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Jurnal Ners 
Vol. 15, No. 2, Special Issue 2020  
http://dx.doi.org/10.20473/jn.v15i2(si).20514 

This is an Open Access article distributed 
under the terms of the Creative Commons 

Attribution 4.0 International License 

 

Original Article 

The Effect of a Cold Compress on Pain During the First Stage of Childbirth at BPM 

Nur Hidayatin, Anita Dwi A, Erika Prawitasari 

Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia 

ABSTRACT 

Introduction: Childbirth is a physiological process that happens as part of 
a woman's development into becoming a mother. The process can be 
traumatic for some women because of the pain that they experience. Cold 
compress therapy is one of the non-pharmacological approaches to 
reducing pain. The objective of this study is to determine the effect of a cold 
compress on pain in the first stage of childbirth. 

Methods: This was an experimental study with a one group pretest-
posttest design. The population of this research consisted of women who 
had given birth, totaling 15 respondents. The samples were chosen using 
Accidental Sampling. The data was taken through observations and it was 
analyzed using the Wilcoxon Signed Rank test with a significance level of 
0,05. 

Results: There were changes in pain level with a significance value of ρ = 
0,008 with a testing rule ρ < 0,05. This shows that the cold pack affected 
the level of pain during the first stage of childbirth. 

Conclusion: A cold compress is effective at reducing the pain felt during 
childbirth. The items used to make a cold compress are easy to find and a 
woman can make it herself. A cold compress can be given without causing 
harmful effects for either the babies or the mothers who are giving birth. 

ARTICLE HISTORY 

Received: Feb 27, 2020 
Accepted: April 1, 2020 

KEYWORDS 

a cold compress; childbirth pain; 
uterine contractions; first stage 

CONTACT 

Nur Hidayatin  
 nur.hidayatin-
2019@fkp.unair.ac.id 
 Faculty of Nursing, Universitas 
Airlangga, Surabaya, East Java, 
Indonesia 

Cite this as:  Hidayatin, N., A, A. D., Prawitasari, E. (2020). The Effect of a Cold Compress on Pain During the First Stage 
of Childbirth at BPM.  Jurnal Ners, Special Issues, 473-475. doi: 
http://dx.doi.org/10.20473/jn.v15i2(si).20514 

 

INTRODUCTION  

Childbirth is the process of the thinning and opening 
of the cervix followed by the descent of the fetus into 
the birth canal. This is followed by the birth of the 
fetus(Deye, N., Vincent, F., Michel, P., Ehrmann, S., Da 
Silva, D., Piagnerelli, M., … Laterre, P.-F. (2016). The 
first stage of labor pain is often experienced by 
mothers who are about to give birth(Srivastava, Avan, 
Rajbangshi, & Bhattacharyya, 2015). This pain 
originates from the lower abdomen as a result of the 
cervix opening and thinning. The pain spreads to the 
lower back and down to the thighs. Here it is caused 
by the fetal head pressure on the mother's 
spine(Spector et al., 2013). As the volume and 
frequency of the uterine contractions increases, the 
pain will feel stronger. Pain during childbirth is 
considered to be the single strongest physiological 
pain, so there is the opinion that it does not need to be 
reduced in intensity. This is paired with the belief that 
it can be relieved using non-pharmacological 

therapy(Mesenburg et al., 2018). One form of non-
pharmacological therapy is cold compress therapy. 
This is because cold compresses can have an analgesic 
effect. This can provide relaxation to tense muscles 
and joint stiffness(Perez-Brena, Updegraff, Umaña-
Taylor, Jahromi, & Guimond, 2015).  

According to the WHO, one report estimates that 
there are 210 million deliveries annually. Out of this 
number, 20 million women experience pain as a 
result of childbirth. About 8 million experienced life-
threatening complications and more than 500,000 die 
(Van der Gucht & Lewis, 2015). A total of 240,000 
from this amount make up almost 50% from South 
and Southeast Asian countries, including Indonesia. 
Previous childbirth experiences can also affect a 
mother's response to pain(Vowles, McCracken, 
Sowden, & Ashworth, 2014). Primigravida mothers 
do not have the experience of childbirth compared to 
multigravida mothers. Mothers who are giving birth 
for the first time will feel stressed or afraid in the face 
of childbirth (Deye, N., Vincent, F., Michel, P., 

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N. HIDAYATIN, ET AL. 
 

474 | pISSN: 1858-3598  eISSN: 2502-5791 

Ehrmann, S., Da Silva, D., Piagnerelli, M., … Laterre, P.-
F. (2016). Stress or fear physiologically can cause the 
uterine contractions felt to be increasingly painful 
(Deye, N., Vincent, F., Michel, P., Ehrmann, S., Da Silva, 
D., Piagnerelli, M., … Laterre, P.-F. (2016).  

