Home About us Editorial board Search Browse articles Submit article Instructions Contacts Login 
Users Online: 1120
Home Print this page Email this page


Previous article Browse articles Next article 
J Edu Health Promot 2018,  7:101

The effect of auriculotherapy on the severity and duration of labor pain

Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Submission07-Jan-2018
Date of Acceptance12-Mar-2018
Date of Web Publication02-Aug-2018

Correspondence Address:
Mrs. Masoume Pirhadi
Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jehp.jehp_141_17

Rights and Permissions

INTRODUCTION: Pain is a common phenomenon and an inevitable part of the labor process. Labor pain is one of the most severe pains. Auriculotherapy is one of the nonpharmacological aspects of relieving pain, reduces the intensity of pain, and improves its compatibility. The purpose of this study was to determine the effect of auriculotherapy on labor pain in primiparous women.
MATERIALS AND METHODS: This clinical trial was performed on 84 pregnant women aged between 18 and 35 years, who referred to Isfahan Shahid Beheshti Hospital in 2017. This study was carried out between two groups: control group (receiving routine hospital care) and interventional group (20 min for auriculotherapy). We used the McGill Short-Form Standard questionnaire with Visual Analog Scale. Data were analyzed by SPSS software using paired t-test and ANOVA.
RESULTS: The results showed that there was no significant difference between demographic variables in the two groups. Statistical analysis also showed that the severity of labor pain in the interventional group (auriculotherapy) was lower than that of the control group (P = 0.001).
CONCLUSION: Auriculotherapy reduces the severity of labor pain in primiparous women. Due to the easy, inexpensive, and noninvasive nature of this method, its use has been recommended in these cases.

Keywords: Auriculotherapy, delivery, pain, primiparous women, Iran

How to cite this article:
Valiani M, Azimi M, Dehnavi ZM, Mohammadi S, Pirhadi M. The effect of auriculotherapy on the severity and duration of labor pain. J Edu Health Promot 2018;7:101

How to cite this URL:
Valiani M, Azimi M, Dehnavi ZM, Mohammadi S, Pirhadi M. The effect of auriculotherapy on the severity and duration of labor pain. J Edu Health Promot [serial online] 2018 [cited 2019 May 26];7:101. Available from: http://www.jehp.net/text.asp?2018/7/1/101/238356

  Introduction Top

Pain is an important health phenomenon that exists from birth to the final stages of life and is one of the factors that patients refer to clinics and treatment centers.[1] According to the International Association for the Study of Pain, pain is an unpleasant feeling and mental experience that is associated with potential or actual damage.[2]

Pain is a common phenomenon and an inevitable part of the labor process.[3] This pain is caused by stimulation of the neuroreceptors (T10-L1) due to contraction of the uterus and is felt in the visceral, pelvic, and lumbosacral (S2, S3, and S4) regions.[4] Increased labor pain and anxiety by stimulating the sympathetic nervous system leads to increased secretion of catecholamines, which reduces the contractions of the uterus, prolongation of the first and second stages of labor, increased midwifery interventions, increased request for cesarean section, and the mother's dissatisfaction with the labor experience.[5],[6] Therefore, control and management of labor pain is the goal of all maternity care units, where pharmacological and nonpharmacological methods are used for pain relief.[7],[8]

In pharmacological methods, the sense of pain is reduced physically.[9] Using medication to reduce labor pain is often expensive and has harmful effects.[10] Nonmedicinal techniques include breathing techniques, relaxation techniques, Lamaze techniques, acupuncture, acupressure, reflexology, massage, hypnosis, music therapy, aromatherapy, prayer therapy, and using transcutaneous electrical nerve stimulation device.[11],[12],[13]

Nonpharmacological methods of pain control are important elements in midwifery care and, in many women, it is the first choice.[5],[14] Among the benefits of using nonpharmacological methods, their effect on keeping the mother alert is the difference with the pharmacological methods that cause strong bonding between mother and infant after delivery.[15],[16]

