The Effect of Chewing Gum in Managing Labor Pain Intensity and Anxiety Level in Primiparous Women: A Randomized Controlled Trial

Document Type : Original Article

Authors

1 Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran;

2 Department of Midwifery and Reproductive Health, School of Nursing & Midwifery, Babol University of Medical Sciences, Babol, Iran;

3 Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran;

4 Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

5 Health Research Institute, Babol University of Medical Sciences, Babol, Iran

Abstract

Background: Fear and anxiety of the pain caused by childbirth is the main resistance of women against natural childbirth; therefore, women prefer cesarean delivery. The utilization of non-pharmacological treatments can make the childbirth process pleasurable for the mother. This study aimed to determine the effect of chewing gum on anxiety and labor pain intensity in primiparous women.
Methods: This randomized controlled study was conducted in two public health centers (Babol, Iran) from May 2021 to October 2022. The participants comprised 116 primiparous women with a gestational age of 38–42 weeks and a diagnosis of labor pain. The pregnant women were subjected to block randomization and allocated to two groups of 58 patients. The intervention group received chewing gum for 20 minutes in the three stages, including dilatation of 3–4 cm, 5–7 cm, and 8–10 cm. The control group received only standard care. The tools used for data collection included demographic and obstetric characteristics, the State-Trait Anxiety Inventory (STAI) questionnaire, and the Visual Analog Scale (VAS). The data were analyzed hroughtSPSS, version 22, using the Chi-square test, Repeated Measures ANOVA, paired t test, independent t-test, and ANCOVA. A significance level of less than 0.05 was considered.
Results: There was a significant difference in the mean pain scores after the intervention between the two groups in dilatation of 3-4 cm (P=0.003), 5-7 cm (P<0.001), and 8-10 cm (P<0.001); also, the chewing gum group had lower pain intensity. There was a significant difference in the mean state anxiety (P<0.001) and trait anxiety (P<0.001) scores after the intervention between the two groups, and the gum chewing group had lower anxiety.
Conclusion: Chewing gum is a practical alternative method for decreasing anxiety and pain intensity during childbirth in primiparous women.
Trial Registration Number: IRCT20100510003902N5.

Highlights

Farideh Mohsenzadeh-Ledari (Google Scholar) (PubMed)

