Massage During Pregnancy and Postpartum

Effectiveness of sacral massage during labor in pregnant women: A systematic review and meta-analysis

BACKGROUND AND AIM

Performing sacral massage during the childbirth process can provide numerous benefits due to its potential to alleviate stress and exhaustion. This systematic review and meta-analysis aimed to assess the effectiveness of sacral massage in pregnant women during labor.

METHOD

A comprehensive search was conducted in main databases from inception to 18th May 2024. The quality of included randomized control trials (RCTs) and quasi-experimental studies was assessed using the Jadad Scale and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS), respectively. All analyses were performed using the RevMan version 5.3. The GRADEpro GDT tool was utilized to determine the level of certainty of the evidence.

FINDINGS

Nine articles were included in the systematic review and eight studies were included in the meta-analysis. The findings showed that in the sacral massage group, the labor pain intensity was significantly decreased (SMD= -2.40, 95 % CI -3. 5 to -1.29, p<0.0001, I² = 97 %). The findings also showed that sacral massage does not significantly alter the length of the first labor stage (MD=-0.04, 95 % CI -0.27 to 0.20, p = 0.77, I² = 0 %) and the total duration of labor (MD= -0.56, 95 % CI -1.66, 0.55,p = 0.32, I² = 90 %). The certainty of evidence for labor pain was moderate and for duration of the first stage and total duration of labor were very low.

CONCLUSION

This study demonstrated that sacral massage was an effective, non-pharmacologic method that significantly alleviating pain in women during childbirth. As a result, this intervention can be implemented in clinical settings during labor.

The effect of acupressure and massage on labor pain and birth satisfaction: a randomized controlled trial

OBJECTIVE

This randomized controlled trial was conducted to determine the effect of acupressure and massage used for the management of labor pain in the latent, active, and transition phases of the first stage of labor on labor pain and birth satisfaction.

METHODS

The study was conducted with 66 pregnant women who met the sampling criteria and participated voluntarily at a public hospital in Nicosia. The participants were randomly assigned to one of three groups: a massage group, an acupressure group, or a control group. Participants in the massage group received 10 min of sacral massage during contraction and 10 min of endorphin massage during rest, for a total of 30 min of massage per phase. Participants in the acupressure group received 3 min of acupressure to the LI 4 point at the same dilation intervals, when the contraction was most intense. The control group received no intervention. Pain perceived by the pregnant woman was evaluated with the Visual Comparison Scale (VAS) at the beginning and end of each phase. Postpartum, the Birth Satisfaction Scale was applied.

RESULTS

Massage application was found to be more effective in reducing labor pain than acupressure or the control group. Massage and acupressure did not negatively affect APGAR scores. The lowest oxytocin use was found in the massage group. The group with the highest birth satisfaction scores was also the massage group.

CONCLUSION

Massage application is more effective than acupressure application in reducing labor pain and increasing birth satisfaction.

Investigating the impact of haptotherapy on maternal-fetal attachment in unplanned pregnancies

BACKGROUND

Mothers who experience unplanned pregnancies tend to show less maternal attachment to the fetus, which can lead to diminished self-care during pregnancy, and affect well-being of the fetus. Consequently, unintended pregnancies are associated with heightened maternal and fetal consequences due to mothers' negligence. Hippotherapy intervention has emerged as a viable approach to enhance maternal-fetal communication. The ultimate goal of this study was to broaden our current understanding of haptotherapy's impact on maternal-fetal attachment in unplanned pregnancies.

MATERIALS AND METHODS

This field trial research was conducted at comprehensive health centers in Isfahan using convenient sampling method. The study consisted of two groups of mothers, each consisting of 33 individuals with unplanned pregnancies between 20 to 24 weeks. The experimental group received haptotherapy intervention for 10 weeks, while the control group received standard pregnancy care. For data collection the participants were given demographic and fertility questionnaire prior to the study, and Cranley's maternal-fetal attachment questionnaire both before and after the study. Moreover, T-test, Mann-Whitney U test, and Chi-square test were used for data analysis.

RESULTS

Prior to the intervention, there was no significant difference in the average maternal-fetal attachment scores between the experimental and control groups (P = 0.56). However, a significant increase became apparent after the intervention. The experimental group exhibited a significant improvement in the mean attachment scores compared to their pre-intervention levels (t=-9.20, P = 0<0.001). In contrast, the control group's score remained unchanged, with no significant difference observed (=1.69, P = 0.1).

CONCLUSION

Haptotherapy has been found to enhance maternal-fetal attachment in mothers experiencing unplanned pregnancies. This valuable intervention is recommended as an innovative and secure approach in maternal health care services to help reduce the potential complications associated with such pregnancies.

Swedish massage as an adjunct approach to Help suppOrt individuals Pregnant after Experiencing a prior Stillbirth (HOPES): a convergent parallel mixed-methods single-arm feasibility trial protocol

BACKGROUND

Women experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress.

OBJECTIVE

This paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data.

METHODS

HOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists' private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women's experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned.

DISCUSSION

The HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth.