Alternative medicine for labor pain control is considered as a substitute for pharmacological therapies such as epidural anesthesia.[17] One of the alternative medicinal methods is the auriculotherapy.[18] Auriculotherapy is the stimulation of the ear as an acupressure method that, by applying pressure in the specific areas of the ear, leads to rehabilitation and returns energy to the body and improves the overall condition of the body.[19],[20] Auriculotherapy is noninvasive in comparison with acupuncture and an acceptable method by the patient that the external ear is stimulated.[21],[22] We use the ear to reach almost all the anatomical points of the body, as well as different parts of the brain, the spinal cord, and the central and peripheral nerves. Auriculotherapy is effective not only in controlling pain but also in balancing the level of hormones and neurotransmitters in the body and the brain.[23],[24] One of the other benefits of this method is the activation of the energy channel and the regulation of energy flow in the body, as well as stimulation of the internal organs of the body such as the uterus and the ovary.[25] Treatments such as reflexology and acupuncture have a general effect on the overall health of the body, but auriculotherapy also affects the body's organs, in addition to its effect on overall health of the body.[26] Improving the overall circulation of the body, deep relaxation, brain stimulation, and improving the immune system as a disease prevention tool are among the other benefits of auriculotherapy.[27]

Auriculotherapy is used in many cases, including painful menstrual bleeding, uterine bleeding, inadequate milk secretion, vomiting, and acute diarrhea. In the case of labor pain, it should be noted that the uterus develops muscle cramps at contraction during labor, such as menstruation, and most women consider labor pain to be similar to menstrual pain.[28] In addition, in the study of Mirzaei et al., it was reported that massaging of the uterine spot of ear reduced the severity of labor pain in the interventional group.[29] Dolatian et al. suggested reflexology as one of the effective ways to reduce the severity of labor pain.[30] Another study conducted by Valiani et al. in Isfahan on the effect of reflexology on the severity of labor pain and its consequences indicated the effect of this method on reducing the severity of labor pain and increasing the satisfaction of mothers.[31]

In the recent years, the Iranian Ministry of Health and Medical Education has been looking for ways to reduce cesarean delivery and reduce labor pain, in which nonpharmacological methods are among these methods for reducing labor pain.

According to the Community Development Program for Health Promotion and Medical Education, which has declared natural delivery as a priority, and by considering the fact that the development of auriculotherapy is expanding, the fact that most of the researches were done on compressive and reflexology points, and few researches have been done on the effect of auriculotherapy, the researcher aimed to determine the effect of auriculotherapy on the severity of labor pain in primiparous women.

  Materials and Methods Top

The present study is a randomized clinical trial that was conducted in 2017 on primiparous women aged 18–35 years, who referred to Shahid Beheshti Hospital in Isfahan. The study was conducted in two groups of intervention (auriculotherapy, n = 42) and control group (receiving routine nursing care, n = 42) by simple sampling and randomly assigned to two groups by odd and even numbers. The inclusion criteria included first pregnancy (nulliparous), Iranian nationality, gestational age 37–41 weeks of pregnancy, singleton pregnancy, fetal cephalic presentation, cervical dilatation 3 cm–5 cm, satisfaction of participation in the study, lack of febrile and infectious disease, lack of high-risk pregnancies including the underlying diseases (diabetes, hypertension, asthma, migraine, kidney disease, psychiatric disorders, epilepsy, or seizure) and any pregnancy-related illness (gestational diabetes, gestational hypertension, polyhydramnios, or oligohydramnios), lack of a history of obstetric problem during pregnancy (placenta previa and threatened abortion), and lack of any disorder, which is inconsistent with vaginal delivery (anatomic abnormalities of the pelvis, pelvis tightness, prolonged latent phase, etc.).

Samples were excluded during the study if they did not want to continue the intervention or in case of problems such as respiratory distress, bleeding, unexplained dystocia, and, if necessary, we informed the responsible physician and midwife and they were taken under special care.

The instrument was McGill's Short-Form Standard Questionnaire with Visual Analog Scale (VAS). The severity of pain was assessed by the research units in different dilatations.

After obtaining written consent, the women were randomly assigned into control and interventional groups. Initially, the embryo's health was assessed and the severity of pain was recorded in a dilatation of 3–5 cm and uterine contraction. In the interventional group, the mother was first in the half-sitting position. Then, her ears were cleaned with cotton immersed in alcohol. Since the onset of the active phase, stimulation of the points on the left ear was performed by a pointer device. (The patient's response was taken into consideration during the technique.) Shen Men, Zero, thalamus, endocrine, autonomous, cerebral, sensorial, pelvic, uterus, posterior pituitary, prostaglandin, and external genitalia points were stimulated for 1 min with manual pointer and seeds.[32] After 30 min of the first intervention, the intensity of pain was recorded and again the intensity of pain was measured in dilatation of 6–8 cm. Once again, the specific points were stimulated in 9–10 cm dilatation for 5 min, and the pain intensity was recorded 30 min later. The severity of pain was recorded for the last time in the second stage of labor when the embryo was exited. In the control group, who received oxytocin for induction of childbirth and received only routine care in the hospital, the intensity of pain was measured after the first contraction in dilatations of 3–5 cm, 6–8 cm, and 9–10 cm, and the second stage of labor when the embryo was released. The researcher, in the same way as the intervention group, sat close to the participants in the control group and calmly stimulated the inert points of their ears so that the psychological and inductive effects of the intervention are similar in the two groups. Finally, eye contact and communication with the control group were performed as in the interventional group. The data recorded in the questionnaire were analyzed using SPSS software version 20(IBM Company, Armonk, NY). The researcher considered P < 0.05 to be statistically significant.

