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.

The present study was undertaken to produce a detailed specification of a programme of massage, controlled breathing and visualization performed regularly by birth partners, from 36 weeks gestation and assisted by a trained professional, following hospital admission during labour and birth. As current research on massage interventions for pain relief in labour is poorly characterized, we began by undertaking a feasibility study on an established massage programme [Goldstone LA. Massage as an orthodox medical treatment past and future. Complementary Therapies in Nursing & Midwifery. 2000;6:169-75]. The intervention was designed in light of experimental findings that repeated massage sessions over 14 days increases pain threshold, by an interaction between oxytocin and opioid neurons [Lund I, Yu L-C, Uvnas-Moberg K, Wang J, Yu C, Kurosawa M, et al. Repeated massage-like stimulation induces long-term effects on nociception: contribution of oxytocinergic mechanisms. European Journal of Neuroscience 2002;16:330-8]. A 4 week time-frame was selected to coincide with a physiological increase in maternal pain threshold [Cogan R, Spinnato JA. Pain and Discomfort Thresholds in Late Pregnancy. Pain 1986;27:63-8, Whipple B, Josimovich JB, Komisaruk BR. Sensory thresholds during the antepartum, intrapartum, and postpartum periods. International Journal of Nursing Studies 1990;27(3):213-21, Gintzler AR, Komisaruk BR. Analgesia is produced by uterocervical mechano-stimulation in rats: roles of afferent nerves and implications for analgesia of pregnancy and parturition. Brain Research 1991;566:299-302, Gintzler AR, Liu N-J. The maternal spinal cord: biochemical and physiological correlates of steroid-activated antinociceptive processes. In: Russell JA, Douglas AJ, Windle RJ, Ingram CD, editors., Progress in Brain Research. Volume 133. The Maternal Brain. Neurobiological and Neuroendocrine adaptation and disorders in pregnancy and postpartum. Amsterdam: Elsevier Science, 2001. p. 83-97]. The main objective was to measure the effects of the programme on maternal pain perception during labour and birth. To detect any effect of massage during labour, on maternal cortisol and catecholamines, cord venous blood was taken to measure plasma concentrations following birth. Twenty-five nulliparous (N) and 10 multiparous (M) women participated in the study. Cortisol values were similar to published studies following labour without massage but pain scores on a Visual Analogue Scale (VAS), at 90min following birth were significantly lower than scores recorded 2 days postpartum [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35]. The mean score was 6.6. Previous studies suggest that a reduction from 8.5 to 7.5 would significantly reduce pharmacological analgesia in labour [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35].