Objective: to investigate the eﬀects of antenatal reﬂexology on labour outcomes. Design: secondary analysis of a pilot three-armed randomised controlled trial conducted between July 2012 and September 2013. Setting: a large UK inner city hospital maternity department. Participants: ninety primiparous women with a singleton pregnancy experiencing low back and / or pelvic girdle pain. Interventions: six weekly 30-minute reﬂexology treatments compared to sham (footbath) treatments or usual antenatal care only. Measurements: labour outcome data including labour onset, duration of the second stage of labour, epidural and Entonox usage, and mode of delivery. Participant feedback was collected prior to each treatment. Findings: labour outcomes were collected for 61 women (95.3%) who completed the study. The second stage of labour duration data, available for 42 women (62.5%) who had vaginal births, showed a mean reduction of 44 minutes in the reﬂexology group (73.56 minutes; SD= 53.78) compared to the usual care (117.92 minutes; SD=56.15) (p
Bibliographical noteReference text: References
Adams, S.S., Eberhard‐Gran, M., Eskild, A., 2012. Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics Gynaecology 119, 1238–1246. Altman, M.R., Lydon‐Rochelle, M.T., 2006. Prolonged second stage of labor and risk of adverse maternal and perinatal outcomes: a systematic review. Birth 33, 315–322. Bird, J., Jones, R., 2015. Bad backs: pregnancy and labour. Retrieved from 〈http://www. royalberkshire.nhs.uk/patient-information-leaﬂets/Maternity/Maternity—badbacks-during-pregnancy-and-labour.htm〉 on 26th March 2017. Blanks, A.M., Thornton, S., 2003. The role of oxytocin in parturition. BJOG: An International Journal of Obstetrics Gynaecology 110, 46–51. Brown, A., Johnston, R., 2013. Maternal experience of musculoskeletal pain during pregnancy and birth outcomes: signiﬁcance of lower back and pelvic pain. Midwifery 29, 1346–1351. Cheng, Y.W., Hopkins, L.M., Caughey, A.B., 2004. How long is too long: does a prolonged second stage of labor in nulliparous women aﬀect maternal and neonatal outcomes? American Journal of Obstetrics and Gynecology 191, 933–938. Cheng, Y.W., Shaﬀer, B.L., Nicholson, J.M., Caughey, A.B., 2014. Second stage of labor and epidural use: a larger eﬀect than previously suggested. Obstetrics Gynecology 123, 527–535. Close, C., Sinclair, M., Liddle, D., McCullough, J.E.M., Hughes, C., 2016. Women's experience of low back and/or pelvic pain (LBPP) during pregnancy. Midwifery 37, 1–8. Close, C., Sinclair, M., McCullough, J.E.M., Liddle, D., Hughes, C., 2015. A pilot randomised controlled trial (RCT) investigating the eﬀectiveness of reﬂexology for managing pregnancy low back and/ or pelvic pain. Complementary Therapies in Clinical Practice 23, 117–124. Dolatian, M., Hasanpour, A., Sh, M., Heshmat, R., 2011. The eﬀect of reﬂexology on pain intensity and duration of labor on primiparas. Iranian Red Crescent Medical Journal 7, 475–479. Enzer, S., 2004. Maternity Reﬂexology Manual 2nd edn.. Soul to Sole Reﬂexology Limited, England. Gamble, J.A., Creedy, D.K., 2001. Women's preference for a caesarean section: incidence and associated factors. Birth 28, 101–110. Hall, H.R., Jolly, K., 2014. Women's use of complementary and alternative medicines during pregnancy: a cross-sectional study. Midwifery 30, 499–505. Hildingsson, I., Rådestad, I., Rubertsson, C., Waldenström, U., 2002. Few women wish to be delivered by caesarean section. BJOG: An International Journal of Obstetrics Gynaecology 109, 618–623. Hunter, R.F., McDonough, S.M., Bradbury, I., et al., 2012. Exercise and auricular acupuncture for chronic low-back pain: a feasibility randomized-controlled trial. The Clinical Journal of Pain 28, 259–267. Jenabi, E., Mohajeran, M.H., Torkamani, M., 2012. The eﬀect of reﬂexology on relieving the labor pain. Iranian Journal of Obstetrics, Gynecology Infertility 14, 34–38. Kalder, M., Knoblauch, K., Hrgovic, I., Münstedt, K., 2011. Use of complementary and alternative medicine during pregnancy and delivery. Archives of Gynecology and Obstetrics 283, 475–482. Karlström, A., Nystedt, A., Johansson, M., Hildingsson, I., 2011. Behind the myth–few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery 27, 620–627. Kjærgaard, H., Olsen, J., Ottesen, B., Dykes, A.K., 2009. Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset. Acta obstetricia et gynecologica Scandinavica 88, 402–407. Kosfeld, M., Heinrichs, M., Zak, P.J., Fischbacher, U., Fehr, E., 2005. Oxytocin increases trust in humans. Nature 435, 673–676. Le Ray, C., Audibert, F., Goﬃnet, F., Fraser, W., 2009. When to stop pushing: eﬀects of duration of second-stage expulsion eﬀorts on maternal and neonatal outcomes in nulliparous women with epidural analgesia. American Journal Of Obstetrics and Gynecology 201, (361-e1). Marquardt, H., 2007. Reﬂex Zone Therapy of the Feet: a Comprehensive Guide For Health Professionals. Healing Arts Press, Vermont. McCullough, J.E.M., Liddle, S.D., Sinclair, M., Close, C., Hughes, C.M., 2014. The physiological and biochemical outcomes associated with a reﬂexology treatment: a systematic review. Evidence-Based Complementary and Alternative Medicine, 2014. McNeill, J.A., Alderdice, F.A., McMurray, F., 2006. A retrospective cohort study exploring the relationship between antenatal reﬂexology and intranatal outcomes. Complementary Therapies in Clinical Practice 12, 119–125. McVicar, A.J., Greenwood, C.R., Fewell, F., D’arcy, V., Chandrasekharan, S., Alldridge, L.C., 2007. Evaluation of anxiety, salivary cortisol and melatonin secretion following reﬂexology treatment: a pilot study in healthy individuals. Complementary Therapies in Clinical Practice 13, 137–145. Mens, J.M., Vleeming, A., Stoeckart, R., Stam, H.J., Snijders, C.J., 1996. Understanding peripartum pelvic pain. Implications of a Patient Survey Spine 21, 1363–1369. Mirzaei, F., Kaviani, M., Jafari, P.E., 2010. Eﬀect of foot reﬂexology on duration of labor and severity of ﬁrst-stage labor pain. Iranian Journal of Obstetrics, Gynecology and Infertility 13, 27–32. Miyazato, K., Matsukawa, K., 2010. Decraesed cardiac parasymphatetic nerve activity of pregnant women during foot baths. Japan Journal of Nursing Science 7, 65–75. Moghimi-Hanjani, S., Mehdizadeh-Tourzani, Z., Shoghi, M., 2015. The eﬀect of foot reﬂexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Medica Iranica 53, 507–511. Mollart, L., 2003. Single-blind trial addressing the diﬀerential eﬀects of two reﬂexology techniques versus rest, on ankle and foot oedema in late pregnancy. Complementary Therapies in Nursing and Midwifery 9, 203–208.
J.E. Mccullough et al. Midwifery 55 (2017) 137–144
Mollart, L., 2015. Women, midwives and reﬂexology: making a diﬀerence. Women and Birth 28, S50. Mollart, L., Foureur, M., Skinner, V., 2015. Pregnant women and health professionals views on CAM in pregnancy speciﬁcally acupressure and being involved in a randomised controlled trial. Women and Birth 28, S50. Morhenn, V., Beavin, L.E., Zak, P.J., 2012. Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Alternative therapies in health and medicine 18, 11–18. Motha, G., McGrath, J., 1993. The eﬀect of reﬂexology on labor outcome. Journal of Association of Reﬂexologists 4, 2–4. Mukherjee, B., 2017. Nine best acupressure points for easing labor pains. Retreived from 〈http://www.modernreﬂexology.com/acupressure-points-for-easing-labor-pains/〉 on 22 January 2017. Myles, T.D., Santolaya, J., 2003. Maternal and neonatal outcomes in patients with a prolonged second stage of labor. Obstetrics Gynecology 102, 52–58. National Centre for Health and Care Excellence, 2017. Antenatal care for uncomplicated pregnancies Clinical guideline [CG62]. Retrieved from 〈https://www.nice.org.uk/ guidance/cg62/chapter/1-Guidance〉 on 4th February 2017. National Centre for Health and Care Excellence, 2016. Intrapartum care for healthy women and babies Clinical guideline [CG190]. Retrieved from 〈https://www.nice. org.uk/guidance/cg190/chapter/Recommendations#second-stage-of-labour〉 on 4th February 2017. Neal, J.L., Ryan, S.L., Lowe, N.K., et