravidas, which means that they
have had a past experience of labor pain, the mean
pain scores were all above the moderate level in
reference to the VAS. This implies that more or
less, parturients will need interventions for labor
pain. 



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 7.27± 1.39 1.9321 15

 1.39
28 0.77 0.4477 2.048

 6.87± 1.46 2.1316 15

 1.46


 0.77 < 2.048
NOT SIGNIFICANT

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The experimental group obtained a mean of
6.87± 1.46, while the control group has a mean of
7.27±1.39. At a 0.05 level of significance, a T-stat/t-
value of 0.77 was obtained. The Tcrit (two-tailed) is
2.048. Since the statistical t of 0.77 is less than the
Tcrit (two-tailed) of 2.048, by conventional criteria
this difference is considered to be not statistically
significant. The result obtained is somehow
expected since at initial assessment no intervention
is done on both groups and subjects from
both groups belong to same inclusion criteria, thus
asserting homogeneity of the sample population.
This homogeneity is verified by the result of the t-
test of the age, gravidity, educational attainment
and pre natal check-ups of the subjects. Moreover,
the lack of significant difference between the
groups will provide a good comparison in the
succeeding time points since the mean labor pain
scores have a small disparity and they all started at
the same level of pain. 

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 8.33± 1.05 1.1025 15
1.05
28 0.7513 0.4587 2.048


 8.00± 1.36 1.8496 15
1.36


 0.7513 < 2.048
NOT SIGNIFICANT
earlier time period used in their studies. This
The experimental group obtained a mean of implies that earlier time period should be used in
8.00± 1.36, while the control group has a mean of the application of SP6 acupressure to be able to
8.33± 1.05. At a 0.05 level of significance, a T- fully assess the pain relieving effect. Lee, et al
stat/t-value of 0.75 was obtained. The Tcrit (two- started measuring the pain scores at latent phase
tailed) is 2.048. Since the statistical t of 0.75 is less (3 cm) while this study started at transitional phase
than Tcrit (two-tailed) of 2.048, by conventional (7 cm). In this case a higher pain scores are
criteria this difference is considered to be not obtained in this study and a small disparity in the
statistically significant. The result in this part is scores were noted since it is already the last phase
somehow contradictory to studies conducted by of the first stage of labor. In the transition phase the
Chung, et al (2003) and Lee, et al (2004). Their contractions gradually occur more frequently, and
results presented a significant difference between the pain becomes severe or unbearable
the mean labor scores at all time points. The (McDonald, 2005).
contradiction in the results can be attributed to an

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 9.13± 0.83 0.6889 15
0.83




28 1.3807 0.1783 2.048
8.60± 1.24 1.5376 15
1.24



 1.3807 < 2.048
NOT SIGNIFICANT
 The experimental group obtained a mean of
8.60± 1.24, while the control group has a mean of
9.13± 0.83. At a 0.05 level of significance, a T-
stat/t-value of 1.38 was obtained. The Tcrit (two-
tailed) is 2.048. Since the Tcrit (two-tailed) of 2.048
is greater than the statistical t of 0.18, by
conventional criteria this difference is considered to
be not statistically significant. This result is
contradictory from a parallel study conducted by
Lee et al. The study conducted by Lee presented
significant differences at all time points following
their intervention. However, their study applied
acupressure on SP6 point at an earlier phase of
labor, which is 3 cm dilatation and applied it
continuously for 30 minutes. Therefore, they have a
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longer time to evaluate the pain relieving effects of
acupressure beyond 30 minutes after intervention.
According to Wong et al (2010), a reduction in pain
intensity could be felt more after 30 minutes, 1 hour
and 2 hours after SP6 acupressure. This could
explain the lack of significance in the result of this
study, because the researchers failed to measure
the pain beyond the 30 minute mark after the
intervention. The researchers failed to measure the
pain 30 minutes after intervention/ 60 minutes after
initial assessment because most of the subjects
have already delivered the fetus at this time.

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For the experimental group, three (20%) out
of fifteen had a labor duration of 20 minutes from 7
cm to full dilatation. One (4%) respondent had a
duration time of 22 minutes. One (4%) had thirty
one minutes. One (4%) had thirty five minutes. One
(4%) had forty minutes. One (4%) had fifty three
minutes. One (4%) had fifty five minutes. One (4%)
had sixty minutes. One (4%) had seventy two
minutes. One (4%) had ninety minutes. One (4%)
had ninety three minutes. On the other hand, for
the control group, one (4%) respondent had
acquired a labor duration of thirty five minutes. One
(4%) had forty minutes. One (4%) had forty five
minutes. One (4%) had fifty five minutes. Two
(13%) had fifty seven minutes. Three (20%) had
sixty five minutes. One (4%) had sixty seven
minutes. One (4%) had seventy five minutes and
lastly, one (4%) had eighty three minutes.
Figure 4.a shows that the experimental (SP6
acupressure) group has shorter labor duration time
from 7 cm to full dilatation compared to the control
group. This suggests that application of

acupressure on the SP6 acupoint is an effective
technique in decreasing the labor duration time
from 7 cm to full dilatation.

