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Massage Today
December, 2012, Vol. 12, Issue 12

Bringing Relief to First-Time Mothers During Labor

By Massage Therapy Foundation Contributor

Contributed By Jolie Haun, PhD, LMT; Sandy Anderson, BA, LMT, ABT; April Neufeld, BS, LMT, NCTMB

The Massage Therapy Foundation is always looking for ways to expand its borders. This month's review reaches internationally to a study conducted at Baharlou University Hospital in Tehran, Iran. This recent publication in the Archives of Gynecology and Obstetrics examined the "effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor" in first time mothers.

Since the beginning of time, the majority of women of childbearing age have reported experiencing intense pain and anxiety during labor, particularly first time mothers. Mortazavi and colleagues collected important data for women seeking relief during labor. The study included 120 women pregnant for the first time. Participants were between 16 and 36 years of age, with an average age of 23. Participants had normal term pregnancies (gestational age between 37 and 42 weeks) without complications at the time of admission to the hospital; and had cervical dilatation of no more than 4cm. Potential participants were not included in the study if a cesarean procedure was needed or if Oxytocin infusion was needed to accelerate or augment the progression of labor.

pregnant lady - Copyright – Stock Photo / Register Mark Participants were randomized into three groups of 40 participants: those receiving massage, those with an attendant, and a control group (no massage and no attendant). Participants in the massage group received firm rhythmic massage for 30 minutes during labor in three phases: latent phase (3–4 cm cervical dilation), active phase (5–7 cm cervical dilation), and deceleration phase (8–10 cm cervical dilation). These women were encouraged to close their eyes and breathe deeply while receiving massage. The massage protocol included shoulder and back massage, abdominal effleurage, and/or sacral pressure, depending on the participant's preference. After a 30-minute massage at each stage, pain, anxiety and satisfaction levels were evaluated. Satisfaction was also measured 30 minutes after delivery (considered phase 4). A self-reported pain intensity scale was used to measure the labor pain. Anxiety and satisfaction were measured with a standard visual analog scale.

In the attendant group, an attendant who provided emotional support stayed with the mother throughout the entire labor. Participants in the control group received standard care, with no additional intervention. Outcomes regarding pain, anxiety, and satisfaction were also assessed in both the attendant and control groups.

Results indicated that participants in the massage group had lower pain scores in the second and third phases, compared to the attendant group. However, levels of reported anxiety were lower in the attendant group in second and third phases. Overall, satisfaction was higher in the massage group in all four phases. The massage group had lower pain and anxiety scores compared to the control group and higher satisfaction scores in the massage group compared to the control group. Participants in the attendant group also showed higher satisfaction when compared to the control group. Data findings also indicated that the duration of active phase was lower in the massage group compared to the other groups.

Mortazavi and colleagues conclude that the presence of an attendant can reduce anxiety and improve satisfaction. Additionally, massage is a safe and effective alternative for reducing pain and anxiety during labor and increases satisfaction. Notably, the active phase length was reduced by massage therapy and the presence of an attendant when compared to the control group.

However, before conclusions about the data can be made, study limitations should be noted. The small sample size in this study limits the power of the findings. Studies with larger sample sizes, representing diverse ethnic and cultural populations, as well as geographical locations are needed. In addition, objective outcomes, beyond those that are self-reports in nature, are needed to avoid participant response bias. For example, future studies can evaluate the effects of massage to reduce labor pain by evaluating bio-factors associated with pain and anxiety such as heart rate variability, cortisol levels and the use of pain medication.

Although these study limitations represent some concern for confounding effects (i.e. factors that influence outcomes that are not being measured), the research findings are compelling and warrant further investigation. These preliminary findings reveal massage and attendant presence provide a significant benefit for women during labor, which should be explored in obstetrics practice. Obstetricians serving women in need of perinatal care can provide enhanced support by providing patients with options to integrate complementary modalities into birthing plans.

As massage therapists continue to diversify their practice to meet clients' needs and clients look for new ways to integrate massage therapy into their approach to healthcare, Mortazavi and colleagues present compelling evidence that the approach to birthing plans can be significantly improved through the presence and practice of massage therapists, and offer a pleasant complementary treatment during labor.

These findings also contribute to the wide field of massage therapy research. These data support the evidence-based practice of massage to treat anxiety and pain during labor; consistent with previous findings supporting the use of massage to reduce anxiety and pain associated with chronic pain, lower back pain, muscle pain in general, and cancer pain that is often associated with treatment. This study also illustrates the beneficial effects of massage therapy are experienced across different cultural and ethnic groups and geographic locations.

Source: Mortazavi SH, Khaki S, Moradi R, Heidari K, Vasegh Rahimparvar, SF. Effects of massage therapy and presence of attendant on pain, anxiety and satisfaction during labor. Arch Gynecol Obstet (2012) 286:19–23.

To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search Pub Med for massage therapy studies.

Click here for more information about Massage Therapy Foundation Contributor.


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