Massage, reflexology and other manual

methods for managing pain in labour

This version published: 2012; Review content assessed as up-to-date: December

20, 2011.

Link to full article: [Cochrane Library]

Plain language summary

The pain of labour can be intense, with tension, anxiety and fear making it worse.
Many women would like to labour without using drugs such as narcotics or
epidurals, and turn to complementary therapies to help them manage the pain of
labour. Many complementary therapies are tried and in this review we have
looked to see if massage, reflexology and other manual healing methods are
effective. Other complementary therapies like acupuncture, mindbody
techniques, hypnosis and aromatherapy have been studied in other reviews.
Massage involves manipulating the bodys soft tissues and it can be done by the
midwife or partner. It helps women relax and so reduces the tension which
increases pain in labour. Reflexology is gentle manipulation or pressing on certain
parts of the foot to produce an effect elsewhere in the body. Other manual healing
methods include osteopathy, shiatsu and zero balancing etc.

We found six studies, with data available from five trials on 326 women, looking
at the use of massage in labour for managing pain. There were no studies on any
of the other manual healing methods. The six studies were of reasonable quality
but more participants are needed to provide robust information. We found that
women who used massage felt less pain during labour when compared with
women given usual care during first stage. However, more research is needed.
Abstract

Background: Many women would like to avoid pharmacological or invasive

methods of pain management in labour, and this may contribute towards the
popularity of complementary methods of pain management. This review
examined currently available evidence supporting the use of manual healing
methods including massage and reflexology for pain management in labour.

Objectives: To examine the effects of manual healing methods including massage

and reflexology for pain management in labour on maternal and perinatal
morbidity.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's

Trials Register (30 June 2011), the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library 2011, Issue 2 of 4), MEDLINE (1966 to 30
June 2011), CINAHL (1980 to 30 June 2011), the Australian and New Zealand
Clinical Trial Registry (30 June 2011), Chinese Clinical Trial Register (30 June
2011), Current Controlled Trials (30 June 2011), ClinicalTrials.gov, (30 June
2011) ISRCTN Register (30 June 2011), National Centre for Complementary and
Alternative Medicine (NCCAM) (30 June 2011) and the WHO International
Clinical Trials Registry Platform (30 June 2011).

Selection criteria:Randomised controlled trials comparing manual healing

methods with standard care, no treatment, other nonpharmacological forms of
pain management in labour or placebo.

Data collection and analysis: Two authors independently assessed trial quality
and extracted data. We attempted to contact study authors for additional
information.

Main results: We included six trials, with data reporting on five trials and 326
women in the metaanalysis. We found trials for massage only. Less pain during
labour was reported from massage compared with usual care during the first stage
of labour (standardised mean difference (SMD) 0.82, 95% confidence interval
(CI) 1.17 to 0.47), four trials, 225 women), and labour pain was reduced in one
trial of massage compared with music (risk ratio (RR) 0.40, 95% CI 0.18 to 0.89,
101 women). One trial of massage compared with usual care found reduced
anxiety during the first stage of labour (MD 16.27, 95% CI 27.03 to 5.51, 60
women). No trial was assessed as being at a low risk of bias for all quality
domains.

Authors' conclusions:Massage may have a role in reducing pain, and improving

women's emotional experience of labour. However, there is a need for further
research.

Editorial Group: Cochrane Pregnancy and Childbirth Group.

Publication status: New.

Citation: Smith CA, Levett KM, Collins CT, Jones L. Massage,

reflexology and other manual methods for pain management in labour.
Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.:
CD009290. DOI: 10.1002/14651858.CD009290.pub2. Link to Cochrane
Library. [PubMed]

Pregnancy and birth: Managing pain during childbirth

Last Update: October 16, 2013; Next update: 2016.

Women who are about to give birth often have mixed feelings especially if it
is their first child. Many of them wonder: Will the pain be as bad as everyone
says? How will I cope with it? Are there alternatives to painkillers?

Giving birth to a child is one of lifes most intense experiences. Towards the end
of pregnancy, when everyday life has become more difficult, most women cannot
wait to finally have the baby. The anticipation of that moment is often mixed with
feelings of excitement and anxiety. They will have heard a lot of stories and
opinions about what happens or should happen during childbirth. And they
will have seen quite a few dramatic birth scenes in TV shows and movies.

Some women have already seen films about birth in a childbirth class or on the
internet. But when it is right about to happen, it is still uncharted territory no one
actually knows beforehand how labor will really feel and how well the birth will
go.

It is not possible to plan everything that happens during childbirth. Women have
to be ready for unexpected turns. Having a very specific idea of what the birth will
be like could make the actual birth disappointing. Being well-informed is just as
important as getting support from others when preparing for the birth. Partners or
other people who would like to be there during the birth can also provide the best
support if they are well-informed.

How can I cope with labor pain?

Giving birth is a physical and emotional challenge, and having good support
really makes a difference. For many women, it is a relief to have someone there to
encourage them and make it as comfortable as possible, perhaps by massaging
their back or preparing heat packs. People like their partner, a friend or a midwife
could provide this kind of support.

Reliable support makes a real difference. It not only helps women get through
labor emotionally: research has shown that continuous support can shorten labor a
little and reduce the likelihood of needing pain relief.

Midwives are well-trained and experienced in finding the best way for women to
cope with pain. They can react quickly during childbirth and explain what your
options are. Sometimes women feel reluctant to bother the busy staff at the
hospital or birthing center with a lot of questions. But having your questions
answered is a critical part of the support needed in labor too. Being stressed and
anxious can have effects like making your muscles tense, which does not make it
easier to cope with pain. The traditional ways in which women have always
helped themselves get through labor include:

Getting into different positions like sitting up instead of lying to find the most
comfortable position.

