Journal of Nursing Research Vol. 11, No.

4, 2003

Effects of LI4 and BL 67 Acupressure on Labor

Pain and Uterine Contractions in the First
Stage of Labor
Ue-Lin Chung Li-Chiao Hung* Su-Chen Kuo** Chun-Liang Huang***
ABSTRACT: Acupressure is said to promote the circulation of blood and qi, the harmony of yin and yang, and the

secretion of neurotransmitters, thus maintaining the normal functions of the human body and providing
comfort. However, there has been little research-based evidence to support the positive effects of
acupressure in the area of obstetric nursing. The purpose of this study is to determine the effect of LI4
and BL67 acupressure on labor pain and uterine contractions during the first stage of labor. An
experimental study with a pretest and posttest control group design was utilized. A total of 127
parturient women were randomly assigned to three groups. Each group received only one of the
following treatments, LI4 and BL67 acupressure, light skin stroking, or no treatment/conversation
only. Data collected from the VAS and external fetal monitoring strips were used for analysis. Findings
indicated that there was a significant difference in decreased labor pain during the active phase of the
first stage of labor among the three groups. There was no significant difference in effectiveness of
uterine contractions during the first stage of labor among the three groups. Results of the study
confirmed the effect of LI4 and BL67 acupressure in lessening labor pain during the active phase of the
first stage of labor. There were no verified effects on uterine contractions.
Key Words: acupressure, labor pain, uterine contractions, meridian theory.

Introduction
Pain is 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. Recent research on labor pain has
emphasized the importance of non-pharmacological paincoping strategies, but the effectiveness of these strategies
when used in labor has not been directly examined.
Acupressure, a noninvasive technique of traditional Chinese medicine (TCM), has been reported to be useful to both
induce labor and manage labor pain (Jimenez, 1995;
Stephens, 1997). Regrettably, a lack of controlled clinical trials to validate its effectiveness has limited its dispersion in
education and in practice. Therefore, the primary aim of this
study is to evaluate the effectiveness of acupressure on labor
pain and uterine contractions during the first stage of labor.

Two specific hypotheses were examined: (1) Upon receiving

LI4 (Large Intestine 4) and BL67 (Bladder 67) acupressure,
the parturient women experienced greater labor pain relief
than those in the effleurage and control groups during the
latent, active, and transitional phases of the first stage of labor.
(2) Upon receiving LI4 and BL67 acupressure, the parturient
women showed more effective uterine contractions than those
in the effleurage and control groups during the latent, active
and transitional phases of the first stage of labor.
In TCM, it is believed that there are 14 channels of
energy, like rivers, running throughout the body. These
channels are called meridians and through them currents of
energy flow through the body, enhancing blood flow, nourishing tissue, and facilitating normal functions of the body
(Beal, 1992; Betts, 1999; Coggins & Freels, 2000; Cook &
Wilcox, 1997; Simkin, 1995). The presentations of the
meridians near the skin surface are acupoints. According to

RN, EdD, Professor & President, National Taipei College of Nursing; *RN, MS, Head Nurse, National Taipei College of Nursing Hospital;
** RN, PhD, Associate Professor, Graduate Institute of Nurse-Midwifery, National Taipei College of Nursing; ***MD, MS, Deputy
President, National Taipei College of Nursing Hospital.
Received: March 4, 2003 Revised: August 14, 2003 Accepted: September 12, 2003
Address correspondence to: Su-Chen Kuo, No. 365, Ming-Te Rd., Peitou, Taipei 112, Taiwan, ROC.
Tel: 886(2)2822-7101 ext. 3262; Fax: 886(2)2826-3974; E-mail: suchen@mail1.ntcn.edu.tw

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J. Nursing Research Vol. 11, No. 4, 2003