TRIAL REGISTRATION

CLINICALTRIALS

gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

Rehabilitation of anterior knee pain in the pregnant athlete: Considerations and modifications by trimester

BACKGROUND

Anterior knee pain is a common symptom many females experience during pregnancy. There are several musculoskeletal changes that occur in anatomy and physiology throughout the course of pregnancy that impact the lower extremity kinetic chain. Pregnant athletes, recreational through competitive, who attempt to maintain a high activity level through each trimester may be at increased risk for anterior knee pain due to a greater demand for lumbopelvic and hip stabilization.

CLINICAL QUESTION

What are the evidence-driven rehabilitation guidelines and specific modifications needed to treat anterior knee pain in the female athlete during each trimester of pregnancy?

KEY RESULTS

We aim to provide an overview of rehabilitation treatment guidelines for pregnant females with anterior knee pain, presenting specific physiological changes and rationale for modifications, discussed by trimester. We recommend our program be conducted under the supervision of a physical therapist working closely with the athlete's obstetrics and sports medicine team.

CLINICAL APPLICATION

The number of women who are active during pregnancy is increasing. We provide an overview of the guidelines and considerations for treating women with anterior knee pain during a healthy and uneventful pregnancy.

Revealing the impact of lifestyle stressors on the risk of adverse pregnancy outcomes with multitask machine learning

Psychosocial and stress-related factors (PSFs), defined as internal or external stimuli that induce biological changes, are potentially modifiable factors and accessible targets for interventions that are associated with adverse pregnancy outcomes (APOs). Although individual APOs have been shown to be connected to PSFs, they are biologically interconnected, relatively infrequent, and therefore challenging to model. In this context, multi-task machine learning (MML) is an ideal tool for exploring the interconnectedness of APOs on the one hand and building on joint combinatorial outcomes to increase predictive power on the other hand. Additionally, by integrating single cell immunological profiling of underlying biological processes, the effects of stress-based therapeutics may be measurable, facilitating the development of precision medicine approaches.

Objectives

The primary objectives were to jointly model multiple APOs and their connection to stress early in pregnancy, and to explore the underlying biology to guide development of accessible and measurable interventions.

Materials and Methods

In a prospective cohort study, PSFs were assessed during the first trimester with an extensive self-filled questionnaire for 200 women. We used MML to simultaneously model, and predict APOs (severe preeclampsia, superimposed preeclampsia, gestational diabetes and early gestational age) as well as several risk factors (BMI, diabetes, hypertension) for these patients based on PSFs. Strongly interrelated stressors were categorized to identify potential therapeutic targets. Furthermore, for a subset of 14 women, we modeled the connection of PSFs to the maternal immune system to APOs by building corresponding ML models based on an extensive single cell immune dataset generated by mass cytometry time of flight (CyTOF).

Results

Jointly modeling APOs in a MML setting significantly increased modeling capabilities and yielded a highly predictive integrated model of APOs underscoring their interconnectedness. Most APOs were associated with mental health, life stress, and perceived health risks. Biologically, stressors were associated with specific immune characteristics revolving around CD4/CD8 T cells. Immune characteristics predicted based on stress were in turn found to be associated with APOs.

Conclusions

Elucidating connections among stress, multiple APOs simultaneously, and immune characteristics has the potential to facilitate the implementation of ML-based, individualized, integrative models of pregnancy in clinical decision making. The modifiable nature of stressors may enable the development of accessible interventions, with success tracked through immune characteristics.

The most appropriate cervical dilatation for massage to reduce labor pain and anxiety: a randomized clinical trial

Background

Managing labor pain by performing massage is one of the useful strategies to reduce the rate of cesarean section and increase the tendency of women for pregnancy. Therefore, it is necessary to determine the best time for massage therapy to reduce the labor pain and anxiety. In this regard, the present study was conducted to determine the cervical dilatation appropriate for performing massage in order to reduce the labor pain and anxiety.

Methods

This randomized clinical trial study was conducted on 60 nulliparous pregnant women. Eligible participants with active phase of labor were divided randomly into two groups. The intervention group received the massage three times in of dilatation 5–7–9 cm for 20 min each time by same person without the use of oil in the LDR, based on Kimber massage instructions. In the control group, all routine care was performed except massage. Pain intensity was assessed using pain ruler. Demographic and anxiety data were collected through questionnaires.

Results

The difference between the mean pains in the studied groups was significant in 7 cm (p < 0.0001) of cervical dilatation but was not significant in 5 cm (p = 0.084) and 9 cm (p = 0.591) dilatation. Massage effectively decreased pain intensity. The mean maternal anxiety was not significant at the beginning of the study, but was significant after performing massage (p < 0.0001) and anxiety score in the massage group decreased from 63.36 ± 5.28 (severe anxiety) at the beginning to 42.60 ± 5.83 (moderate anxiety) at the end of the study. In the control group, it increased from 66.33 ± 7.66 to 67.1 ± 5.65.

Conclusion

The appropriate dilatation of cervix for massage in order to reduce labor pain was observed in 7 cm. Also, massage had a significant effect on reducing anxiety. Therefore, massage is recommended as a routine care in 7 cm cervical dilatations.

Trial registration

This trial was registered with the Iran Trial Center (trial ID: IRCT20140118016255N5). https://en.irct.ir/trial/28120