Walking around if possible. Walking and moving around might help relieve the
pain a little and make the birthing process easier, or even speed it up.

Trying out cold or heat packs. This can relieve pain and especially the back
pain that often accompanies labor pains.

Breathing calmly and consciously, or trying out special breathing techniques

The position of a womans body is particularly important in labor. If, for instance,
the baby's head is pressing too deeply against your back, changing position can
usually relieve the pain and make it much easier to push. And if the baby moves
or changes position, you can respond by changing your position until it feels
better.
Childbirth classes teach techniques that can be used to take advantage of gravity
during labor. Some people swear by particular positions or breathing techniques.
Different women will find different things to be helpful something that makes
the birth easier for one woman might only help a little, or even make things less
pleasant, for another.

For many women, labor pain is different from other painful experiences. This is
partly because it is pain with a positive goal and because they know it will
definitely end quite soon. Finally holding your baby in your arms at the end of it
all is an enormous reward for all the effort.

Are there alternatives to medication?

There are a lot of tips for relieving pain during childbirth without using
medication. But only a few of the commonly recommended measures have proven
to be effective in studies. These include:

Relaxation techniques and yoga: Studies suggest that some women feel less
pain while giving birth if they do relaxation exercises. Techniques like Jacobsons
progressive muscle relaxation, or breathing and movement exercises taken from
Hatha Yoga, can help distract women from the pain, relax their muscles, and help
them breathe more calmly.

Bathing: Relaxing in a warm bathtub, shower or whirlpool can help relieve pain
in some women.

Massage: Having a back or foot massage can relax and calm your muscles. Your
partner or another person who will accompany you during the birth can learn
some gentle massage techniques beforehand.

There is no scientific proof for the effectiveness of the following approaches:

Acupuncture: In acupuncture, thin needles are inserted into the skin at specific
points on the body to relieve pain. Because the needles are not taken out, they can
 make it harder to move about during the birth. Previous research has led to
contradictory results.

Hypnosis: Hypnosis aims to help people relax and achieve an inner state of
maximum concentration. When in this state, your own perception of for
example pain can be influenced by what someone else tells you. Self-hypnosis
is also possible, by repeating certain instructions to yourself. Previous studies on
the effectiveness of hypnosis are not reliable enough to say whether it can relieve
labor pain.

Injecting sterile water into the lower back: This aims to help relieve severe
back pain during labor. It is not commonly used, and there is no good-quality
research on its effectiveness.

Transcutaneous electrical nerve stimulation (TENS): In this approach,

electrodes that send out small electrical impulses are taped to the skin, causing a
mild tingling sensation. Women can adjust the intensity and frequency of the
impulses themselves. The theory behind it is that these impulses override the pain
signals, so that you feel less pain. But previous research suggests that TENS has
little influence on pain perception. There is also not enough research on whether
this approach might have side effects for the baby.

Biofeedback: This relaxation technique uses a computer to make it possible to

see or hear different signals from your body, such as your pulse or breathing rate.
This way you can also see how your own body responds to pain or anxiety. The
aim is to then relax your body by consciously focusing on reducing these signals.
This has not been proven to be effective during childbirth.

There is also no evidence that women feel less pain when listening to calming
music or sounds, or if they use aromatherapy, homeopathy or have acupressure.

How can partners help?

Having someone there to support you during childbirth can be helpful in many
ways. The following things are essential for good support:
 Make sure that the pregnant woman is not left alone (unless she would like to
have some time alone): It can make a big difference to feel that someone you are
close to is there to help take care of things.

Remain attentive and flexible, and focus on her needs, but also be willing to leave
her alone if that is what she would prefer.

Encourage her, for instance by saying how well she is doing everything.

Try to make things as comfortable as possible for her: All of the little niceties
make a big difference and can really help make things easier like having
someone show understanding or care, being kept warm or being given a gentle
massage.

Help her keep track of what is going on: Encourage her to ask questions. Or she
might want you to ask the midwife or doctor for her instead.

Childbirth can, of course, also be so overwhelming for the person accompanying

the woman that they feel helpless and need some support themselves. And
hospitals do not always allow partners or other people to accompany women in
every stage of the birthing process. It might help to discuss this with the doctor or
midwife before the birth, so that there are no surprises.

Some people might worry about dealing with seeing the woman in so much pain,
or how they might react to seeing so much blood. But during the actual birth, they
often find it easier than expected to focus on her, and block out other things
happening at that moment.

It could also be helpful to talk to each other beforehand about what to do in an

emergency. The person accompanying the pregnant woman might need to make
some decisions, especially if the woman needs a Cesarean section and is given a
general anesthetic. Knowing what is important to her can help make it easier to
make better decisions when the time comes. By taking a childbirth class together,
couples can learn about many things that could be useful when making those
kinds of mutual decisions.

Letting the birth run its course

Many women and their partners realize afterwards that talking about the pain
relief options helped them feel more ready for the birth, but that the actual birth
was then very different than they had expected.

Trying to imagine exactly what the birth will be like is not very helpful: Doing so
can make it more difficult to be flexible in unexpected and changing situations. It
might seem surprising, but in the middle of labor, pain and pain management are
often far less important than might be expected. Many women are very satisfied
with their birth and care, even if they were in a lot of pain.

Some women worry far too much about whether other people think they are
coping well or doing everything right during labor. But when you are giving
birth, what helped other women is not important: The only thing that matters is
what works best for you and your baby. For instance, screaming or wailing during
the birth is completely acceptable. The midwives and doctors will have seen it all
before and they will not be easily shocked. The main thing is that you feel good,
and that you deliver a healthy baby. You can do whatever you feel like doing to
make the birth easier for you.

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