Professional Documents
Culture Documents
Kamilya Jamel Baljon, Muhammad Hibatullah Romli, Adibah Hanim Ismail, Lee Khuan, Boon How Chew
Kamilya Jamel Baljon, Muhammad Hibatullah Romli, Adibah Hanim Ismail, Lee Khuan, Boon How Chew
acid accumulated in nerve endings that may cause block- the descending pain suppression mechanism by activa-
ages and induce pain.53 tion of descending efferent pathways.56 The inhibition
Reflexology also results in body relaxation and stimu- of pain-transmission neurons involves a combination
lation of any blocked nerve endings, which may propel of physiological and neurological mechanisms and it is
any sluggish glands or organs to regain their normal func- commonly activated by noxious stimulation.57 Figure 2
tioning.54 Ambiguity remains regarding the theories and summarises the possible mechanisms action of massage
mechanism of action of foot reflexology for labour pain, therapy.58
as compared with that for general pain.6 35 36 Nonetheless, The three aforementioned therapies (ie, breathing
it is plausible to believe that reflexology techniques would
exercises, foot reflexology and backmassage (BRM))
have similar physiological effects for labour pain that bring
for labour pain management have been shown to influ-
about a sense of well-being, analgesia and subsequently
ence the secretion of certain stress hormones such as
the perception of pain relief.37 Figure 1 summarises the
possible mechanisms of reflexology therapy. cortisol, adrenocorticotropic hormone (ACTH)39 59
Massage therapy is another type of commonly used oxytocin (OT),59 and possibly also the endorphins.44 45
complementary and alternative medicine (CAM) for the Endogenous oxytocin is a key component in the molec-
promotion of health and well-being.35 Massage is a potent ular pathways that buffer reaction to stress and decrease
mechanical stimulus that produces a short-lived analgesic sensitivity to pain and inflammation60; cortisol is
effect by activating the ‘pain gate’ mechanism.55 Longer an important hormone released during stressful
lasting pain control appears to be mediated mainly by conditions.39
use a block of size 4 with a 1:1 allocation ratio, leading to a outlines the Consolidated Standards of Reporting Trials
possibility of 6 permutations. All possible block sequences flow diagram.
will be randomly generated with the help of free software
from the internet https://www. sealedenvelope. com/ Data collection
simple- randomiser/ v1/. A random list will be created Every questionnaire will be coded with a unique number.
after the sample size number, treatment groups, block Data collection in the delivery room will be facilitated
sizes, list length and stratification factors are entered into by the trained research coordinator and two outcome
the software. The order of the subjects will be used by the assessors. The outcome assessors will be assigned to the
research coordinator who will be stationed in the delivery control or the intervention group on the same day. Once
room to conduct the random group allocation for primi- the form is completed by the outcome assessors, it will be
gravidae in labour who have achieved a cervical dilation kept by the research coordinator in a safe location in the
of 6 cm. The principal investigator, outcome assessors delivery room.
and massage therapist in this trial will not be involved Throughout all of the outcome assessment time points,
in the allocation of the interventional groups. Figure 3 a massage therapist will be present in the delivery room of
The differences between the groups and times level intensity measured with PBI and VAS at 1 hour post inter-
will be analysed using a generalised linear mixed model vention as the main coprimary outcomes. This is because
(GLMM). GLMM is appropriate where repeated measure- the effects of the massage and reflexology will still be
ments are made on the same statistical units. GLMM will observable, and thus the intervention group can be fairly
also be used to accommodate non-normal distribution in compared with the control group.46 50–53
outcome data. The variables of time in a categorical form, Any significant baseline imbalances will be adjusted for
intervention group, group*time interaction and the base- in the analysis. If necessary, multiple imputations will be
line random part of the model will include a random conducted for the missing data. A calculated 95% CI and
intercept and an unstructured correlation matrix for the two-sided α of 0.05 will be used to test significance. In
correlation of measurements within pregnant women. addition, we will analyse PBI and VAS at the same time
The fixed part of the model will include pain score, points and measure the agreement between PBI and VAS
whereby the difference in pain score at every time point by using the Spearman correlation coefficient and inter-
will be tested using a linear contrast. We will take the pain class correlation. We will analyse other outcomes using
Figure 5 (A) Timeline of outcomes measurement in the intervention group. (B) Timeline of outcomes measurement in the
control group. AASPWL, Anxiety Assessment Scale for Pregnant Women in Labour; PBI, Present Behavioural Intensity; VAS,
Visual Analogue Scale.
the same statistical strategy mentioned above. Addition- stress hormones level of ACTH, cortisol and oxytocin
ally, we will conduct time series analyses to examine the are objective measurements that will indicate the stress
patterns of change in the outcomes between the two response to the BRM intervention conducted on the
groups and after BRM intervention. primigravidae. This is one of the strengths of our study.
