Intrapartum massage programme enhances analgesic-free labour

Intrapartum massage combined with slow rhythmic breathing and visualization helps modulate pain perception in nulliparous pregnant women, resulting in a shift towards the use of weaker analgesia and higher rates of analgesic-free labour, a randomized controlled trial in Hong Kong has shown.

The trial included 479 healthy, low-risk nulliparous pregnant Chinese women aged ≥18 years whose partners were available to learn massage technique. The women were recruited at 32–36 weeks of gestation from the Prince of Wales Hospital (PWH) and Kwong Wah Hospital (KWH). [Hong Kong Med J 2021;27:405-412] 

Primary outcome results showed that the use of epidural analgesia or pethidine did not differ significantly between women in the massage group (n=233; mean age, 31.3 years) and the control group (n=246; mean age, 30.7 years) (12.0 percent vs 15.9 percent; p=0.226).

However, fewer women in the massage group requested epidural analgesia (2.1 percent vs 5.7 percent in the control group), and more women in the massage group had analgesic-free labour compared with the control group (29.2 percent vs 21.5 percent; p=0.041).

At the time when pethidine or epidural analgesia was requested, cervical dilatation was significantly greater in the massage vs control group (3.8 ± 1.7 cm vs 2.3 ± 1.0 cm; p<0.001).

“A structured childbirth massage programme delivered by qualified midwife trainers can provide couples with both theoretical knowledge and practical skills, which help to modulate pain perception among labouring women,” wrote the researchers from the Chinese University of Hong Kong, PWH and KWH.

“With appropriate training, massage can be an efficacious option for labour pain relief, with no associated adverse effects on delivery,” they suggested.

In the trial, women in the massage group and their partners attended a 2-hour childbirth massage programme class at 36 weeks of gestation. The class included a 30-minute theoretical explanation of the evidence underpinning the childbirth massage programme, and a 90-minute practicum on massage technique, controlled breathing and visualization delivered by accredited midwifery trainers.

The massage, applied over the lower back and four limbs, was synchronized with slow rhythmic breathing and combined with visualization (ie, imagination) of comforting objects to bring about relaxation.

After the training, the couples were encouraged to practise the massage technique regularly at home in the evening, in a dimly lit and quiet environment, to bring about relaxation and improve the quality and duration of sleep.

On admission prior to delivery, an accredited midwife trainer verified the massage technique of each couple in the massage group. The women were encouraged to relax through self-massage on the abdomen and legs if labour was not yet established. When labour commenced, the partner provided arm and shoulder massage for relaxation or lateral sacral massage for pain relief, according to the woman’s preference. The massage could be continued throughout labour, with no limit on duration.

Women in both the massage and control groups were otherwise given the same intrapartum care. There were no significant differences between the groups in terms of maternal age, height, demographic characteristics, proportion of women who underwent induction or augmentation of labour, mean duration of labour, delivery by caesarean section, gestational age at delivery, birthweight, or proportion of babies with Apgar score of ≥8 at 5 minutes.

“To our knowledge, our study included the largest number of nulliparous labouring women among similar published studies,” the researchers noted.