  Results Top

The results of the study showed that the mean age of the pregnant mothers participating in the intervention group was 27.35 (4.35) years and in the control group was 28.36 (4.41) years. Statistical analysis showed no significant difference between the two groups in terms of age (P > 0.05). The mean of gestational age in the intervention group was 39.16 (1.47) and in the control group was 39.71 (0.92), which was not statistically significant (P > 0.05).

According to the findings, in the interventional group, 4 (3.9%) participants were illiterate, 14 (32.6%) had undergraduate and diploma education, and 25 (58.1%) had associate and bachelor's degree. Mothers' level of education in the control group was as follows: 3 (7.7%) were illiterate, 18 (42.9%) had a diploma and undergraduate education, 20 (6.47%) had associate and bachelor's degree, and finally 1 (4.2%) had master's and higher degrees. There were no significant differences between the two groups regarding the level of education (P > 0.05).

In the interventional group, 36 (7.83%) were homemakers, 4 (3.9%) were employees, 2 (7.4%) were workers and farmers, and 1 (3.3%) was self-employed.

In the control group, 34 (81%) were homemakers, 6 (14.3%) were employees, 1 (4.2%) was workers and farmers, and 1 (4.2%) was self-employed. Based on the results of the analysis, the two groups did not have any significant difference in terms of employment status (P > 0.05). As shown in [Table 1], in the interventional group, the mean pain severity before and after the auriculotherapy was 2 (1.51) and in control group was 3.05 (1.36), which did not differ significantly (P = 0.371). After performing the first stimulation of auriculotherapy in 3–5 cm cervical dilatation, the severity of pain in the intervention group was significantly less than the pain intensity in the control group (P = 0.001).
Table 1: Comparison of mean pain intensity in two groups

Click here to view

The results showed that after the next interventions in 6–8 cm dilatation of the cervix (P = 0.001) and 9–10 cm dilatation (P = 0.001) and finally in the second stage of labor (P = 0.001), pain severity showed significant changes as the pain intensity in the interventional group was less than pain intensity in the control group.

Furthermore, the findings in [Table 2] indicate that the duration of the first stage of labor (P = 0.008) and the second stage of labor (P = 0.001) was significantly different in the two groups. However, the duration of the third stage of labor in the two groups did not differ significantly (P = 0.25).
Table 2: Comparison of mean length of delivery stages in two groups

Click here to view

  Discussion Top

In this study, 84 pregnant women were studied. It was concluded that the severity of labor pain based on VAS index of McGill Short-Form Standard Questionnaire was lower in interventional group (auriculotherapy) than in control group. In other words, the results of the study showed that the intervention of auriculotherapy led to a decrease in participants' pain in different stages of labor.

In addition, based on the findings of the study, auriculotherapy examination showed a significant decrease in the mean duration of the first and second stages of delivery.

Given the fact that the auriculotherapy is a subclass of acupuncture and reflexology, this method also by resulting in the reduction of adrenaline, noradrenaline, and increasing endorphin makes regular uterine contractions, which can be effective in shortening labor time.

