Application of Acupressure and Breathing Techniques During Gentle Birth: A Qualitative Study of Midwives’ and Doulas’ Experiences
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Abstract
Background: Fear of labor pain may influence women's preferences during childbirth, highlighting the need for non-pharmacological approaches. Acupressure and breathing techniques have been used during labor; however, research has largely focused on effectiveness, while limited research has explored their practical application and adaptation to maternal condition and comfort in gentle birth. This study aimed to explore midwives' and doulas' experiences in applying these techniques during gentle birth.
Methods: This study employed a qualitative descriptive design. Seven midwives/doulas were purposively selected as primary informants and interviewed until no new information emerged. One senior midwife and one Traditional Chinese Medicine practitioner served as key and supporting informants, respectively. Data were collected through in-depth interviews and analyzed thematically. Ethical approval was obtained from the Nalanda Institute LRPM Team.
Results: Acupressure application varied according to maternal condition and stage of labor, supporting contractions and labor progression, pain relief, and maternal comfort. Breathing techniques adapted to labor intensity and stage, progressing from deep abdominal breathing to vocalized and blowing breathing as contractions intensified and the baby was expelled.
Conclusion: This study highlights the application of acupressure and breathing techniques in gentle birth. The findings provide insights into individualized non-pharmacological support and may inform midwifery and doula practice.
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Alimoradi, Z., Kazemi, F., Valiani, M., & Gorji, M. (2019). Comparing the effect of auricular acupressure and body acupressure on pain and duration of the first stage of labor: Study protocol for a randomized controlled trial. Trials, 20(1). https://doi.org/10.1186/s13063-019-3896-0
Delgado, A., Marinho, G., Melo, R. S., Pinheiro, F., & Lemos, A. (2024). Effectiveness of breathing exercises during first stage of labor: A systematic review and meta-analysis. European Journal of Integrative Medicine, 68, 102370. https://doi.org/https://doi.org/10.1016/j.eujim.2024.102370
Furong He, Baixiao Zhao, & Meifeng Zheng. (2018). Literature analysis on moxibustion at Yongquan (KI 1) for insomnia. Zhongguo Zhen Jiu, 5413–5414. https://doi.org/10.13703/j.0255-2930.2018.05.024
Heim, M. A., & Makuch, M. Y. (2023). Breathing Techniques During Labor: A Multinational Narrative Review of Efficacy. The Journal of Perinatal Education, 32(1), 23–34. https://doi.org/10.1891/jpe-2021-0029
Hutchison, J., Mahdy, H., Jenkins, S. M., & Hutchison, J. (2025, February 15). Normal Labor: Physiology, Evaluation, and Management. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK544290/
Issac, A., Nayak, S. G., Priyadarshini, T., Balakrishnan, D., Halemani, K., Mishra, P., Indumathi, P., Vijay, V. R., Jacob, J., & Stephen, S. (2023). Effectiveness of breathing exercise on the duration of labour: A systematic review and meta-analysis. Journal of Global Health, 13. https://doi.org/10.7189/jogh.13.04023
Karimi, L., Mahdavian, M., & Makvandi, S. (2020). A systematic review and meta-analysis of the effect of acupressure on relieving the labor pain. In Iranian Journal of Nursing and Midwifery Research (Vol. 25, Number 6, pp. 455–462). Wolters Kluwer Medknow Publications. https://doi.org/10.4103/ijnmr.IJNMR_257_19
Laborde, S., Allen, M. S., Borges, U., Dosseville, F., Hosang, T. J., Iskra, M., Mosley, E., Salvotti, C., Spolverato, L., Zammit, N., & Javelle, F. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711. https://doi.org/https://doi.org/10.1016/j.neubiorev.2022.104711
Larki, M., Karimi, L., Jahanfar, S., Mohammadi, S., & Makvandi, S. (2025). Unveiling the latest evidence: an updated systematic review and meta-analysis and GRADE assessment on the effectiveness of acupressure in managing labor pain. BMC Complementary Medicine and Therapies, 25(1). https://doi.org/10.1186/s12906-025-04908-9
Maciocia, G. C. A. (2015). The Foundations of Chinese Medicine: A Comprehensive Text (Third Edition). Elsevier.
