Contributed by Derek R. Austin, PT, DPT, MS, BCTMB, CSCS; MK Brennan, MS, RN, LMBT; Jolie Haun, PhD, EdS, LMT

Labor hurts. Labor is an often painful and sometimes long process causing much distress to women during the birthing process. Recent research published in the International Journal of Therapeutic Massage and Bodywork reports on an evaluation of the effects of massage therapy in managing labor pain. The article titled, "Massage Therapy and Labor Outcomes: a Randomized Controlled Trial" was published in December 2012. This randomized controlled trial (RCT) was conducted with pregnant women at the British Columbia (BC) Women's Hospital in Vancouver. Findings indicate massage therapy appears to be an effective pain management technique during labor.

Previous randomized trials have reported reductions in mothers' pain when massage therapy is provided during childbirth. However, these trials have been limited by small sample sizes and using non-massage therapists for the massages, and not all of the results showing effects have been statistically significant.

This study by Janssen et al. is the first published study on labor pain where massage therapy was provided by a regulated massage therapist. In British Columbia, registered massage therapists have to complete two years of massage training and normally work under insurance.

Seventy-seven women participated in this RCT. Thirty-seven women received massage during labor and 40 women received standard care. The standard care group received routine medical care without the massage intervention. The women in both study arms were also able to use non-invasive pain management techniques. There were no dropouts, meaning that all 77 women who began the study finished the study and responded to research follow-up.

Exclusion criteria included co-morbidities or complications during pregnancy. Inclusion criteria included first time term pregnancy, single gestation with the maternal age between 18 and 35. In the massage group, Swedish massage was administered by a registered massage therapist during active labor for up to 5 hours. Women could choose to pause the massage or have it administered intermittently, and massage was stopped if the participant decided to have epidural analgesia. Five hours was chosen as the maximum time that the massage therapist would work with the participant.

The primary effects were based on the timing of epidural analgesia with respect to cervical dilation. The authors hypothesized that massage therapy would lengthen the time before a woman would choose to use epidural analgesia as measured by greater cervical dilation.

The secondary effects were on measures of labor pain and outcome. The authors looked at many factors, specifically contraction pain, length of stages of labor, need for narcotic or other analgesia, cervical dilation at the time of epidural insertion and mode of delivery. There were no adverse effects or events reported in the study.

The researchers found that women in the massage therapy group received epidural analgesia at higher cervical dilation than the women in the routine care group, although they were admitted on average at a less advanced stage of labor. The analysis of variance showed about a 1cm difference, which was not statistically significant. Similarly, pain levels on the McGill Pain Questionnaire were consistently lower in the massage group, but were not statistically significant. This study did show a trend toward a delay in epidural injections, which may result in a reduction of assisted vaginal deliveries and decreased time between the first two stages of labor.

The authors suggest that continuing massage throughout labor might have stronger effects on pain that could be statistically significant. Perhaps massage therapy can further reduce pain once epidural analgesia is given; in this study, massage was stopped if the patient chose an epidural.

While it is the largest study to date of massage therapy in labor, this study still involved only 77 women, just 1% of the approximately 7500 births that take place annually at BC Women's Hospital. Future research should expand sample sizes, which would help identify significant effects of massage therapy to support conclusive findings of the effects of massage in this context. It would be very interesting to see what the overall effects would be if a hospital were to provide massage therapy during even 10% of annual births.

In the current study, 60% of women asked to participate were willing to receive massage therapy during labor, indicating that massage is well-accepted by women giving birth. There were also no cases of a woman or her support person(s), nursing or the medical staff asking the massage therapist to discontinue treatment.

This research demonstrates that massage therapists can effectively integrate into an obstetrics healthcare team to provide pain relief during childbirth. This research provides implications for the continued growth and application of massage modalities in the role of health care.

If you are interested in performing research like this study on massage and labor pain or on any other topic, check out the Research Grant Contest from the Massage Therapy Foundation. The MTF will be awarding up to $30,000 for a one-year project period. For more information, visit www.massagetherapyfoundation.org/research-grants/. The deadline to apply is March 2, 2015. Research is funded by the Massage Therapy Foundation by help from your donations.

The MTF has ongoing efforts such as this monthly review to support research literacy among massage therapists. Please consider donating to MTF to support these continued efforts to promote research literacy among massage therapists. To learn more about the effects of massage therapy, you can review the Massage Therapy Foundation article archives, read accepted MTF Research Grant abstracts, or search PubMed for massage therapy studies.

Reference:

1. Janssen P, Shroff F, Jaspar P. Massage therapy and labor outcomes: a randomized controlled trial. Int J Ther Massage Bodywork. 2012;5(4):15-20. Epub 2012 Dec 19. Erratum in: Int J Ther Massage Bodywork. 2013;6(1):25. PubMed PMID: 23429706; PubMed Central PMCID: PMC3528187.