In the study of Mirzaie et al. (2010) which aimed to find the effect of foot massage on uterus pain point (reflexology) on pain intensity of the first stage and duration of labor, the results showed that the pain intensity in the interventional group decreased compared to the control group.[31] A research by Dolatian et al. (2010) conducted to determine the effect of massage on the severity of labor pain before intervention, immediately after intervention, and in dilations of 6–7 cm and 8–10 cm in the three groups of massage, support, and routine care showed that the severity of labor pain in the massage group was significantly lower than that in the other two groups.[30] In the study of Valiani et al., with the aim of evaluating the effect of reflexology on the severity of pain and delivery outcome, a significant difference was observed in the pain score between the two interventional and control groups before and after the intervention in both stages, indicating the effect of reflexology on reduction of severity of pain, which is consistent with the results of the present study.[31] Furthermore, Rastegarzade et al., in another study in Ahwaz on determining the effect of auriculotherapy on the pain of the active phase of labor reported that auriculotherapy reduces labor pain in the active phase of labor.[24]

Based on the present study, it has been found that auriculotherapy reduced the duration of the first and second stages of labor in the interventional group (auriculotherapy) compared to the control group (P < 0.001). However, no significant difference was observed during the third stage of labor. It seems that auriculotherapy has effect on the increase of endorphin, which can be the cause of increase in oxytocin from posterior pituitary, which leads to this outcome and shortens the length of delivery stages.

According to studies, fear and anxiety increase the secretion of adrenaline and norepinephrine, which act unlike oxytocin. This causes disruption of uterine contractions and prolonged labor. Reflexology by reducing adrenalin and neuradrenaline levels and increasing endorphins and oxytocin decreases mother's stress and leads to regular uterine contractions, which can be effective in shortening labor duration.[33]

Moghimi Hanjani et al. reported that reflexology would shorten the duration of labor ( first, second, and the third stages of labor).[33] However, there was no significant difference in the reflexology and control groups in the McNeil et al's. study and they reported that in reflexology group, patients who received reflexology four times or more (60 min) had shorter duration of labor than that of the control group.[34]

  Conclusion Top

Although according to the results of this study and that of few other available studies, it cannot be conclusively stated, it seems auriculotherapy can be used as one of the nonpharmacological methods to reduce labor pain. In this technique, making physiological changes and releasing endorphins and relaxation causes muscle relaxation, which eventually leads to pain reduction, improvement in labor progress, and positive changes in other symptoms. In general, this study suggests that auriculotherapy is effective on the duration and severity of labor pain.

This study is one of the few studies to investigate the effect of auriculotherapy on pain intensity and duration of delivery stages. Among the limitations of this study are repeated manipulations and unnecessary midwifery interventions in the hospital that may be involved in the occurrence of doubled pains and impairment in the labor process. However, considering the same conditions for all study units in the two groups, this has not caused any problems in the results of the research.


This study was approved by the Nursing and Midwifery Care Research Center of Isfahan University of Medical Sciences. Therefore, we are grateful to the deputy research associate of the university and the research center. Also, we thank the staff of Shahid Beheshti Hospital for their cooperation in conducting research and to all the pregnant women who participated in the research.

Financial support and sponsorship

This study was financially supported by the Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.

Conflicts of interest

There are no conflicts of interest.