The independent effect(s) of sociodemographic and VAS is one of several ways of measuring the effective-
obstetric characteristics on each primary and secondary ness of BRM, and is a commonly used graphic rating
outcome at 1 hour post intervention will be analysed method.70 78However, VAS might not be the gold stan-
using multiple linear regression analyses. dard to measure labour pain, given the inconsistency of
its results and its ceiling effect.78 90Recognising this inad-
equacy, we will ensure that the participants understand
Discussion the VAS scoring at admission to the delivery room before
Safe and efficient pain management is important for
they are asked to indicate their pain level later. Labour
pregnant women and their families,18 and different types
pain outcome will also be measured via pain inten-
of CAM have been shown to be beneficial to reduce
sity assessment using the PBI,74 which will be rated by
or alleviate labour pain. However, evidence is scarce
outcome assessors. Multiple measurements will be taken
regarding the effects of combined therapies.87 There-
during and after contraction, and before and after the
fore, we designed this trial to study the effects of BRM
intervention. There will also be other outcomes, related
on labour pain and other psychological and physiolog-
to maternal response to pain, namely anxiety level and
ical impacts among primigravidae. The study protocol
maternal stress hormones.91
for the RCT is to determine the combined effect of BRM
on the intensity of pain and level of anxiety in primigrav- This study has several other limitations. First, the inter-
idae during the first stage of labour. Additional outcomes vention will be performed for 1 hour, during which it may
that will be assessed include stress hormones, maternal be interrupted by routine medical care such as regular
V/S, FHR, duration labour, neonatal Apgar score and vaginal examinations, V/S measurements and FHR moni-
maternal satisfaction. toring. However, we believe that this will not reduce the
In this study, the intervention will be applied only once effect of the BRM intervention, because we can start the
and only during the first stage of labour even though the BRM before or after the labour care routine. Second, the
first stage of labour among primigravidae takes approx- process of labour and birthing is unpredictable even if
imately 8–12 hours. By timing the intervention after the participants are at low risk. In certain instances, the
cervical dilation of 6 cm, the effect of the combined BRM process of the intervention might not go well as planned
could exert its greatest influences (if any) on the labour and this may reduce the sample size. Some patients may
experience of the primigravidae and neonatal outcome, end up needing a caesarean section, and some may suffer
because this period is believed to accompany the highest from other obstetric complications during delivery. As
levels of labour pain.88 89 a result, we have inflated the sample size accordingly.
We will assess the outcomes using a mixture of subjec- Third, the results from this study will not be generalis-
tive and objective tools. For example, pain intensity and able to multigravidae as we include only primigravidae.
anxiety levels are subjective measurements, based on the Nevertheless, we believe that primigravidae will benefit
personal feelings and judgments of the respondents. the most from the intervention as they are likely to expe-
Duration of labour, neonatal Apgar score and maternal rience a higher level of labour pain and a longer duration
of labour compared with multigravidae. Fourth, placebo procedures involved in the research preintervention and
effects can influence patient outcomes after (CAM), postintervention. They will inform the potential benefits
resulting in high rates of good outcomes, which may be and risk of the intervention research. Participants will be
wrongly attributed to specific treatment effects.92 given an affirmation of confidentiality and protection of
We recognise that the expertise and experience level of the data collection. The results will not be disseminated
the reflexologist is an important factor in the quality of to the study participants, except if one of the participants
treatment provided and this may affect the outcomes of would like to know her results, her mobile number will be
the BRM. The massage therapists and the outcome asses- taken and a message will be sent.
