The Proven Benefits of Touch During Labor

By: Meridith Bradshaw

Each laboring woman is unique in the type of support she may want during labor. It is important that each woman be supported in having the kind of birth experience
she most desire while upholding the health of mother and baby in that process. Support through touch has been proven to reduce the anxiety and pain experience during labor (Chang et al, 2006) thus creating potential for decrease use of pharmacological interventions.

When women are left alone, fear and anxiety are more likely to dominate her experience, possibly leading to a longer and more challenging birth. Yet, our “modern” hospital health care practices have made it much easier and more efficient for nurses to offer pain and anxiety relieving medication, than for them to offer support techniques such as massage, breathing and holding. This phenomenon could be due to the demands on nurses and hospital staff to insure that labor progresses in a timely manner with the utmost attention towards avoiding expensive malpractice lawsuits.

The gate control theory of pain states that the brain can only process so many stimuli in any given moment. Painful stimuli travel slower over nerve pathways than pleasurable stimuli. Massaging hairless parts of the body such as the hands and feet transmit signals of pleasure to the brain quicker than signals of pain. The other important hairless part of the body during labor is the mouth. Kissing between the partner and laboring woman not only initiates the gate control theory but facilitates a reflexive relaxation response in the perineum necessary for birth. This theory is a wonderful indicator for the use of massage and touch during labor, as laboring women who receive those pleasurable sensations are often less aware of pain and ultimately will have fewer medical interventions and possibly a shorter labor (Field et al, 1997). Acupressure, the application of finger pressure or deep massage to traditional acupuncture points located along the body's meridians or energy flow lines has been reported to reduce labor pain and promote progress (Simkin et al, 1995)

One study by (Chang M. et al, 2002) examined the effects of massage on pain and anxiety during labor. Sixty primiparous women expected to have a normal childbirth at a regional hospital in Taiwan were randomly assigned to either the experimental (women receiving massage) or control (women not receiving massage) group. In the experimental group, the woman’s partner was trained to give massage for 30 minutes during the latent, active and transitional phases of labor during uterine contractions in each phase. The intensity of pain and anxiety between the two groups was compared in the latent phase, active phase and transitional phase. The massage techniques used were effleurage, sacral pressure and shoulder and back-kneading. In both groups, there was a relatively steady increase in pain intensity and anxiety level as labor progressed. A t-test demonstrated that the experimental group had significantly lower pain reactions in the latent, active and transitional phases. Anxiety levels were only significantly different between the two groups in the latent phase. Eighty-six percent of the experimental group subjects reported that massage was helpful in providing pain relief and psychological support during labor.

In the Journal of Psychosomatic Obstetric and Genecology (Field et al, 1997) a study of twenty-eight women were recruited from prenatal classes and randomly assigned to receive massage in addition to coaching in breathing from their partners during labor, or to receive coaching in breathing alone. The massaged mothers reported a decrease in depressed mood, anxiety and pain, and showed less agitated activity and anxiety and more positive affect following the first massage during labor. In addition the massaged mothers had shorter labors, a shorter hospital stay and less postpartum depression.
Interventions of baccalaureate nursing students, trained as doulas, were examined for their association with epidural anesthetic use (Van Zandt et al 2005). Doulas trained to support laboring mothers, are associated with shorter labors and fewer medical interventions. Data from a convenience sample of 89 vaginal births attended between 1999 and 2002 were analyzed. Analysis showed an association of lower epidural use with increased complementary doula interventions (.62 OR, P=.003) and an association of higher epidural use with longer labors (1.22 OR, P=.004). These findings support previous research of decreased analgesia use by doula-supported women and suggest benefits of the interventions by student nurse doulas. Students trained in providing low-tech supportive care may change the environment for intrapartum nursing practices. Institutional changes may be required to allow greater opportunity for intrapartal nurses to provide support to laboring women.

If the evidence shows the experience of pain and anxiety during labor can be reduced with the presence of touch then our medical system can re-evaluate the increased use of pharmacological pain interventions. There is a myriad of reasons women chose to use drugs and that doctors feel the need to prescribe them but decreasing the use of these medicines and offering nurturing touch will have healthy benefits for mother and baby as well as potentially reducing the high cost associated with labor and delivery in our country. There is an increasing number of massage therapists who are becoming trained in labor massage and as doulas. It is imperative that our society continue expanding our knowledge about the benefits of touch during labor and educate those in the medical field of its emotional benefits so that every woman who wants massage during labor can receive it from a nurse, doula, birth partner or midwife.

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BIBLIOGRAPHY

Chang, Mei-Yueh, Chung-Hey Chen, Kuo-Feng Huang. “A comparison of massage effects on labor pain using the Mcgill Pain questionnaire.” Journal of Nursing Research vol. 14, No.3, 2006.

Chang, Mei-Yueh, Shing-Yaw Wang, chung-Hey Chen. “Effects of massage on pain and anxiety during labor: a randomized controlled trial in Taiwan.” Journal of Advanced Nursing 7 Jan. 2002: 38(1), 68-73.

Field, T, M. Hernandez, S. Taylor, O. Quintino, L. Burman. “Labor pain is reduced by massage therapy.” Journal of Psychosomatic Obstetrics and Gynecology Dec. 1997: 18(4), 286-291.

Simkin, P. “Reducing pain and enhancing progress in labor: a guide to nonpharmacologic methods for maternity caregivers.” Birth Sep. 1995; 22(3): 161-171.

VanZandt, SE, L. Edwards, ET. Jordan. “Lower epidural anesthesia use associated with labor support by student nurse doulas: implications for intrapartal nursing practice.” Complimentary Therapy Clinical Practice Aug. 2005; 11(3): 153-160.