Cook and Wilcox (1997), the most common disturbance

occurring during labor and delivery is obstructions in these
meridians. Stimulating acupoints along the channel by acupressure may help remove obstructions, revitalize the
meridians, and help restore health. Some scientists indicate
that the reason why pain relief can be achieved by acupressure is that it interferes with the transmission of pain stimuli and perhaps increases the endorphin level in the blood
(Melzack & Wall, 1995; Newnham, 1984). Acupressure
may also stimulate the release of oxytocin from the pituitary gland, which directly stimulates uterine contractions.
Therefore, if labor is slow, contractions are weak and/or the
cervix is slow to dilate, stimulating acupoints may help
regulate contractions and restore a balance to the labor.
A variety of acupoints are documented in medical
studies as being able to induce labor and to reduce labor
pain. Theoretically and empirically supported acupoints,
namely LI4 and BL67, were selected for use in this study as
being easy for nurses to locate and to manage (Beal, 1992;
Kwang & Chaou, 1998; Lu & Chu, 1993, see Figure 1).
From the perspective of western medicine, labor pain
and the intensity of uterine contractions have a positive correlation with each other. Pharmacological interventions for pain
relief usually impede the effectiveness of uterine contractions.
Medications for the augmentation of labor and labor induction will increase the intensity of the uterine contractions but
also increase the labor pain. From a TCM point of view, acupressure, a natural remedy, can restore balance during labor
and not only reduce labor pain, but also enhance the labor process by increasing uterine contractions (Beal, 1999; Kwang &
Chaou, 1998; Lu & Chu, 1993). In this study, the effects of
LI4 and BL67 acupressure during the first stage of labor were

Ue-Lin Chung et al.

examined in terms of the level of labor pain relief and the

effectiveness of uterine contractions. Labor pain was measured by using the Visual Analogue Scale (VAS) and uterine
contractions were assessed by calculating the Montevideo
Unit (MU) from fetal monitoring strips.
According to the gate control theory, any form of skin
contact, for instance, touch, light stroking (effleurage),
rubbing, and/or massage, can promote comfort (Clark,
Affonso, & Harris, 1979). In order to distinguish whether
the pain-reducing effects are a result of the meridian effect
or the tactile stimulation of acupressure, three groups (one
group with acupressure, one group with effleurage, and one
group with no treatment) were utilized to increase the internal and external validity of the study.

Methods
Design and Sampling
A pretest/posttest control group design was used to
minimize the effect of extraneous variables on the dependent variable of the study. Based on the experimental design
adopted, a two-step selection process was used to insure a
completely randomized sample and distribution using blind
drawings (Burns & Grove, 1999; Montgomery, 1976). The
first drawing determined the sequence of the three groups:
acupressure, effleurage and control group. The second
drawing determined the distribution of numbers between the
three groups using an arbitrary range of one to 150. Subjects
were assigned numbers based upon the admission sequence
of parturient women who met the criteria for selection. The
sampling criteria were: (1) an estimated gestational age of
the fetus between 37 and 42 weeks, (2) no high-risk pregnancy conditions, (3) mothers carrying one fetus, and (4)
able to interact verbally in Chinese. All parturient women
who received medications during labor such as induction
with oxytocin or an epidural block, or who had cesarean sections, were excluded from the study.

Instruments

Figure 1. LI4 (Large Intestine 4) and BL67 (Bladder 67).

252

VASs have been adopted to estimate the intensity of labor

pain in many studies and have been found to be valid and reliable (Harrison, 1991; Molina, Sola, Lopez, & Pires, 1997;
Niven & Gijsbers, 1996). A scale of 0 to 10 is used to quantify
the intensity of pain. For easier administration and scoring,
feedback received from the pilot testing, a graphic rating scale
with an interval of one centimeter, was added to the VAS in
this study. An open-ended questionnaire, reviewed by experts,
was also used to gather qualitative data about labor pain expe-

Effects of Acupressure in Labor

rienced by subjects. Since the use of an external fetal monitor

in labor is a common obstetric practice in Taiwan, data of uterine activity was collected for use from these monitors. The
MU, a common method for quantification of uterine activity,
was used to measure the effectiveness of the uterine contractions, in which the frequency and intensity of uterine contractions are considered. External fetal monitors used in the study
were manufactured by Hewlett Packard and were well maintained and calibrated. The application of the monitor and data
collection from the monitor were executed by five
nurse-midwives who had a minimum of five years of experience in labor and delivery. Data sets of uterine activities were
analyzed by two obstetricians well trained in terms of the MU.
The two obstetricians were not informed which group the data
came from. The establishment of consistency in administering
treatment was essential. The five nurse-midwives responsible
for caring for the subjects in the study were trained in the procedures and steps of providing acupressure, effleurage, and no
medical treatment as part of the care.

