Update on Nonpharmacologic Approaches to Relieve Labor Pain and Prevent Suffering

Penny Simkin, PT; April Bolding, PT


J Midwifery Womens Health. 2004;49(6) 

In This Article

Touch and Massage

Touching another human being can communicate positive messages such as caring, concern, reassurance, or love. Massage, "the intentional and systematic manipulation of the soft tissues of the body to enhance health and healing,"[44] is used during labor to enhance relaxation and reduce pain and suffering. A systematic review[10] identified 2 RCTs: one on touch and one on massage. A third trial was published since the review.[45]

Effectiveness of Touch and Massage in Reducing Pain and Suffering During Labor

One of the trials[46] included in the systematic review studied 90 women. The "touch" group received 5 to 10 seconds of reassuring touch each time the woman expressed anxiety during a 30-minute period between 8- and 10-cm dilation. The controls received usual care. The women's blood pressure and the number of expressions of anxiety significantly decreased in the "touch" group. The postpartum assessments of anxiety during the study period were lower in the "touch" group.

The second trial of massage[47] described in the systematic review (N = 28) randomized women to receive either usual care (control group) or massage of head, back, hands, and feet by their partners for 20 minutes per hour for 5 hours during labor. The frequent massage reduced the women's pain and anxiety and improved their mood.

A more recent RCT conducted in Taiwan[45] included 60 women, 30 of whom received massage and 30 women in a control group who received usual care. The primary researcher gave massage 3 times, once during each phase of labor (latent, active, and transition), and taught the woman's partner how to do it. Massages lasted for 30 minutes in each phase, and were then repeated by the partner. Pain intensity was rated by a nurse observing each woman's manifestations of pain using a present behavioral intensity scale. Anxiety was measured by using a visual analog scale for anxiety. Although pain intensity increased steadily through progressing phases of labor, the massage group had statistically significant lower pain intensity scores at each phase of labor (0.73 vs 1.30 in latent; 1.73 vs 2.17 in active; and 2.17 vs 2.87 in transition phases). Anxiety levels were significantly lower in the massage group during the latent phase (37.2 vs 53.5 on a 100-point scale); 87% of the women in the massage group reported that the massage was helpful in providing pain relief and psychological support.

There are few drawbacks to the use of touch or massage. The partners have to be taught appropriate massage techniques before labor (i.e., in childbirth classes) or during labor (i.e., by a skilled doula, nurse, midwife, or massage therapist). These few small studies indicate that women appreciate being touched and massaged during labor, and these simple interventions may reduce pain and enhance feelings of well-being.


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