Mukhoirotin, M., & Mustafida, H. (2020). Pemberian Akupresur Kombinasi Titik BL32 dan LI4, Titik BL32 dan Sp6 Untuk Menurunkan Intensitas Nyeri Persalinan. Journal of Holistic Nursing Science, 7(2), 133–141. https://doi.org/10.31603/nursing.v7i2.3118
Nurlaela, E., & Tridiyawati, F. (2022). The Effect of Deep Breath Relaxation and Acupressure Point Li4 is Exposed to the Intensity of Labor Pain Kala I at the Duren Sawit Health Center in Jakarta. East Asian Journal of Multidisciplinary Research (EAJMR), 1(6), 979–986. https://journal.formosapublisher.org/index.php/eajmr/index
R Melzack, & P D Wall. (1965). Pain mechanisms a new theory. https://doi.org/10.1126/science.150.3699.971
Resmiye Kaya Odabas, Yasemin Sökmen, & Ayten Taspinar. (2023). The effect of acupressure on postpartum fatigue in women delivering by caesarean section: A randomized controlled study. Elsevier, 19(3), 293–299. https://doi.org/https://doi.org/10.1016/j.explore.2022.12.001
Rina Aritonang, T., Rachmawati, I., Simanjuntak, F., & Studi Kebidanan, P. (2022). Efektifitas Teknik Tiup-Tiup Botol Terhadap Persalinan Kala II di Klinik Enggal Sehat Kopo Serang Banten. https://stikes-nhm.e-journal.id/OBJ/index
Salsabila, F., & Hidayanti, D. (2023). The Effects of SP6 and LI4 Acupressure Points on Pain and Duration Reduction During The First Stage of Labor: An Evidence-Based Case Report. International Conference on Interprofessional Health Collaboration and Community Empowerment, 4(1), 1–6. https://doi.org/10.34011/icihcce.v4i1.233
Sanjaya, I. N. H., & Pemayun, C. I. M. (2023). Improving the quality of midwife services with gentle birth. Indonesian Journal of Perinatology, 4(1), 15–18. https://doi.org/10.51559/inajperinatol.v4i1.31
SKI. (2023). Survei Kesehatan Indonesia (SKI). Kementerian Kesehatan RI.
WHO. (2021a, June 9). WHO Statement on Caesarean Section Rates. https://www.who.int/news-room/questions-and-answers/item/who-statement-on-caesarean-section-rates-frequently-asked-questions#
WHO. (2021b, June 16). Caesarean section rates continue to rise, amid growing inequalities in access. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access
WHO. (2025). WHO recommendations on maternal health guidelines approved by the WHO Guidelines Review Committee second edition. WHO.
Widayati, E., Harahap, T. S., & Nurmaya, S. (2025). The Relationship Between Oxytocin Massage and Labor Pain in Mother at Mrs. A Midwife’s Practice, Mande District, Cianjur Re-gency, Indonesia. Health Dynamics, 2(2s), 46–51. https://doi.org/10.33846/hd202s07
Widiantari, K., & Dewianti, N. M. (2021). Pengalaman Ibu Multigravida Bersalin dengan Metode Gentle Birth di Klinik Bumi Sehat Kabupaten Gianyar. JOMIS (Journal of Midwifery Science), 5(1), 10–20. https://doi.org/10.36341/jomis.v5i1.1335
Zuarez-Easton, S., Erez, O., Zafran, N., Carmeli, J., Garmi, G., & Salim, R. (2023). Pharmacologic and nonpharmacologic options for pain relief during labor: an expert review. In American Journal of Obstetrics and Gynecology (Vol. 228, Number 5, pp. S1246–S1259). Elsevier Inc. https://doi.org/10.1016/j.ajog.2023.03.003