Procedures
The study encompassed two phases, preparation and
execution.
The Preparation Phase
1. Five nurse-midwives participating in the study were thoroughly trained and educated in providing acupressure and
effleurage, and were trained in the data collection procedure.
2. In order to maintain the validity and reliability of acupressure performance, three steps were taken to assure
the validity and reliability of the acupressure treatment
(Betts, 2001; Chen, Lin, Wu, & Lin, 1999; Perinatal
Education Associates, 2001):
(1) An acupressure protocol was established based on a
relevant literature review and consultation with licensed traditional Chinese physicians who had graduated from medical
schools in Taiwan and had practiced acupuncture for more
than 15 years. The protocol contains a selection of the
acupoints, the manual techniques of acupressure and time
duration of intervention. Three acupoints, LI6, BL67, and
SP6 (Spleen 6) were originally chosen. SP6 was eliminated
after pilot testing due to a high rejection rate by subjects
because of the intolerable pain brought on by stimulation of
that acupoint (see Figure 2). Accurate location of the
accupoint was confirmed if the subjects felt soreness, numbness, heaviness, distention, and/or warmth. The time of inter-

J. Nursing Research Vol. 11, No. 4, 2003

vention was limited to 20 minutes, consisting of five minutes

for each acupoint. Thumb pressure was applied to LI4 and
pressure was applied to BL67 using the eraser end of a pencil
with eraser. Five cycles of acupressure would be completed in
one minute, with each cycle comprising 10 seconds of sustained pressure and 2 seconds of rest without pressure.
(2) Control of finger pressure, accuracy of points, and
accuracy of manual techniques were implemented as follows:
(A) The force of finger and pencil eraser pressure was controlled by an evaluation of intrarater reliability in order to
maintain the consistency of the pressure. Pressure exerted
against acupoints would range between 3 and 5 kg. The pressure was measured with a scale with increments starting at 20
gm to a maximum capacity of 6 kg. All five nurse-midwives
were instructed to practice daily for two weeks prior to the
study. The force of finger and pencil eraser pressure was
measured 20 times at the same place and height for one week
for each nurse-midwife. The mean forces of the right thumb
pressure and the pencil eraser pressure were 3.79 kg (SD =
0.33) and 3.23 kg (SD = 0.58) respectively. A tiredness factor
of finger pressure was evaluated three times with measurements of forces before the first subject was treated and after
the last subject was treated on the same day for each
nurse-midwife. The mean thumb pressure forces before and
after were 3.59 kg (SD = 0.53) and 3.47 (SD = 0.58) respectively, and the mean pencil earser pressure forces were 3.27
kg (SD = 0.13) and 3.25 kg (SD = 0.11) respectively. (B) The
accuracy of acupoint allocation and the appropriateness of the
manual techniques of acupressure were also evaluated. Each
nurse-midwife identified the three points from 10 postpartum
clients and applied the manual techniques of acupressure.
Three experts were asked to determine how proficient the
nurse-midwives were at the methods and confirmed 100%
accuracy in terms of acupoint selection and a 90% to 100%
agreement on appropriateness of manual techniques.
(3) Prior to the study, three two-hour training courses
were conducted to ensure that the five nurse-midwives

Figure 2. SP6 (Spleen 6).

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Ue-Lin Chung et al.

were able to provide the treatment accurately in terms of

adequate control of finger pressure, accuracy of acupoints,
and dexterity in the manual techniques. Monthly meetings
were scheduled during the six-month data collection period
to discuss problems or areas requiring further clarification
to maintain consistency of the treatment application.

around as per normal routine care. Upon completion of a

20-minute monitoring period, subjects resting in a comfortable position were asked to assess their perception of labor
pain using the VAS. The acupressure, effleurage or the no
treatment regimen was rendered by the primary
nurse-midwife for 20 minutes as shown in Table 1. After
the procedure, subjects were again asked to assess their perception of labor pain using the VAS. The external fetal
monitor continued to gather necessary information on uterine contractions for another 20 minutes. Monitor strips for
the first and last 20 minutes of the hour were collected for
analysis of the pre-and post-intervention uterine activity.
When subjects were in manageable positions and opted to
be assessed, the intervention was then conducted and data
was collected every 60 minutes for each subject after her
cervical dilatation reached 2 centimeters.

