Background & aim: Pain management during childbirth is a key component of midwifery care, with non-pharmacological methods widely recommended. Acupressure with ice may provide pain relief, but findings remain inconsistent. Therefore, this systematic review and meta-analysis evaluated the effects of LI4 massage with ice on labor pain.
Methods: This meta‑analysis was performed on articles published up to April 07, 2025. PubMed-Medline, Web of Science, ScienceDirect, and Cochrane Library databases were searched. The potential for bias in both randomized and non-randomized trials was assessed utilizing the Cochrane Risk of Bias Tool for Randomized Trials (RoB-1) and the Risk of Bias Assessment Tool for Non-Randomized Studies (ROBINS-I). Data were analyzed using CMA software version 2. Continuous outcomes were analyzed using MD or SMD, as appropriate, with 95% CIs, and pooled estimates were calculated using a random-effects model.
Results: Of 224 articles, 12 studies were included in the systematic review, and 9 were included in the meta-analysis. The results demonstrated that LI4 massage with ice can reduce labor pain compared with the control group 30 minutes after intervention (MD = −1.25, 95% CI: −1.96 to −0.54, P-value<0/001), and 60 minutes after intervention (SMD = −1.85, 95% CI: −2.61 to −1.10, P-value<0/001). However, no significant reduction was observed immediately after the intervention (MD = −1.89, 95% CI: −4.65 to 0.87, P-value = 0.179).
Conclusion: Based on the results, the acupressure point (LI4) with ice significantly relieved labor pain. Health care providers, especially midwives, can perform this procedure at a hospital or maternity clinic due to its cost-effectiveness and simplicity.