  References Top

New Methods of Pain Treatment – The Site of the Specialized Clinic of Control and Treatment of Pain in Tehran; 2013.  Back to cited text no. 1
(IASP) IAftSoP; 2010.  Back to cited text no. 2
Trout KK. The neuromatrix theory of pain: Implications for selected nonpharmacologic methods of pain relief for labor. J Midwifery Womens Health 2004;49:482-8.  Back to cited text no. 3
De La Brière A. Causes of pain in obstetrics. Soins 2013;778:15-8.  Back to cited text no. 4
Shnol H, Paul N, Belfer I. Labor pain mechanisms. Int Anesthesiol Clin 2014;52:1-7.  Back to cited text no. 5
Serçekuş P, Okumuş H. Fears associated with childbirth among nulliparous women in Turkey. Midwifery 2009;25:155-62.  Back to cited text no. 6
Abushaikha L, Oweis A. Labour pain experience and intensity: A Jordanian perspective. Int J Nurs Pract 2005;11:33-8.  Back to cited text no. 7
Mohammadkhani Shahri L, Abbaspour Z, Aghel N, Mohammadkhani Shahri H. Effect of massage aromatherapy with lavender oil on pain intensity of active phase of labor in nulliparous women. J Med Plants 2012;2:167-76.  Back to cited text no. 8
Funai F, Norwitz E. Management of Normal Labor and Delivery. Uptodate, Thursday January 01, 2009.  Back to cited text no. 9
Simki P, Ancheta R. The Labor Progress Handbook Early Interventions of Prevent and Treatment Dystocia. 3rd Edition Blackwell Science; 2011.  Back to cited text no. 10
Namazi M, Amir Ali Akbari S, Mojab F, Talebi A, Alavi Majd H, Jannesari S, et al. Effects of citrus aurantium (bitter orange) on the severity of first-stage labor pain. Iran J Pharm Res 2014;13:1011-8.  Back to cited text no. 11
McKinney E. Maternal-Child Nursing. 2nd ed. St. Louis, MO: Elsevier Saunders; 2005.  Back to cited text no. 12
Henderson C, Macdonald S. Myles, Midwifery a Textbook for Midwifes. 13th ed. Bailliere Tindall; 2013.  Back to cited text no. 13
Billington P, Stevenson M. Critical Care in Childbearing for Midwives. Blackwell; 2007.  Back to cited text no. 14
Pillittere A. Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family. Lippincott Williams and Wilkins; 2007.  Back to cited text no. 15
Caton D, Corry MP, Frigoletto FD, Hopkins DP, Lieberman E, Mayberry L, et al. The nature and management of labor pain: Executive summary. Am J Obstet Gynecol 2002;186:S1-15.  Back to cited text no. 16
Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, et al. Acupressure to reduce labor pain: A randomized controlled trial. Acta Obstet Gynecol Scand 2010;89:1453-9.  Back to cited text no. 17
Lliadou M. Labour pain and pharmacological pain relief practice points. Health Sci J 2009;3:197-201.  Back to cited text no. 18
Lee MK, Chang SB, Kang DH. Effects of SP6 acupressure on labor pain and length of delivery time in women during labor. J Altern Complement Med 2004;10:959-65.  Back to cited text no. 19
Poole H, Glenn S, Murphy P. A randomised controlled study of reflexology for the management of chronic low back pain. Eur J Pain 2007;11:878-87.  Back to cited text no. 20
Xavier R. Facts on reflexology (foot massage). Nurs J India 2007;98:11-2.  Back to cited text no. 21
Poorghazneyn T, Ghafari F. The effect of reflexology on the intensity of fatigue on pregnant women referred to health center of Ramsar city. J Fac Nurs Midwifery 2007;12:5-11.  Back to cited text no. 22
Tipping L, Mackereth PA. A concept analysis: The effect of reflexology on homeostasis to establish and maintain lactation. Complement Ther Nurs Midwifery 2000;6:189-98.  Back to cited text no. 23
Rastegarzade H, Abedi P, Valiani M, Haghighi MH. The effect of auriculotherapy on labor pain intensity in nulliparous women. JAP 2015;6:54-63.  Back to cited text no. 24
Ramnerö A, Hanson U, Kihlgren M. Acupuncture treatment during labour – A randomised controlled trial. BJOG 2002;109:637-44.  Back to cited text no. 25
Quinn F, Hughes M. Reflexology in the management of low back pain: A pilot randomized. Complementary Therapies in Medicine. Elsevier; 2008. p. 3-8.  Back to cited text no. 26
Cabyoglu M, Ergene N, Tan U. The mechanism of acupuncture and clinical applications. INT J Neurosci 2006;116:115-25.  Back to cited text no. 27
Yerby M. Pain in Childbearing, Key Issues in Management. Bailliere Tindall; 2002.  Back to cited text no. 28
Mirzaei F, Kaviani M, Jafari P. The effect of reflexology on the anxiety of primiparous women. Hayat J 2008;16:65-71.  Back to cited text no. 29
Dolatian M, Hasanpour A, Heshmat R, Alavi Majd H. The effect of reflexology on pain intensity of labor. J Zanjan Univ Med Sci 2009;18:52-61.  Back to cited text no. 30
Valiani M, Shiran E, Kianpour M, Hasanpour M. Reviewing the effect of reflexology on the pain and certain features and outcomes of the labor on the primiparous women. Iran J Nurs Midwifery Res 2010;15:302-10.  Back to cited text no. 31
Motha G. Reflexology in Pregnancy. Complementary Therapies in Medicine. Elsevier; 2008.  Back to cited text no. 32
Moghimi Hanjani M, Shoghy M, Mehdizadeh Torzani Z, Ahmadi G, Khodadvastan Shahraki M. The effect of foot reflexology on anxiety during of labor on primiparous. J Army Univ Med Sci 2012;10:219-24.  Back to cited text no. 33
34. McNeill JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the relationship between antenatal reflexology and intranatal outcomes. Complement Ther Clin Pract 2006;12:119-25.  Back to cited text no. 34


  [Table 1], [Table 2]


Previous article  Next article
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Tables

 Article Access Statistics
    PDF Downloaded104    
    Comments [Add]    

Recommend this journal