3. Revisions regarding the procedures were made based upon

feedback from pilot testing. During the pilot testing procedure, the subject and her family member had questioned
why the acupressure was being performed. In order to
decrease the Hawthorne effect, the answer was revised
from the acupressure will make you feel better to this is
a special type of care for women in labor in our hospital.
The Execution Phase
1. Qualified parturient women were assigned to the acupressure, effleurage, and control groups based upon the
fully randomized procedure. The procedure and performance of acupressure and effleurage are described in
Table 1. In the control group, the nurse-midwife stayed
in the room with the subject during the 20-minute intervention period taking notes or merely conversing with
the subject or family members.
2. Other than the designated treatment, all subjects received
the same routine care for clients in labor, a one on one
midwifery care routine.
3. Following normal hospital routine and beginning with a
cervical dilatation of 2 centimeters or more, each subject
received continuous external fetal monitoring until the cervix had dilated to 10 centimeters. During that time, subjects
were encouraged to get out of bed, sit, stand and/or walk

4. Within one to two hours after delivery, with the permission of the subjects, one-on-one interviews were conducted to understand the subjects feelings and opinions
about the care received. An interview guide which was
reviewed by a panel of experts and pilot tested on three
postpartum clients was used. Open questions like Tell
me about your labor experience and Describe the care
you received were used to explore subjects feelings
about the care. With the permission of the subjects, a tape
recorder was used during interviews, and the recordings
were transcribed verbatim and then analyzed. The qualitative data collected was used to help clarify the results
revealed by analysis of the quantitative data.
5. The data were collected by the investigator and four
midwives from September 2000 to March 2001.

Table 1.
Procedure and Performance of Acupressure and Effleurage
Acupressure
Sites and duration

Left LI4
Right LI4
Right BL67
Left BL67

Manual techniques

Thumb pressure was applied to LI4 or pressure was

applied via pencil-end eraser to BL67.
Five cycles of acupressure were completed in one
minute, with each cycle comprising 10 seconds of
sustained pressure and 2 seconds of rest without
pressure.

254

5 minutes
5 minutes
5 minutes
5 minutes

Effleurage
Left upper-outer arm 10 minutes.
Right upper-outer arm 10 minutes.

Up and down light skin stroking may be

performed in accordance with the breathing
patterns of the subjects, approximately 12 to 30
strokes per minute.

J. Nursing Research Vol. 11, No. 4, 2003

Effects of Acupressure in Labor

Ethical Considerations
In order to minimize the Hawthorne and novelty
effect, two stages of consent for participation were
adopted. Consent to participate was obtained from subjects
upon admission and only by telling them that this was a
hospital study; no specific information was given. Assurances were provided that whether or not they decided to be
involved in the study, it would not make any difference to
their medical care and all information collected would be
treated confidentially and used only for the research. Candidates also had the right to withdraw at any time during
the study. During the initial consent stage, no subjects
declined. The second stage of consent was obtained after
the final interview when the purpose and the procedure of
the study were explained to the subjects. The subjects were
again asked for their consent to the use of their information
in the final data analysis. If the subjects declined to partici-

pate in the study at this point, the data collected from them
would be discarded. No participants declined. During the
study, a total of 23 subjects withdrew from the study either
to opt for cesarean sections or pain medications, seven subjects from the acupressure group and eight from each of the
other two groups.

