Research

Regular massage for maternal pain and anxiety in labour

Evaluation of complementary therapies

In 2006 a meta analysis was published in the Cochrane Database of Systematic Reviews, on selected trials on complementary therapies, for pain management in labour (Smith et al 2006). The authors concluded that few therapies have been subjected to proper scientific scrutiny and methodological problems were found in all trials. To date adequate evidence has been published on acupuncture and hypnosis, although the numbers are small and methodological weakness were identified. Only one massage trial met inclusion criteria and it was not sufficiently large or well designed to provide reliable evidence. This conclusion has also been reported in the draft guidelines for intrapartum care by the National Institute of Clinical Excellence (NICE). These authors state that there is insufficient evidence on the efficacy of massage during labour and recommend further trials to test its effects on maternal pain perception and birth outcomes.

Evidence on pharmacological interventions

Recent research indicates that most commonly used methods of pharmacological pain relief interfere with the physiological processes of labour and birth, increasing the need for obstetric interventions and adversely affecting the initiation, and duration of lactation and the long term health of the fetus. (Anand & Scalzo 2000, Kotaska al 2006, Mazouni et al 2006, Torvaldsen et al 2006, Jonas et al 2007). Despite this growing evidence of adverse effects of pharmacological interventions, research on the neurophysiology of labour pain and on non-pharmacological coping strategies remains very limited.

Recommendations for research on complementary therapies

Good quality clinical trials need to be carried out on non-pharmacological methods of pain relief, to decrease obstetric interventions, promote normal birth and increase the initiation and duration of lactation. Clinical trials on non-pharmacological interventions are needed to provide an evidence base that supports or refutes the use of a range of complementary and alternative interventions for pain and anxiety, from late pregnancy to birth (Smith et al 2006).

To contribute to recent recommendations for improving the quality and reliability of clinical trials to investigate the effects of massage on maternal pain perception in labour, we have worked systematically through a rigorous process of designing, testing and refining a programme of massage, breathing and visualisation, to coincide with endogenous changes in maternal pain threshold, from 36 weeks gestation until birth. We began with a feasibility study on the intervention to produce a detailed specification of the programme and put in place the environmental conditions needed to make it conducive for women to receive massage during labour (McNabb et al 2006). This was followed by a placebo controlled pilot study, which has demonstrated that the effects of the programme on maternal pain perceptions cannot be accounted for by the social support offered as part of the intervention. The findings have also been used to calculate the precise numbers needed for an adequately powered trial to demonstrate significance.

References

  • Anand KJS, & Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behaviour? Biology of the Neonate. 2000; 77: 69-82
  • Jonas W, Wiklund I, Nissen E, Randjo-Arvidson A-B, Uvnas-Moberg K. Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices. Early Human Development. 2007; 83: 55-62
  • Kotaska AJ, Klein MC, Liston RM. Epidural analgesia associated with low-dose oxytocin augmentation increases cesarean births: a critical look at the external validity of randomized trials. Am J Obstet Gynecol. 2006; 194(3):809-14.
  • Mazouni C, Porcu G, Bretelle F, Loundou A, Heckenroth H, Gamerre M. Risk factors for forceps delivery in nulliparous patients. Acta Obstet Gynaecol Scand. 2006; 85(3):298-301
  • McNabb M, Kimber L, Haines A, McCourt C. Does regular massage from late pregnancy to birth decrease maternal pain perception during labour and birth? A feasibility study to investigate a programme of massage, controlled breathing and visualization from 36 weeks of pregnancy until birth. Complementary Therapies in Clinical Practice 2006; 12: 222-231
  • Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain management in labour(Review) The Cochrane Collaboration, 2006; John Wiley & Sons Ltd
  • Torvaldsen S, Roberts CL, Simpson JM, Thompson JF, Ellwood DA. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. Int Breastfeeding J. 2006; 1:24