ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X Effect of Moxibustion Therapy at SP6 (Sanyinjia.
Acupressure Point on Labor Pain Intensity During First Stage Active Phase Andita Rania Salsabila1.
Anik Purwati2.
Reny Retnaningsih3
1,2,3,
Midwifery Study Program.
Faculty of Health Sciences.
Institute of Science and Health Technology Dr.
Soepraoen Hospital Malang.
Malang.
Indonesia Corresponding Author: anikasyda@itsk-soepraoen.
Article history:
Submitted, 2026/03/08 Accepted, 2026/04/10 Published, 2026/04/13 Keywords:
Moxibustion.
SP6
(Sanyinjia.
labor pain.
stage active phase.
complementary therapy.
Cite This Article:
Salsabila AR.
Purwati A.
Retnaningsih R.
Effect of moxibustion therapy at SP6 (Sanyinjia.
acupressure point on labor pain intensity during first stage active phase.
J Ilm Kebidanan (The J Midwifer.
:86.
DOI: 10.
33992/jik.
ABSTRACT
The active phase of the initial stage of labor is characterized by escalating pain intensity due to uterine contractions and cervical Inadequate pain management can lead to significant discomfort and stress for laboring women.
Preliminary observations at independent midwifery practices Yulis Indriana indicated that most mothers experienced moderate to severe pain during this phase.
Nonpharmacological interventions, such as moxibustion therapy at the SP6 .
acupressure point, may reduce pain.
This study aimed to analyze differences in labor pain intensity before and after moxibustion therapy during the active phase.
A quasi-experimental study with a non-equivalent control group design was conducted, involving 32 respondents selected through accidental sampling, with 16 in the intervention group and 16 in the control group.
Pain intensity was measured using the Numeric Rating Scale .
Data were analyzed using univariate and bivariate methods with a significance level of p < The intervention group exhibited a significant reduction in pain intensity from 7.
88 A 0.
719 to 5.
13 A 0.
< 0.
whereas the control group showed no significant change, from 69 A 0.
873 to 7.
75 A 0.
= 0.
A significant difference between groups was also identified .
< 0.
Moxibustion therapy at SP6 may reduce labor pain intensity and can be considered a complementary intervention in midwifery practice.
INTRODUCTION
Childbirth is a physiological process involving the delivery of the fetus through the birth canal, accompanied by cervical dilatation and coordinated uterine contractions.
While seen as a natural procedure, labor is often linked to considerable discomfort, especially during the active portion of the first stage1.
This phase is distinguished by a gradual increase in the strength, frequency, and duration of uterine contractions, as well as cervical dilation, all of which contribute to an increased perception of Inadequately managed labor pain can trigger stress responses, such as elevated catecholamine levels, potentially resulting in maternal exhaustion, anxiety, reduced placental perfusion, and ineffective uterine contractions3.
Therefore, effective pain management is essential to ensure a safe and comfortable childbirth experience.
Improving labor pain management is also aligned with global health priorities, including the Sustainable Development Goals (SDG.
, which aim to reduce maternal mortality to 70 per 100.
000 live The World Health Organization (WHO) emphasizes the importance of providing supportive care Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X during labor as part of quality maternal care.
WHO data shows that only about 15% of births occur without or with minimal pain, while most mothers experience moderate to severe pain 5.
In Indonesia, approximately 85Ae90% of women experience pain, and only 7Ae15% have pain-free births6.
This indicates that labor pain remains a significant problem and requires attention.
Labor pain can be managed through pharmacological and nonpharmacological approaches.
While pharmacological methods are effective, they may be associated with side effects and are not always feasible in all settings7.
In contrast, nonpharmacological approaches, such as relaxation techniques, massage, acupressure, and moxibustion, are considered safer, with minimal side effects, and are relatively easy to implement in midwifery practice8.
These approaches are also consistent with the principles of woman-centered care, which emphasize maternal comfort and support.