Results
Characteristics of Subjects
There were a total of 127 subjects who both met the
sampling criteria and consented to participate in the
study. The attrition rate and reasons for attrition were
about the same across the three groups. The major reason
for attrition was the subjects deciding to receive pain
medication and/or labor induction. The demographic
characteristics of the subjects (as shown in Table 2) were

Table 2.
Comparison of Demographic Characteristics Among Three Groups (N = 127)

Variables

Acupressure Group
(n1 = 43)
Frequency
%

Effleurage Group
(n2 = 42)
Frequency
%

Control Group
(n3 = 42)
Frequency
%

c2

p value

Age
15 - 30
31 - 42

29
14

32.2
37.8

28
14

31.1
37.8

33
9

36.7
24.3

1.939

.379

Religion
Yes
None

33
10

44.0
19.2

19
23

25.3
44.2

23
19

30.7
36.5

9.201

.10

Education
Junior high or below
Senior high
College or above

9
19
15

32.1
27.9
48.4

11
23
8

39.3
33.8
25.8

8
26
8

28.6
38.2
25.8

4.708

.319

Occupation
Employed
Housewife

24
19

43.6
26.4

17
25

30.9
34.7

14
28

25.5
38.9

4.578

.101

Family Income Monthly, NT$

< 50000
50000 - 80000
80000

11
26
6

20.8
40.6
60.0

21
18
3

39.6
28.1
30.0

21
20
1

39.6
31.3
10.0

9.123

.058

Dysmenorrhea
None
Yes

17
26

33.3
34.2

16
26

31.4
34.2

18
24

35.3
31.6

0.209

.901

Drug for Dysmenorrhea

None
Yes

30
13

34.9
31.7

29
13

33.7
31.7

27
15

31.4
36.6

0.343

.842

Note. % of married women was 41/43, 39/42, 39/42, almost identical for three groups. n1: number of subjects in the acupressure
group; n2: number of subjects in the effleurage group; n3: number of subjects in the control group. N = n1 + n2 + n3.

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Ue-Lin Chung et al.

as follows: the mean age for all subjects was 27 years

(SD = 5.69) and ages ranged from 15 to 42 years, most of
the subjects were high school graduates, 93.7% of the
subjects were married, 59.1% of the subjects were religious, 56.7% of the subjects were housewives, 58.3% of
the subjects had a total household monthly income of
NT$50,000 or more, and 67.7% had no experience of
using pain medication for dysmenorrhea. The obstetric
characteristics of the subjects (as shown in Table 3) were
as follows: 52.8% of the subjects were primiparous,
79.5% had never attended childbirth preparation classes,
63% were at 37 to 40 gestational weeks, and 37% were
over 40 weeks. Eighty-one point one percent had husbands accompanying them during labor, the newborn
gender was divided half and half, and newborns mean
birth weight was 3168 g (SD = 378.6) and birth weights
ranged from 2550 to 3980 g. There was no significant
difference in demographic and obstetric data among subjects in the three groups (p > .05). The data indicated a
homogeneity in the basic data of the subjects across the
groups.

Pre- and Post-Intervention Difference in Pain

Perception Among the Three Groups
Since labor pain varies as the labor progresses, the
analysis of pain perception in labor was compiled according to the three phases of the first stage of labor. The mean
score of pre- and post-intervention difference in pain perception measured by VAS was taken in three phases,
latent, active and transitional. As shown in Table 4, the
results indicate that there was a significant difference in
decreased labor pain among three groups in the active
phase of the first stage of labor (c2 = 6.36, p = .041). There
was no significant difference in decreased labor pain
among the three groups in the latent and transitional
phases of the first stage of labor. On further analyzing the
data for the active phase using the Wilcoxon two-sample
test, the results indicated that there was no significant difference in decreased labor pain between the acupressure
and effleurage groups (W = 2.556 , p = .109) or between
the effleurage and control groups (W = 1.223, p = .268).
There was a significant difference in decreased labor pain
between the acupressure and control groups (W = 5.607 ,

Table 3.
Comparison of Obstetric Characteristics Among Three Groups (N = 27)