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In the experimental group, one (4%) out of
fifteen had a labor duration of 5 minutes from full
dilatation to the delivery of the fetus. One (4%)
respondent had a duration time of 7 minutes. One
(4%) had 9 minutes. One (4%) had 10 minutes.
One (4%) had 12 minutes. Then, two (13%) had
fifteen minutes. Two (13%) had nineteen minutes.
One (4%) had 20 minutes. One (4%) had twenty
two minutes. One (4%) had twenty five minutes.
Two (13%) had thirty five minutes. And then one
(4%) had eighty four minutes. On the other hand,
for the control group, one (4%) respondent had
acquired a labor duration of ten minutes. One (4%)
had fifteen minutes. One (4%) had seventeen
minutes. One (4%) had eighteen minutes. One
(4%) had twenty minutes. One (4%) had twenty one
minutes. One (4%) had twenty two minutes. One
(4%) had twenty three minutes. One (4%) had
twenty four minutes. One (4%) had twenty five
minutes. One (4%) had twenty seven minutes. One
(4%) had twenty nine minutes. One (4%) had forty
minutes. One (4%) had forty two minutes. And
lastly, one (4%) had sixty five minutes. The data
shows that among the 15 respondents in the
experimental group, only one respondent exceeded
the labor duration time from full dilatation to delivery
of fetus as compared to the control group. This
implies that majority (14 out of 15: 93%) of the
subjects under the experimental group who had
received the SP6 acupressure had a shorter labor
duration time full dilatation to delivery of fetus than
those in the control group. 


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 59.27 ±12.43 26.53 ± 13.61



 44.27 ± 25.15
There were 30 subjects who participated
wherein a total mean score of 59.27 ±12.43 was
obtained from the control group and 44.27 ± 25.15
for the experimental group from 7cm to full
dilatation. The data were arranged from the
shortest to longest labor duration time in minutes
for both the control and experimental group. In
general, the experimental group has a shorter
mean labor duration time compared to the control
group primarily because acupressure treatment has
a positive effect on the duration of labor, namely by
shortening the first stage of labor (Lee, et al.,
2004). According to the meridian theory, labor is
viewed as a consequence of imbalance of two
energy entities and this imbalance may be
corrected by utilizing acupressure. Based on this


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22.13 ± 19.34
belief acupressure has been used frequently to
enhance labor, manage labor pain, and shorten
delivery time. Further, acupressure may stimulate
the release of oxytocin from the pituitary gland
which directly stimulates uterine contractions thus
enhances the progression of labor (Chung, 2003).
There were 30 subjects who participated
wherein a total mean score of 26.53 ± 13.61 was
obtained from the control group and 22.13± 19.34
for the experimental group from full dilatation to
delivery of the newborn. The data were arranged
from the shortest to longest labor duration time in
minutes for both the control and experimental
group. Among the 15 subjects in the experimental
group, only one subject exceeded the labor
duration time from full dilatation to delivery of fetus
as compared to the control group.
 