Moxibustion is a traditional East Asian therapy that involves applying heat generated by burning mugwort (Artemisia argyi foliu.
to specific acupuncture points.
Stimulation at the SP6 .
point has been associated with reduced labor pain intensity 3.
Compared with other methods, moxibustion offers several advantages, including its simplicity, non-invasiveness, relatively low cost, and ease of application, without requiring complex equipment, making it particularly suitable for midwife-led settings.
Prior research has established the effectiveness of SP6 stimulation in alleviating labor pain.
the majority of data has concentrated on acupressure or alternative methods.
Consequently, there is insufficient evidence on the effectiveness of moxibustion as a form of thermal stimulation, particularly in midwife-led independent practices in Indonesia.
Given the high prevalence of labor pain and the limited access to pharmacological analgesia in such settings, identifying safe, cost-effective, and easily applicable nonpharmacological interventions is essential.
This study aims to examine the impact of moxibustion therapy at the SP6 .
acupressure point on the intensity of labor pain during the active period of the first stage of labor in autonomous midwifery practices in Indonesia.
METHOD
This research utilized a quasi-experimental methodology incorporating a non-equivalent control group with pretest and posttest assessments.
Two groups were included: an intervention group undergoing moxibustion therapy and a control group receiving conventional care devoid of moxibustion.
The severity of pain was assessed prior to and following the intervention in both groups.
The research was carried out from January to March 2026 at midwifery practices Yulis Indriana.
Malang.
From July to September 2025, the population consisted of 60 mothers who were in the active phase of the initial stage of labor.
A total of 32 respondents were recruited and allocated into two groups .
in the intervention group and 16 in the control grou.
Sample size determination utilised FedererAos formula for experimental investigations.
however, practical and clinical constraints necessitated the use of accidental sampling.
Respondents were chosen based on predefined inclusion and exclusion criteria, which encompassed term pregnancy .
-42 week.
, cervical dilatation of 4-7 cm, cephalic presentation, stable mother and fetal conditions, and willingness to participate.
Mothers experiencing obstetric problems, utilising analgesics, suffering from skin issues, or exhibiting foetal distress were excluded.
To mitigate selection bias and enhance group comparability, participants were assigned sequentially according to their admission order, and baseline variables .
ge, education, occupation, and parit.
were evaluated to guarantee homogeneity between groups.
The intervention group received moxibustion therapy with a moxa stick (Artemisia vulgari.
at the SP6 .
acupressure point for 15 minutes, with the device positioned approximately 2-3 cm from the skin surface.
The intervention was delivered once during the active phase, given clinical feasibility and prior evidence supporting brief-duration stimulation.
To ensure safety, precautions were implemented to prevent burns, including continuous observation of skin responses and maintaining an appropriate distance.
All procedures were carried out in accordance with a standardised protocol (SOP) by trained midwives.
Meanwhile, the control group received routine midwifery care, including labour Published by Midwifery Department of Health Polytechnic.
Ministry of Health.
Denpasar.
This is an Open Access (OA) article distributed under the terms of the Creative Commons Attribution Share-Alike 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X monitoring, emotional support, and positioning assistance, without any complementary interventions.
This design was intended to maintain comparability between groups while isolating the specific effect of moxibustion therapy.
Pain intensity was evaluated using the Numeric Rating Scale (NRS) ranging from 0 to 10, a validated and reliable instrument commonly used in clinical pain evaluation.
Although pain levels were categorised, the analysis used numerical scores to reflect changes in pain intensity accurately.
Data were analyzed with SPSS version 25.
Descriptive statistics were utilized to summarize participant characteristics and pain levels.
The Wilcoxon Signed Rank Test was used to evaluate within-group differences, whereas the Mann-Whitney U test was employed to compare differences between the intervention and control groups.
Statistical significance was established at p < 0.
The Ethics Committee of the Institute of Science and Health Technology, dr.