Variables
Parity
Primiparous
Multiparous

Acupressure Group
(n1 = 43)
Frequency
%

Effleurage Group
(n2 = 42)
Frequency
%

Control Group
(n3 = 42)
Frequency
%

c2

p value

20
23

29.9
38.3

21
21

31.3
35.0

26
16

38.8
26.7

2.211

.331

9
4

34.6
33.7

12
30

46.2
29.7

5
37

19.2
36.6

3.591

.166

29
14

36.3
29.8

24
18

30.0
38.3

27
15

33.8
31.9

1.012

.603

35
8

34.0
33.3

34
8

33.0
33.3

34
8

33.0
33.3

0.004

.998

23
20

35.9
31.7

20
22

31.3
34.9

21
21

32.8
33.3

0.297

.862

15
9
19

38.5
23.7
38.0

11
16
15

28.2
42.1
30.0

13
13
16

33.3
34.2
32.0

0.682

.711

Prenatal Training Course

Yes
None

Gestational Weeks
37 - 40
41 - 42

Accompanied during Labor

Husband
Others

Sex of Newborn
Male
Female

Body Weight of Newborn

< 3000 g
3001 3300 g
> 3301 g

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Effects of Acupressure in Labor

Table 4.
Comparison of Mean Scores of VAS Difference Among Three Groups
Acupressure Group
Phases of labor

Effleurage Group

Control Group

Frequency

SD

Frequency

SD

Frequency

SD

c2

p value

37
37
8a

-0.01
0.17
0.19

1.04
1.32
1.33

32
34
13

0.45
0.66
0.28

1.16
1.36
1.01

29
39
20

0.55
0.81
0.05

0.89
1.23
0.42

5.9554
6.3592
1.4680

.051
.041*
.480

Latent
Active
Transitional

Note. c2 of Kruskal-Wallis Test. aThe decreased number of subjects in the transitional group was due to some subjects (1) having
short transitional phases (less than one hour) and (2) not wanting to be assessed during this difficult period. *p < .05.

the Bonferroni multiple comparison test indicated that the

duration of the first stage of labor of the acupressure group
was shorter than that of the control group. No significant
difference was found between the acupressure and the
effleurage group in terms of the duration of the first stage
of labor.

p = .017). W is the Wilcoxon rank sum statistic (Chang,

2002; Lee, 1996).

Pre- and Post-Intervention Difference in

Effectiveness of Uterine Contractions
A comparison of the mean of the pre- and post-intervention MU difference among the three groups (Table 5)
revealed that there was no significant difference among the
three groups in all three phases of the first stage of labor (c2
= 1.359, p = .506; c2 = .822, p = .662; c2 = .555, p = .757).

Responses From the Interview

Thirty-three percent of the acupressure group
expressed positive feelings towards the treatment and
stated they could really feel the difference in a lessening of
labor pain after acupressure treatment. Overall, patient
responses were consistent with the quantitative data examined. Approximately one-third of the effleurage group
voiced positive feelings toward the light stroking of the
skin over the outer-upper area of the arm. The women indicated they enjoyed being touched and the stroking dis-

Other Findings
For a more in-depth analysis of the data, the duration
of the first stage of labor was examined for the three
groups. From Table 6, the results indicate that there was a
significant difference in the duration of the first stage of
labor among the three groups (F = 4.055, p = .019). Using

Table 5.
Comparison of the Mean of Montevideo Units Difference Among Three Groups
Acupressure Group
Phases of labor
Latent
Active
Transitional

Effleurage Group

Control Group

Frequency

SD

Frequency

SD

Frequency

SD

c2

p value

35
34
5

20.05
30.51
46.10

56.66
82.69
44.85

33
33
12

15.71
33.98
20.31

50.02
75.38
59.56

29
36
14

5.63
22.12
38.39

59.31
67.08
64.88

1.3594
0.8223
0.5550

.506
.662
.757

Note. c2 of Kruskal-Wallis test.

Table 6.
Comparison of Duration in Hours of First Stage of Labor Among Three Groups
Acupressure Group
Items
First stage of labor

Frequency
43

SD

6.33 2.55

Effleurage Group
Frequency
42

SD

7.13 3.14

Control Group
Frequency
42

SD

8.45 4.39 4.055 .019*

Bonferroni
test
AEC
A < C**

Note. A: population mean of acupressure group; E: population mean of effleurage group; C: population mean of control group; AE:
accept Ho: A = E; EC: accept Ho: E = C; A < C: accept H1:A < C. *p < .05; **p < .01.

