The effects of ice pack application on pain intensity in the active phase of labor and on birth satisfaction among primiparous women

  • Fateme Rahimikian
  • Shirin Shahbazi Department of Reproductive Health Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
  • Shelir Mohammadi* Department of Reproductive Health Midwifery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
  • Shima Haghani Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Keywords: ice pack, birth satisfaction, labor pain, pain management, active phase


Background &Aim: Labor pain is an unpleasant experience for most women and can affect their birth satisfaction. This study investigated the effects of ice pack application on pain intensity in the active phase of labor and on birth satisfaction among primiparous women.Methods & Materials: This randomized controlled trial was conducted on ninety primiparous women. Participants were randomly allocated to either an intervention or a control group. In the intervention group, an ice pack was placed on the sacral area of each participant in the active phase of labor for ten minutes. This intervention was repeated every thirty minutes up to the beginning of the second stage of labor. In both groups, labor pain intensity was assessed before and every one hour after intervention onset and birth satisfaction was assessed 24 hours after delivery. Data were analyzed through the SPSS software (v. 22.0). Results: Groups did not significantly differ from each other respecting participants’ demographic and clinical characteristics. Throughout the study intervention, labor pain intensity increased in both groups; however, the increase in the control group was significantly greater than the intervention group (P < 0.001). Moreover, the mean score of birth satisfaction in the intervention group was slightly greater than the control group, though this difference was not statistically significant (P = 0.24).Conclusion: Without any significant side effects, ice pack application can significantly reduce pain intensity during the active phase of labor. Thus, this intervention is recommended for labor pain alleviation.


Kulkarni S, Sia ST. Hazards of labour pain and the role of non-neuraxial labour analgesia. Trends in Anaesthesia and Critical Care. 2014;4(4):109-114.

Cunningham F, Leveno K, Bloom S, Spong CY, Dashe J. Williams obstetrics, 24e: Mcgraw-hill; 2014.PP.603-610.

Charlton JE. Pain in pregnancy and labor. core curriculum for professional education in pain. 2005.

Leeman L, Fontaine P, King V, Klein MC, Ratcliffe S. The nature and management of labor pain: part II. Pharmacologic pain relief. American family physician. 2003;68(6):1115-1120.

Newham JJ, Wittkowski A, Hurley J, Aplin JD, Westwood M. Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depression and anxiety. 2014;31(8):631-640.

Fair CD, Morrison TE. The relationship between prenatal control, expectations, experienced control, and birth satisfaction among primiparous women. Midwifery. 2012;28(1):39-44.

Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. American Journal of Obstetrics & Gynecology. 2002;186(5):160-172.

Gungor I, Beji NK. Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth. Midwifery. 2012;28(3):348-357.

Goodman P, Mackey MC, Tavakoli AS. Factors related to childbirth satisfaction. Journal of advanced nursing. 2004;46(2):212-219.

Augusta F, Melo AS, KATZ L, Coutinho IC, Amorin MM. Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial.2012; CEP: 520250:110.

Sawyer A, Ayers S, Abbott J, Gyte G, Rabe H, Duley L. Measures of satisfaction with care during labour and birth: a comparative review. BMC pregnancy and childbirth. 2013;13(1):108.

Simkin P, Bolding A. Update on nonpharmacologic approaches to relieve labor pain and prevent suffering. Journal of midwifery & women’s health. 2004;49(6):489-504.

Abbott J , Bowyer L, Finn M. Obstetrics and Gynecology. 2014; pp.106-107.

Baston H, Hall J. Midwifery essentional labour.2010.

Scott F, J. R. The physiologic basic and clinical application of cryotherapy and thermotherapy for the pain practitioner. 2004;7:395-399.

White GE, Wells GD. Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme physiology & medicine. 2013;2(1):26.

Francisco AA, Oliveira SMJVd, Leventhal LC, Bosco CdS. Cryotherapy after childbirth: the length of application and changes in perineal temperature. Revista da Escola de Enfermagem da USP. 2013;47(3):555-561.

Haynes JM. Randomized controlled trial of cryoanalgesia (ice bag) to reduce pain associated with arterial puncture. Respiratory Care; 2015.

Macedo L, Josué A, Maia P, Câmara A, Brasileiro J. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015;101(2):155-160.

Sanders J, Peters TJ, Campbell R. Techniques to reduce perineal pain during spontaneous vaginal delivery and perineal suturing: a UK survey of midwifery practice. Midwifery. 2005;21(2):154-160.

Brown ST, Douglas C, Flood LP. Women's evaluation of intrapartum nonpharmacological pain relief methods used during labor. The journal of perinatal education. 2001;10(3):1.

Paiva CdSB, de Oliveira SMJV, Francisco AA, da Silva RL, Mendes EdPB, Steen M. Length of perineal pain relief after ice pack application: A quasi-experimental study. Women and Birth. 2016;29(2):117-222.

Abdel Ghani R. Effect of heat and cold therapy during the first stage of labor on women perception of birth experience. Journal of Biology, Agriculture and Healthcare. 2014;4.

Pasero C, McCaffery M. Using superficial cooling for pain relief. AJN The American Journal of Nursing. 1999;99(3):24.

Martin CJH, Martin CR. Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery. 2014;30(6):610-619.

Al-Battawi JI, Mahmoud NM, Essa RM. Effect of ice pack application on pain intensity during active phase of the first stage of labor among primiparaous. Journal of Nursing Education and Practice. 2017;8(2):35.

Mardliyana NE, Raden A. Effect of ice gel compress towards labor pain during Active Phase Stage I at private midwivery clinics in Surabaya City area. Majalah Obstetri & Ginekologi. 2017;25(1):21-24.

Purwaningsih A, Rahayu H, Wijayanti K: Effectiveness of warm compress and cold compress to reduce laceration perineum pain on primiparous at Candimulyo Magelang. International journal of research in medical sciences. 2015; 3(1).

Ganji Z, Shirvani MA, Rezaei-Abhari F, Danesh M. The effect of intermittent local heat and cold on labor pain and child birth outcome. Iranian journal of nursing and midwifery research. 2013;18(4):298.

How to Cite
Rahimikian F, Shahbazi S, Mohammadi* S, Haghani S. The effects of ice pack application on pain intensity in the active phase of labor and on birth satisfaction among primiparous women. NPT. 5(3):355-62.
Original Article(s)