Mothers in the condition of giving birth are 
experiencing stress. The body stimulates the body to 
release stress hormones, namely catecholamine and 
adrenalin(Deye, N., Vincent, F., Michel, P., Ehrmann, S., 
Da Silva, D., Piagnerelli, M., … Laterre, P.-F. (2016). 
Catecholamine can be released in high concentrations 
during labor if the mother cannot eliminate her fear 
before giving birth(Deye, N., Vincent, F., Michel, P., 
Ehrmann, S., Da Silva, D., Piagnerelli, M., … Laterre, P.-
F. (2016). As a result, the uterus becomes increasingly 
tense so the blood flow and oxygen sent to the uterine 
muscle decreases. This is because the arteries shrink 
and constrict. The result is an inevitable pain (Deye, 
N., Vincent, F., Michel, P., Ehrmann, S., Da Silva, D., 
Piagnerelli, M., … Laterre, P.-F. (2016). Multigravida 
mothers who have already given birth will be able to 
respond to the pain better. For the mothers who give 
birth in a relaxed state, all layers of muscle in the 
uterus will work together in harmony so then the 
labor will progress smoothly, easily and comfortably. 

MATERIALS AND METHODS  

The research was experimental with a one group pre-
test post-test design. The study was conducted at 
BPM. The study population consisted of all mothers in 
the first stage of birth in BPM, totaling 15 
respondents. The sample selection used was an 
accidental sampling technique. The research data was 
taken using an observation sheet. After tabulation, the 
data was analyzed using the Wilcoxon Sign Rank test 
at a significance level of 0.05. This study was carried 
out beginning with the measurement of the pain scale 
when the mother’s uterus had begun contracting. A 
cold compress was given after measuring the pain 
scale. It was placed on the back of the waist at the top 
of the coccyx when the uterine contractions were 
apparent for 15 minutes. After the compress was 
applied, then we measured the pain scale again. 

RESULTS  

The results obtained showed that before getting cold 
compress therapy, the respondents experiencing mild 
pain totaling 0 (0) respondents. After getting therapy, 
this was felt by 4 respondents (27%). Moderate pain 
before the cold compress was felt by 6 respondents 
(40%) and after, it was felt by 4 respondents (27%). 
Severe pain before the cold compress was felt by 8 
respondents (53%) and after, it was felt by 7 
respondents (46%). The pain was very severe before 
the cold compress for 1 respondent (7%) and after 
being given the cold compress therapy, severe pain 
was felt by 0 respondents (0%). There was a change 
in the pain scale with a significant value of p = 0.008 
with a testing principle p <0.05. This shows that the 
cold compresses affect first stage delivery pain at 
BPM. It can be seen that almost all of the respondents 

before undergoing cold compress therapy 
experienced severe pain. After the cold compress 
therapy was conducted, all respondents experienced 
a decrease in pain even if the decrease was not 
significant. This is because the pain is very subjective. 
After all, how the pain is felt varies in each individual 
in terms of scale in addition to the level, the 
mechanism of pain and their pain adaptations. From 
this, it can be seen that cold compresses greatly affect 
the decrease in labor pain in the first stage. 

DISCUSSION 

The first stage of labor is the result of the contraction 
of the uterine myometrium and the vasoconstriction 
of the blood vessels around the internal genitalia. This 
is in addition to the parasympathetic involvement of 
the efferent nerve fibers around the internal 
genitalia(Mesenburg et al., 2018). Because of these 
two nerve responses, rhythmic and intermittent 
uterine contractions occur. Before a cold compress, 
the nerves that are around the uterus and cervix will 
experience tension. This can cause severe pain in the 
first stage of birth. After the cold compress, the nerves 
around the uterus and cervix begin to relax so then 
the labor pain at the first stage reduces(Perez-Brena 
et al., 2015). The effect of cold compresses on pain 
according to the gate control theory says that skin 
stimulation activates the greater and faster 
transmission of the sensory A-beta nerve fiber 
signals(Van der Gucht & Lewis, 2015).  

This process decreases the pain transmission 
through the small diameter C and A-beta fibers. The 
syntax gate ends the pain implant transmission(Deye, 
N., Vincent, F., Michel, P., Ehrmann, S., Da Silva, D., 
Piagnerelli, M., … Laterre, P.-F. (2016). Cold 
compresses will have an analgesic effect by slowing 
down the speed of the nerve delivery so then the pain 
signal reaches the brain less often and more slowly. 
Other mechanisms that might work are the cold 
perception becoming dominant, thus reducing the 
pain perception. Cold compress therapy is useful as 
vasoconstriction reduces the blood flow to the injured 
body area, preventing the formation of edema and 
reducing inflammation. Local anesthesia can be used 
to reduce the local pain. Cellular metabolism 
decreases to reduce the oxygen demand of the tissue. 
Increased blood viscosity increases blood coagulation 
at the site of the injury. Decreased muscle tension is 
useful for pain relief. 

CONCLUSION 

Childbirth is a series of processes that ends with the 
release of the child from the womb of the mother. This 
process begins with labor contractions, marked by 
the opening of the cervix. It ends with the birth of the 
placenta. The labor process is identical to the pain 
that will be experienced. Physiologically, pain occurs 
when the muscles of the uterus contract to open the 
cervix and push the baby's head towards the pelvis. 
To reduce the pain in the first stage of labor, non-



JURNAL NERS 
 

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pharmacological methods can be applied including a 
cold compress. 

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