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J. Nursing Research Vol. 11, No. 4, 2003

tracted their attention away from their labor pain. The psychological benefits of light stroking demonstrated by subjects did not seem to be reflected by the dependent variables of the study.

Discussion
The Effect of Acupressure on Labor Pain Relief
The findings of the study suggest that there was a significant difference in decreased labor pain among the
three groups in the active phase of the first stage of labor.
The acupressure group experienced the most labor pain
relief out of the three groups. Therefore, the results of the
study support the hypothesis that the acupressure group
experienced a greater decrease in labor pain than those in
the effleurage and control groups during the active phase
of the first stage of labor. Much of the empirical data indicated that acupressure of LI4 and BL67 provided pain
relief during labor (Beal, 1992; Betts, 1999; Brown,
Douglas, & Flood, 2001; Simkin, 1995), however, none of
the information specifies the particular time during the
labor process at which acupressure would be most beneficial. The results of the study fail to support the hypothesis
that the acupressure group experienced a greater decrease
in labor pain than those in the effleurage and control
groups during the latent and transitional phases of the first
stage of labor.
Since the p value for the difference in decreased
labor pain among the three groups in the latent phase is
.051, very close to 0.05, it is promising that with an
increased number of subjects, the acupressure group
would present some degree of effectiveness in labor pain
relief in the latent phase. This phenomenon is worth further investigation. As for the reason why there was no significant difference in labor pain relief among the three
groups in the transitional phase, it could be that the labor
pain was too intense to manage. When the pain was overwhelmingly strong, none of the measures seemed to make
much difference. The acupressure probably worked the
best in terms of pain relief when the pain was moderate (in
the active phase) or even when the pain was mild (in the
latent phase).

The Effect of Acupressure on Uterine Contractions

The results of the study fail to support the hypothesis
that the acupressure group manifested more effective

258

Ue-Lin Chung et al.

uterine contractions than those in the effleurage and control groups during the latent, active and transitional
phases of the first stage of labor. Information offered from
external fetal monitoring might not be as accurate as the
information obtained from internal fetal monitoring. The
record from external fetal monitoring may be influenced
by the position in which the woman in labor lies and by
her pushing. In order to fit this study to the reality of
actual practice of Taiwan, information was only collected
from external fetal monitoring. It is recommended that
similar studies should be replicated in the future, perhaps
in other countries, by using information from internal
fetal monitoring. In the literature it is speculated that the
effects of labor induction or augmentation by acupressure
was a result of increased secretion of oxytocin in the
body. Therefore, further investigations should be conducted to determine the relationship between acupressure
and oxytocin level.

Other Findings
The data suggest that the acupressure group had a
shorter duration of the first stage of labor than the control
group, even though the acupressure did not produce more
effective uterine contractions. Labor is a very complex process and is affected by many intertwined factors. Further
investigation regarding these phenomena is warranted.
The qualitative data collected from the study were
similar to the results found by Brown et al. (2001) and Wu
(2003). Positive feelings were usually aroused and voiced
by patients when nurses applied acupressure or effleurage
to alleviate labor pain. Clearly, this study has further corroborated the findings of previous empirical studies with
regard to the effectiveness and utility of such non-invasive
care.
Many acupoints are said to have benefits in labor
pain relief and labor induction (Betts, 1999; Perinatal
Education Associates, 2001). LI4 and BL67 are the
acupoint sets most frequently mentioned in the literature
by perinatal practitioners. Different sets or combinations
of acupoints should be experimented with in the future to
identify the most useful regimen for clients in labor. In
addition to the indicators employed in the study,
endorphine and oxytocin levels in serum should also be
used as objective indicators to further validate the results
of the study. Unfortunately, quantitative analysis was limited by a relatively small sample size because of the difficulties in collecting data during the transitional phase of

Effects of Acupressure in Labor

the first stage of labor. As a corrective, a much larger sample size should be utilized to test the null hypothesis during the related transitional period.

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