الفهرس 
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Abstract
Postpartum afterpains represent a highly prevalent complaint. It leads to unpleasant
consequences, where it gives rise to neuro-hormonal stress responses, as well as psychological
problems. Additionally, it also can impede breast breastfeeding immediately after delivery and
affect the breast milk flow, as well as decrease the mother’s attention to the neonate, and impair
their relationship. Eventually, both women and their newborns may be deprived of the benefits of
exclusive breastfeeding and forced to resort to artificial feeding as well.
Afterpains management can be divided into two categories: pharmacological and
nonpharmacological measures. While the pharmacological measures have side effects,
nonpharmacological measures are thought to be superior than pharmacological ones because of their
ease of implementation, noninvasiveness, ability to build confidence and increase women’s
participation, absence of adverse effects on mothers, neonates, and leave no breastfeeding
complications.
Hoku point massage is an alternative modality used to relieve pain by massage between
the thumbs and forefingers on the palm side of the hands where the LI4 energy meridian
acupoint is present.
As high prevalence of postpartum afterpains and side-effects of pharmaceutical
analgesics on maternal and neonatal health, as well as there are insufficient research
examining the effectiveness of Hoku point massage as a noninvasive measure to relieve
afterpains intensity in Egypt. Accordingly, this study aimed to determine the effect of Hoku
point massage on postpartum afterpains intensity among multiparous women.
A quasi-experimental research design was conducted among 100 multiparous women at the
postnatal ward of El-Shatby Maternity University Hospital. The women were equally assigned to
one of two groups: a control group was receiving routine hospital care and an experimental group
was receiving Hoku point massage. Each group comprised fifty multiparous women.
Three tools that are used for data collection include; Socio-demographic, reproductive,
and clinical profile structured interview schedule; VAS which is used for subjective
estimation of women’s pain, and a modified version of CPPRS that measured pain intensity
through observable behaviors.
Statistical analysis was done by the researcher after the collection of data by using
Statistical Package for Social Sciences (SPSS version 20) program. The collected data were
categorized, coded, computerized, tabulated, and analyzed using frequency distribution tables,
percentages, mean and standard deviations. The difference sample test, independent t-test,
Wilcoxon test, Friedman’s test, and Chi-square test. A five percent level of significance was
used to find out the statistically significant difference in the results.
The study revealed the following main results:
Socio-demographic characteristics
The mean age was (29.04 ± 5.406, and 29.80 ± 4.686) in the experimental and control
groups respectively.
More than one-half (58%, 56%) of the experimental and control groups, respectively,
had primary and preparatory education.
Majority (90%) of the experimental group were housewives, compared to 78% of the
control group
The vast majority (98%, 96%) of the experimental and control groups respectively were
married.
More than one-half (58%, 62%) of the experimental and control groups respectively
were urban dwellers
No statistically significant difference was noticed between the experimental and control
groups regarding socio-demographic characteristics.
Reproductive history
Regarding gravidity revealed that 42% and 44% of the experimental and control groups
respectively stated that they got pregnant four times or more.
Referring to parity, 42%, and 44% of the experimental and control groups respectively
had delivered four times or more.
Vaginal deliveries without episiotomy were reported by 48% and 44% of both groups
respectively. The table also elucidates that 42% of the experimental and control groups
had three or more living children.
Almost one-half (48%) of the experimental group were in the 38th week of gestations.
The mean of gestational weeks among the experimental and control groups respectively
was almost the same (38.26 ± 0.876, 38.22 ± 0.954).
No statistically significant difference was observed between the experimental and
control group regarding their reproductive history.
No statistically significant difference was observed between the experimental and
control groups concerning their vital signs.
No statistically significant difference was observed between the two groups regarding
fundus level and fundus position. Moreover, fundus consistency displayed that the
fundus was firm & hard among all experimental and control groups.
Afterpains intensity as measured by )VAS(
No statistically significant difference was found between the experimental and control
groups regarding afterpains intensity before intervention (p= 0.461). While a highly
significant difference was observed between both groups immediately after intervention
(p= 0.000). Again, no statistically significant difference was noticed between the
experimental and control groups in relation to their afterpains intensity one hour after
intervention (p= 0.242), In the first session.
In the second session, a highly statistically significant difference was found between
the experimental and control groups concerning afterpains intensity before intervention
(p= 0.006), immediately after intervention (p= 0.000), and one hour after intervention
(p=0.000).
In the first and second sessions, a highly statistically significant difference was observed
among women of the experimental group in relation to their intensity of afterpains as
measured by VAS before and immediately after intervention (p = 0.000), before and one hour
after intervention (p = 0.000), as well as immediately after and one hour after intervention (p
= 0.000).
Afterpains intensity as measured by )CPPRS(
No statistically significant difference was observed between the experimental and
control groups in relation to their afterpains intensity before intervention (p= 0.227).
While a highly significant difference was observed between both groups immediately
after intervention (p=0.000), and one hour after intervention (p=0.003) in the first
session.
In the second session, A highly statistically significant difference was observed among
women of both groups before intervention (p= 0.011), immediately after intervention (p=
0.000), and one hour after intervention (p=0.000).
In the first and second sessions, a highly statistically significant difference was
observed among women of the experimental group in relation to their intensity of
afterpains as measured by CPPRS before and immediately after intervention (p =
0.000), before and one hour after intervention (p = 0.000), as well as immediately after
and one hour after intervention (p = 0.000).
Conclusion
Based on the findings of the present study, it can be concluded that:
The research hypotheses are accepted, where Hoku point massage was effective in the
reduction of postpartum afterpains intensity among multiparous women. Furthermore,
multiparous women who receive Hoku point massage showed observable behaviors indicating
less afterpains intensity than those who do not receive it. Analysis of data showed that there
was a significant difference between the intervention and control groups
Recommendations
Based on the findings of the present study, the following recommendations are suggested:
Postpartum afterpains represent an indicator of uterine involution. however, it is a
highly neglected complaint at hospitals. therefore, strict protocols should be established
in maternity care units for a comprehensive and routine assessment of afterpains, and
interventions to reduce pain should be achieved.
Maternity nurses should attend training programs, implemented by the responsible authorities,
to improve their knowledge and skills regarding non-pharmacological techniques, and the
policies of hospitals need to be altered.
Due to the simplicity, safety, and suitability of Hoku point massage as a nonpharmacological
technique that is effective in elevating postpartum afterpains, without
causing adverse side effects for the mother or baby, postpartum women should be
educated about the importance and how to perform this technique at home.
Considering the importance of health promotion, protection of women, and the high
incidence and prevalence of afterpains, the results of this study trigger the conduction of
high-quality clinical and non-invasive services and encourage taking a step toward
improving the health and satisfaction of women in society.
Further studies should be conducted with a larger sample size, a longer massage duration,
and multiple sessions to verify the findings of this study.