Soepraoen Hospital.
Malang (No.
KEPK-EC/456/1/2.
Informed consent was acquired from all respondents, and data confidentiality was rigorously upheld during the study.
RESULT AND DISCUSSION
According to the research that has been carried out on 32 participants, the following table presents their demographic information, including age, education level, occupation, and parity:
Table 1.
Characteristics of respondent Characteristics Age 20-24 years 25-29 years 30-35 years Total Education Elementary school Junior High School High School/Vocational School College Total Occupation Employed Unemployed Total Parity Primigravida Multigravida Total Frequency Percentage (%) Table 1 presents the characteristics of 32 respondents in both the intervention and control groups, encompassing age, education, occupation, and parity.
Most of the respondents were in the 2024 age range, namely 13 respondents .
6%).
Respondents aged 25-29 years accounted for 10 respondents .
3%), while respondents aged 30-35 years accounted for 9 respondents .
1%).
The majority of respondents have completed high school or technical education, totaling 20 respondents .
5%), while those with a junior high school education comprise 3 respondents .
4%), and those Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X with higher education comprise 9 respondents .
1%).
Based on work status, most respondents did not work 20 respondents .
5%), while those who worked numbered 12 .
5%).
Based on parity, the majority of respondents were primigravida, 20 respondents .
5%), while the remaining 12 respondents .
5%) were multigravida.
The age distribution reveals that most respondents were within the ideal reproductive age range of 20 to 35 years, as the reproductive organs and psychological state of the mother are more developed, hence enhancing preparedness for the delivery process9.
Educational level and occupation varied across respondents but were relatively comparable between groups.
Parity distribution showed a higher proportion of primigravida women.
Previous studies suggest that parity may influence pain perception, as primigravida women tend to report higher anxiety and lower pain adaptation compared to multigravida women10.
The baseline characteristics of the intervention and control groups were similar, showing no significant variations in essential demographic variables that could affect the study This criterion enhances the study's internal validity by reducing the likelihood of selection Table 2.
Pretest and posttest labor pain intensity in the intervention and control groups Group Intervention Control Variable Pretest Posttest Pretest Posttest Median Min Max The analysis presented in Table 2 shows that the intervention group experienced a reduction in labor pain intensity, with the median score decreasing from 8.
00 in the pretest to 5.
00 in the posttest.
This change was statistically significant according to the Wilcoxon Signed Rank test .
< 0.
suggesting that moxibustion therapy at the SP6 .
acupressure point may contribute to a decrease in pain perception during the active phase of labor.
Clinically, this reduction from severe to moderate pain could indicate a potential improvement in maternal comfort, although this interpretation should be considered cautiously due to the quasi-experimental design and the relatively small sample size .
= .
In contrast, the control group exhibited no change in pain intensity, with the median score remaining at 8.
00 from pretest to posttest.
Statistical analysis indicated no significant difference .
= These findings suggest that standard obstetric care, without targeted non-pharmacological interventions, may be insufficient to reduce labor pain during the active phase.
The persistence of pain in the control group likely reflects the physiological processes of labor.
Progressive cervical dilation and increasingly strong uterine contractions elevate nociceptive signaling 11.
Additionally, repeated contractions may induce local tissue hypoxia and increase levels of pain mediators 12.
Psychological factors, such as maternal anxiety, can further amplify pain perception, particularly in primigravida 13.
The reduction in pain observed in the intervention group aligns with previous studies indicating that SP6 point stimulation is associated with decreased labor pain intensity 3.
Mechanistically, moxibustion delivers thermal stimulation that activates cutaneous receptors and promotes the release of endogenous analgesics, including endorphins and enkephalins.
This process also engages a gate control mechanism at the spinal cord level, modulating the transmission of nociceptive impulses to the central nervous system14.
In addition to these analgesic effects.
SP6 moxibustion may enhance uterine blood flow, improve contraction coordination, and elicit a relaxation response, thereby contributing to overall maternal comfort4.