Keywords


1.    Yazdiha MS, Naghibzadeh M, Ghorbani R, et al. The Relationship between Types of Delivery and Methods of Anesthesia with Occurrence of Jaundice in Term Neonates. International Journal of Pediatrics. 2018;6:7959-64.
2.    Cheng ST, Chan KL, Lau RWL, et al. Correction to: A multicomponent intervention for the management of chronic pain in older adults: study protocol for a randomized controlled trial. Trials. 2021;22:842.
3.    Hosseni SF, Pilevarzadeh M, Vazirinasab H. Non-pharmacological strategies on pain relief during labor. Biosciences Biotechnology Research Asia. 2016;13(2).
4.    Yildizeli Topcu S, Akgun Kostak M, Semerci R, et al. Effect of Gum Chewing on Pain and Anxiety in Turkish Children During Intravenous Cannulation: A Randomized Controlled Study. Journal of Paediatric Nursing. 2020;52:e26-32.
5.    Henderson R, Mentz M, Rourke N, et al. Selection and use of pain assessment instruments by physical therapists in paediatric practice, and their attitudes towards pain in children. Physiotherapy. 2015;101:e556.
6.    Vader K, Bostick GP, Carlesso LC, et al. The Revised IASP Definition of Pain and Accompanying Notes: Considerations for the Physiotherapy Profession. Physiotherapy Canada. 2021;73:103-6.
7.    Dumas-Mallet E, Button KS, Boraud T, et al. Low statistical power in biomedical science: a review of three human research domains. Royal Society Open Science. 2017;4:160254.
8.    van Griensven H, Strong J. Pain-E-Book. 3rd ed. India: ‎Elsevier; 2022.
9.    Whiteford G, Jones K, Weekes G, et al. Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation. British Journal of Occupational Therapy. 2020;83:52-61.
10.    Janbabaee G, Moosazadeh M, Agah R, et al. Trend of caesarean section and natural childbirth in governmental and private hospitals during 2007-2014 and its 2021 forecast in Mazandaran province, Iran. Journal of Mazandaran University of Medical Sciences. 2016;25:1-11. [In Persian]
11.    Andaroon N, Kordi M, Kimiaei SA, Esmaeili H. Relationship between Intensity of fear of Childbirth with choosing mode of delivery in Primiparous Women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2017;20:68-75. [In Persian] 
12.    de Castro Gonçalves J, Oliveira AM, Batalha LC, et al. A functional measurement approach to the Children’s Anxiety and Pain Scale-CAPS: contributions to its construct validity. Psicológica Journal. 2014;35:653-74.
13.    Indovina P, Barone D, Gallo L, et al. Virtual Reality as a Distraction Intervention to Relieve Pain and Distress During Medical Procedures: A Comprehensive Literature Review. The Clinical Journal of Pain. 2018;34:858-77.
14.    Lennon R. Pain management in labour and childbirth: Going back to basics. British Journal of Midwifery. 2018;26:637-41.
15.    Jafarzadeh A, Hadavi M, Hasanshahi G, et al. Cesarean or Cesarean Epidemic? Archives of Iranian Medicine. 2019;22:663-70.
16.    Chang CY, Gau ML, Huang CJ, et al. Effects of non-pharmacological coping strategies for reducing labor pain: A systematic review and network meta-analysis. PLoS One. 2022;17:e0261493.
17.    Ali ZAR, Khamis MA, Mohammed NAHM, et al. Effect of back massage and reflexology on labor pain reduction and vital signs during first stage of labor at Sohag University Hospital. Assiut Scientific Nursing Journal. 2020;8:103-12.
18.    Binny J, Joshua Wong NL, Garga S, et al. Transcutaneous electric nerve stimulation (TENS) for acute low back pain: systematic review. Scandinavian Journal of Pain. 2019;19:225-33.
19.    Miquel S, Haddou MB, Day JEL. A systematic review and meta-analysis of the effects of mastication on sustained attention in healthy adults. Physiology & Behavior. 2019;202:101-15.
20.    Kamiya K, Fumoto M, Kikuchi H, et al. Prolonged gum chewing evokes activation of the ventral part of prefrontal cortex and suppression of nociceptive responses: involvement of the serotonergic system. Journal of Medical and Dental Sciences. 2010;57:35-43.
21.    Ireland AJ, Ellis P, Jordan A, et al. Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2016;150:220-7.
22.    Ebrahimian A, Rahmani Bilandi R. Comparisons of the Effects of Watching Virtual Reality Videos and Chewing Gum on the Length of Delivery Stages and Maternal Childbirth Satisfaction: A Randomized Controlled Trial. Iranian Journal of Medical Sciences. 2021;46:15-22.
23.    Çetinkaya ŞŞ, Durmuş A. Effect of Chewing Gum and Stress Ball on Labor Pain, Duration of Labor, and Birth Satisfaction: A Randomized Controlled Study. Forbes Journal of Medicine. 2024;5:51-8.
24.    Salari P, Alavian F, Habibi Rad A, et al. The relationship between stress, anxiety and pain with salivary cortisol levels in first stage of labor in primiparous women. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2013;16:14-21. [In Persian]
25.    Ebrahimian A, Bilandi RR, Bilandī MRR, et al. Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy and Childbirth. 2022;22:49.
26.    Makvandi S, Zargar Shoshtari S, Montazeri S, et al. The effect of chewing sugar-free gum on the anxiety level of active phase of labor in nulliparous women. Razi Journal of Medical Sciences. 2013;20:9-15. [In Persian]
27.    Flores-Orozco EI, Rovira-Lastra B, Peraire M, et al. Reliability of a visual analog scale for determining the preferred mastication side. The Journal of Prosthetic Dentistry. 2016;115:203-8.
28.    Knop C, Oeser M, Bastian L, et al. [Development and validation of the Visual Analogue Scale (VAS) Spine Score]. Der Unfallchirurg. 2001;104:488-97. 
29.    Shahoie R, Karimi A, Sharifish S, et al. Evaluation of the effectiveness of mindfulness-based stress reduction on anxiety in pregnant women. Scientific Journal of Nursing, Midwifery and Paramedical Faculty. 2019;5:83-94. [In Persian] 
30.    Court H, Greenland K, Margrain TH. Measuring patient anxiety in primary care: Rasch analysis of the 6‐item Spielberger state anxiety scale. Value in Health. 2010;13:813-9.
31.    Manouchehri K, Hassanabadi H, Aghabarary M, et al. Linkage between cognitive load theory and academic emotions: Effects of emotion induction on anxiety, cognitive load and learning in nursing students. Contemporary Psychology, Biannual Journal of the Iranian Psychological Association. 2020;14:1-14. [In Persian] 
32.    Behdani F, Sargolzaei M, Ghorbani E. Study of the relationship between lifestyle and prevalence of depression and anxiety in the students of Sabzevar Universities. Journal of Sabzevar University of Medical Sciences. 2000;7:27-37. [In Persian]
33.    Mahram B. Validity of Spielberger state-trait anxiety inventory (STAI) in Mashhad city. [thesis]. Tehran: Allameh Tabatabaei University; 1993. [In Persian]
34.    Baljon K, Romli MH, Ismail AH, et al. Effectiveness of Breathing Exercises, Foot Reflexology and Massage (BRM) on Maternal and Newborn Outcomes Among Primigravidae in Saudi Arabia: A Randomized Controlled Trial. International Journal of Womens Health. 2022;14:279-95.
35.    Amiri P, Mirghafourvand M, Esmaeilpour K, et al. The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial. BMC Pregnancy and Childbirth. 2019;19:534.
36.    Koyyalamudi V, Sidhu G, Cornett EM, et al. New Labor Pain Treatment Options. Current Pain and Headache Reports. 2016;20:11.
37.    Ebrahimian A, Bilandi RR, Bilandī MRR, Sabzeh Z. Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy and Childbirth. 2022;22:49.
38.    Helmy HK, Baraia ZA, Masoud HK, et al. Effect of virtual reality and chewing mint gum on labor pain intensity and anxiety level: A Comparative Study. Egyptian Journal of Health Care. 2022;13:1923-35.
39.    Farzanegan F, Zebarjad SM, Alizadeh S, et al. Pain reduction after initial archwire placement in orthodontic patients: a randomized clinical trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2012;141:169-73.
40.    Mohsenzadeh Ledari F, Barat S, Nasiri Amiri F, et al. Effect of gum chewing after cesarean-delivery on return of bowel function. Journal of Babol University of Medical Sciences. 2012;14:19-24. [In Persian]