With the delivery of the fetus and the placenta, in a process induced by oxytocin and prostaglandins, the uterine muscle initiates the process of involution and bleeding control by contracting rhythmically. When the uterine muscle contracts, the compression of spinal blood vessels reduces blood flow and leads the woman to experience acute pain and cramping1,2. Previous studies have revealed that multiparous women and women who experience dysmenorrhea have higher rates of postpartum uterus pain1,3, 4, 5. Additionally, various uterotonic drugs that are used to prevent and treat postpartum bleeding and oxytocin that is secreted by breastfeeding increase the tone of the uterus and may exasperate the pain1, 2, 3,5. Postpartum uterus pain is a situation that can affect mother-infant bonding and breastfeeding negatively and is a matter of concern for women.1,3

It was reported that 47% of women experienced postpartum uterus pain, the pain was observed within 6-48 hours after delivery, and after 48 hours, uterus pain decreased, and perineum pain was seen more1. In addition to this, it was stated that some women needed analgesics for this pain3. The limited possibility of drug usage in the postpartum period due to the transition of analgesics into breastmilk increases the importance of nonpharmacological pain relief methods.

Acupressure is among the nonpharmacological methods that are used in pain relief6, 7, 8. Acupressure, which is performed by applying pressure on acupuncture points along meridians carrying energy in the body by using one's fingers, palms, and special tapes, allows the energy channels to operate correctly9,10. It is generally based on the practice principles of acupuncture. The only difference is that the facilitation of the correct operation of the energy channels occurs via pressure on certain points in acupressure, as opposed to the use of needles in acupuncture11. Acupressure is used to maintain the state of well-being and solve problems during pregnancy, delivery, and the postpartum period. It is also among the methods that are utilized for pain relief12, 13, 14. Acupressure relaxes muscles by stimulating the secretion of endorphin, acetylcholine, norepinephrine, dopamine, and enkephalin and activates the opioid system. Furthermore, when pressure is applied to the acupuncture points on the body, with the initiation of the nociception process, impulses stimulate serotoninergic and enkephalinergic neurons. This way, the activation of the analgesic system is facilitated14,15. The stimulation of acupressure points allows the establishment of a sympathetic and parasympathetic balance and the healthy continuation of homeostasis16,17. The purpose of using acupressure in pain management is to reduce the use of analgesics by lowering the pain level of the person as much as possible. While acupressure has been frequently used as a relief technique in dysmenorrhea-associated pain18, no study on acupressure in the context of postpartum uterus pain was encountered in the literature. In similar studies, it was stated that postpartum uterine contraction is usually at its peak when the baby starts sucking after delivery, and the Sanyinjiao 6 acupoint (Spleen 6 point-SP6) was used to relieve this pain19. Some other acupressure points that are used in pain relief are the Gallbladder 21 point (GB21), Small Intestine 9 point (SI9), Large Intestine 15 point (LI15), Large Intestine 5 point (LI5), and Large Intestine 4 point (LI4). Among these acupressure points, LI4 and SP6 have been prevalently used in scientific studies and reported to be effective in pain relief8,20,21. Acupressure may be a tool for reducing uterus pain in the postpartum period that emerges by breastfeeding among women and improving their self-care and well-being.

Many studies on postpartum pain management have conventionally focused on incision pain while resting or moving following cesarean delivery or perineum pain (especially following an episiotomy)22,23, but the focus on postpartum uterus contraction pain has not been sufficient. Acupressure provides midwives with a potential opportunity in the management of postpartum uterus pain as an evidence-based independent intervention. Accordingly, the purpose of our study is to determine the effectiveness of acupressure application in relieving postpartum uterus pain that is experienced while breastfeeding.

H0: Acupressure application during breastfeeding following vaginal delivery does not have an effect in reducing uterus pain.