While within-group comparisons suggest potential benefits, interpretation is constrained without between-group analyses involving the control group.
Consequently, additional statistical tests.
Published by Midwifery Department of Health Polytechnic.
Ministry of Health.
Denpasar.
This is an Open Access (OA) article distributed under the terms of the Creative Commons Attribution Share-Alike 4.
0 International License .
ttps://creativecommons.
org/licenses/by-sa/4.
0/).
ORIGINAL ARTICLE
Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864 p-ISSN: 2338-669X such as the Mann-Whitney test, are necessary to rigorously evaluate the effectiveness of moxibustion compared to standard care and to enhance the clinical relevance of the results.
Table 3.
posttest pain levels in intervention and control groups Posttest Group Moxibustion Therapy Standard Treatment Median Based on Table 3, the MannAeWhitney U test revealed a statistically significant difference in posttest pain reduction between the intervention and control groups .
< 0.
This indicates that changes in pain levels differed between groups.
This finding is consistent with the within-group analysis, which found that only the intervention group experienced pain reduction.
Thus, moxibustion therapy at point SP6 .
appears to be associated with lower labor pain intensity than standard care alone.
These results align with previous research showing that SP6 point stimulation is associated with reduced labor pain intensity3.
Theoretically, moxibustion provides thermal stimulation that activates skin receptors and facilitates the release of endogenous opioids such as endorphins.
It also modulates pain transmission through a gate-control mechanism at the spinal level14.
In the control group, the lack of pain reduction may be attributed to the physiological progression of labor, characterized by increased intensity and frequency of uterine contractions during cervical dilation 11.
This progression can lead to tissue hypoxia and the release of pain mediators, as well as increased psychological responses such as anxiety, especially in primigravida mothers13.
These findings suggest that standard obstetric care alone may not be sufficient to reduce labor pain without additional, specialized supportive interventions.
Taken together, these results provide strong evidence for the efficacy of moxibustion, as demonstrated by both within-group and between-group comparisons, and demonstrate a clinically significant reduction in labor pain intensity during the active phase.
This study extends the existing literature by presenting evidence for the application of moxibustion, rather than acupressure, to the SP6 point in midwife-led practice in Indonesia, where such research remains limited.
These findings underscore the potential of moxibustion as a non-pharmacological strategy for labor pain management and confirm its role as a safe, feasible, and complementary intervention to improve maternal comfort in clinical practice.
However, this study did not include effect size estimation or confidence interval analysis, which may limit the interpretation of the magnitude and precision of the observed effects.
CONCLUSION
Application of moxibustion at the SP6 .
acupressure point was associated with a reduction in labor pain intensity during the initial active phase.
This effect is evidenced by a decrease in median pain scores from 8.
00 in the pretest to 5.
00 in the posttest within the intervention group, whereas the control group showed no change in median pain scores from 8.
00 in the pretest to 8.
00 in the posttest.
Statistical analyses using the Wilcoxon and Mann-Whitney tests further confirm that moxibustion yields greater pain reduction than standard care.
This study's main weaknesses include its quasi-experimental design and limited sample size, which warrant caution when generalizing the findings.
The findings endorse moxibustion as a safe and effective nonpharmacological method for improving mother comfort and alleviating labor pain during the initial active phase.
Available online at: http://ejournal.
poltekkes-denpasar.
id/index.
php/JIK ORIGINAL ARTICLE Jurnal Ilmiah Kebidanan (The Journal of Midwifer.
Volume 14.
Number 1 : 86-91 DOI: https://doi.
org/10.
33992/jik.
e-ISSN: 2721-8864
p-ISSN: 2338-669X
ACKNOWLEDGMENTS
The author conveys gratitude to all participants who contributed to this research, facilitating a seamless research process.
Thank you also to independent midwifery practices Yulis Indriana for providing permission and support for the implementation of this research.
REFERENCES