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 59.27± 12.43 154.5049 15

 12.43
28 2.0711 0.0477 2.048

 44.27± 25.15 632.5225 15

 25.15




2.0711 > 2.048

SIGNIFICANT

The experimental group obtained a mean of of 59.27± 12.43. At a 0.05 level of significance, a T-
44.27 ± 25.15, while the control group has a mean stat/t-value of 2.07 was obtained. The Tcrit (two-
tailed) is 2.048. Since the statistical t of 2.07 is
greater than Tcrit (two-tailed) of 2.048, by
conventional criteria this difference is considered to
be statistically significant. This result is consistent
with Lee et al¶s, 2004 study wherein they also
presented a significant difference during the first
stage of labor wherein their experimental group
acquired a mean of 108.3 ± 52.1 minutes and 146.3
± 60.7 for the control group and obtained a t stat of
-2.689. Zeisler et al. (1998) and Tempfer et al.
(1998) reported that acupuncture also shortened
the duration of the first stage of labor. Zeisler et al.
(1998) suggested that acupuncture treatment could
be recommended as a form of childbirth
preparation because of its positive affect on the
duration of labor, namely by shortening the first
stage of labor. Tempfer et al. (1998) reported on a
matched-pair study of the effects of prenatal
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acupuncture on length of labor and maternal blood
levels of interleukin-s, prostaglandin F2-Į, and ȕ-
endorphins, substances known to be involved in the
process of cervical ripening and dilation.
Acupressure on these acupoints is believed to
stimulate the release of oxytocin from the pituitary
gland, which, in turn, stimulates uterine
contractions to enhance the labor process or to
manage labor pain (Cook and Wilcox, 1997).
The application of acupressure on the SP6
acupoint is proven to hasten the first stage of labor
and in turn, can be utilized as an intervention for
laboring women to feel empowered with their
pregnancy experience. Also, it may be implied that
a shortened first stage of labor can lead to lesser
pain sensation during labor since the suffering of
laboring mothers will likewise be reduced.
 
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 26.53± 13.61 13.61 185.2321 15

 22.13± 19.34 19.34 374.0356 15 28 0.7206 0.4771 2.048






0.7206 < 2.048

NOT SIGNIFICANT


The experimental group obtained a mean of 22.13
± 19.34, while the control group has a mean of
26.53± 13.61. At a 0.05 level of significance, a T-
stat/t-value of 0.72 was obtained. The Tcrit (two-
tailed) is 2.048. Since the T-stat/t-value of 0.72 is
greater than the statistical Tcrit (two-tailed) of 2.048,
by conventional criteria this difference is considered
to be not statistically significant. This result is
consistent other studies involving the use of SP6
acupressure. One example is the study conducted
by Lee on 2004 wherein the duration from full
cervical dilatation to delivery of the fetus (second
stage labor) did not differ significantly between the
two groups (t=-1.780, p=0.082). This result can be
attributed to the erratic nature of delivery of the
subjects. Although not statistically significant, the
mean labor duration time of the experimental group
is still lower as compared to the control group.
Based on this finding, SP6 acupressure to some
extent still has an effect on facilitating and
decreasing the mean duration time of the second
stage of labor.
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Based on the findings of this study,
the application of acupressure on the
Sanjinyao point 6 (SP6) in laboring women
proves to be an effective intervention in
decreasing the duration of labor from
transition phase (7 cm) to full dilatation.
However, acupressure showed no
significant effect on labor pain level and on
labor duration from full dilatation to fetal
expulsion.
 "
In the instance that SP6
acupressure statistically revealed no
significant effect in decreasing pain
sensation among laboring mothers, it was
still effective in relieving the painful effects
of labor based on the subjective decrease of
scores in the visual analog scale as pointed
out by the subjects and as they have
verbalized through guided interview.
5


The researchers recommend that
acupressure treatment could be a form of
childbirth preparation because of its positive
effect on the labor duration. Therefore, SP6
acupressure as an intervention has a big
potential of success in various health
settings if used effectively and efficiently
among parturients.
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Based on the results of this study,
the following are recommended on these
sections:



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The researchers recommend that
the application of SP6 acupressure be
strengthened as an independent nursing
function by promoting the use of this safe
and non-pharmacologic intervention in the
labor room because it has been proven to
shorten the duration of labor with the proper
training of delivery room nurses.
 through literature reviews and case studies


1"
 to avoid indiscriminate use of SP6
This intervention could be
implemented by the administration as part
of the protocol in giving care to patients who
are in labor in accordance to the policies,
standards and goals of the hospital and
provided through in-service training and
continuing education for those nurses
looking to improve on their professional
growth and competency in the management
of DR patients.



SP6 acupressure or Complementary
Medicine, in general, could be incorporated
in the course outline of the nursing
curriculum, specifically as an elective,
because it promotes individualistic care in a
patient-centered approach which nursing
students must develop within them as they
grow to become professional nurses.



1) The researchers recommend that
future studies be conducted in a longer
period of time and in different and wider
settings so as to gather more subjects. This
will correspondingly have a significant effect
in the results and will make the findings
more generalizable.
2) A different pain assessment tool,
aside from the Visual Analog Scale, could
be developed by future researchers that
would also measure other factors that may
affect the pain levels felt by the subjects.
The physiologic mechanism behind
pain relief caused by acupressure could be
elaborated and further explained for better
understanding of this effect because
objective proof could pave the way for its
credibility to conventional medicine.
4) Future researchers could identify the
effects of SP6 acupressure as
complementary medicine to high risk clients
acupressure and prevent undue harm to the
mother and fetus.
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