al., 2015. Labor dystocia: uses of related nomenclature. Journal of Midwifery Women's Health 60, 485–498. NHS Choices, 2016. Pelvic pain in pregnancy Retrieved from 〈http://www.nhs.uk/ conditions/pregnancy-and-baby/pages/pelvic-pain-pregnant-spd.aspx? Tabname=getting%20pregnant〉 on 26th March 2017. Nystedt, A., Hildingsson, I., 2014. Diverse deﬁnitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment. BMC pregnancy and childbirth 14, 233. Nystedt, A., Högberg, U., Lundman, B., 2006. Some Swedish women's experiences of prolonged labour. Midwifery 22, 56–65. Özdemir, G., Ovayolu, N., Ovayolu, Ö., 2013. The eﬀect of reﬂexology applied on haemodialysis patients with fatigue, pain and cramps. International Journal of Nursing Practice 19, 265–273. Pallivalappila, A.R., Stewart, D., Shetty, A., Pande, B., McLay, J.S., 2013. Complementary and alternative medicines use during pregnancy: a systematic review of pregnant women and healthcare professional views and experiences. Evidence-Based Complementary and Alternative Medicine, 2013. Peterson, C.D., Haas, M., Gregory, W.T., 2012. A pilot randomized controlled trial comparing the eﬃcacy of exercise, spinal manipulation, and neuro emotional
technique for the treatment of pregnancy-related low back pain. Chiropractic manual therapies 20, 1. Poole, H., Glenn, S., Murphy, P., 2007. A randomised controlled study of reﬂexology for the management of chronic low back pain. European Journal of Pain 11, 878–887. Romano, A.M., Lothian, J.A., 2008. Promoting, protecting, and supporting normal birth: a look at the evidence. Journal of Obstetric, Gynecologic, Neonatal Nursing 37, 94–105. Royal College of Midwives, 2017. Better Births. Retreived from 〈http://www. rcmnormalbirth.org.uk/〉 on the 5th February 2017. Saeki, Y., Nagai, N., Hishinuma, M., 2007. Eﬀects of footbathing on autonomic nerve and immune function. Complementary Therapies in Clinical Practice 13, 158–165. Simms, R., Hayman, R., 2011. Instrumental vaginal delivery. Obstetrics, Gynaecology Reproductive Medicine 21, 7–14. Steel, A., Adams, J., Sibbritt, D., Broom, A., 2015. The outcomes of complementary and alternative medicine use among pregnant and birthing women: current trends and future directions. Women's Health 11, 309–323. Steel, A., Adams, J., Sibbritt, D., Broom, A., Frawley, J., Gallois, C., 2014. Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: an examination of a nationally representative sample of 1835 Australian women. Midwifery 30, 1157–1165. Stephenson, N.L., Dalton, J.A., 2003. Using reﬂexology for pain management a review. Journal of Holistic Nursing 21, 179–191. Szukiewicz, D., Bilska, A., Mittal, T.K., et al., 2015. Myometrial contractility inﬂuences oxytocin receptor (OXTR) expression in term trophoblast cells obtained from the maternal surface of the human placenta. BMC Pregnancy and Childbirth 15, 220. Tiran, D., 2006. Complementary therapies in pregnancy: midwives' and obstetricians' appreciation of risk. Complementary Therapies in Clinical Practice 12, 126–131. Tiran, D., 2010. Reﬂexology in Pregnancy and Childbirth. Churchill Livingstone Elsevier, London. Valiani, M., Shiran, E., Kianpour, M., Hasanpour, M., 2010. Reviewing the eﬀect of reﬂexology on the pain and certain features and outcomes of the labor on the primiparous women. Iranian Journal of Nursing and Midwifery Research 15, 302–310. Wang, M.Y., Tsai, P.S., Lee, P.H., Chang, W.Y., Yang, C.M., 2008. The eﬃcacy of reﬂexology: systematic review. Journal of Advanced Nursing 62, 512–520. Williams, J., Mitchell, M., 2007. Midwifery managers' views about the use of complementary therapies in the maternity services. Complementary Therapies in Clinical Practice 13, 129–135. Witt, C.M., Schützler, L., 2013. The gap between results from sham-controlled trials and trials using other controls in acupuncture research—The inﬂuence of context. Complementary Therapies in Medicine 21, 112–114.
- Reﬂexology Labour Duration Nursing Midwifery Pilot study Low back pain Pelvic girdle pain Clinical Trial