sors will be given the appropriate training on the BRM
for 1 week by the principal investigator who attended a Patient and public involvement
professional training and was certified. After the training, Patients are involved in the questionnaire’s face and content
they will be tested in a pilot study to ensure their compe- validity testing. Based on feedback from the patients in a
tency in performing the BRM. Additional quality control pilot study, improvement to the questionnaires’ approaches
measures for the outcome assessors are planned, as they and trial processes will be implemented. Patient prefer-
will be assigned to the control delivery room or the ences were not directly obtained with regard to choosing
intervention delivery room on the same day. All of the the BRM intervention; this was based on the principal
completed assessment forms will be reviewed and kept by investigator’s practice experience and encounters with
the research coordinator in a safe location in the delivery pregnant women. However, the patients will be involved
room. Any issues on the form such as blank spaces and in the recruitment to and conduct of the study. They will
extreme values will be immediately clarified and resolved. attend antenatal class and agreement by consent to share in
In addition to labour pain, this study will assess the this study. Also, they will answer all questionnaires pre and
anxiety level of pregnant mothers. Unlike labour pain, post the intervention. In addition, they will need to agree to
anxiety level can be affected by individual characteris- BRM as the intervention.
tics, previous life experiences and other environmental
Author affiliations
causes.93 However, we believe that these factors will not 1
Department of Family Medicine, Faculty of Medicine and Health Sciences,
play a significant role after effective randomisation. Universiti Putra Malaysia, Serdang, Malaysia
Apart from the actual labour experience, there are a few 2
Department of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
other external factors that may affect maternal satisfaction, 3
Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences,
such as the delivery room services, the health of the baby, Universiti Putra Malaysia, Serdang, Malaysia
the gender of the child, family support and other psycho-
Acknowledgements The authors would like to acknowledge the assistance
social factors. As satisfaction is a multidimensional and
provided by Um-Al-Qura University, the Research Department in the Directorate of
complex feeling, it is difficult to measure with a single tool Health Affairs, Makkah Region, and Saudi Arabia Culture Mission in Saudi Arabia.
and to narrow it down to only the first stage of labour. Also, they would like to acknowledge Enago for the English language editing
It is understood that a birthing process is a natural event, services for this report.
especially for low- risk women. Thus, the management Contributors KJB drafted, formulated and submitted the manuscript. BHC and KJB
of labour should be conducted in a supportive manner designed the whole study. MHR, AHI and LK contributed to the study designs, and
all authors read, revised and approved the research protocol critically for important
with minimal or no interferences. This study will provide intellectual content and helped to draft the final manuscript. All authors approved
high-quality evidence about the effects of the combined the final manuscript for submission. Authorship eligibility is in accordance with the
BRM for labour pain management. These findings will be International Committee of Medical Journal Editors guidelines.
important for hospitals offerings for expectant mothers Funding This work was supported by the Umm Al-Qura University and Saudi
in providing a rationale for their decisions about which Arabia Culture Mission. The author (KJB) is a student who owns a Financial
alternative treatments to offer, to primigravidae and their Guarantee, which covers the study and research process. The Financial Guarantee
will cover all the research's payments.
family members during decision- making about labour
Disclaimer The funders will not be involved in the study design, data collection,
pain management.
analysis and interpretation of the data and writing of the manuscript.
Competing interests None declared.
Ethics approval and consent to participate
Ethics approval was obtained from the Ethical Committee Patient and public involvement Patients and/or the public were not involved in
the design, or conduct, or reporting, or dissemination plans of this research.
for Research Involving Human Subjects of the Ministry
Patient consent for publication Obtained.
of Health in the Saudi Arabia (H-02- K-076-0319-109)
on 14 April 2019, and from the Ethics Committee for Provenance and peer review Not commissioned; externally peer reviewed.
Research Involving Human Subjects (JKEUPM) Univer- Open access This is an open access article distributed in accordance with the
siti Putra Malaysia on 23 October 2019, reference number Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
(JKEUPM-2019–169). Additional administrative approval and license their derivative works on different terms, provided the original work is
will be requested from the medical director of the MCH. properly cited, appropriate credit is given, any changes made indicated, and the use
The participant information sheet for the pregnant is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
women will be also provided. If they are interested and ORCID iDs
eligible to participate, pregnant women will sign consent Kamilya Jamel Baljon http://orcid.org/0000-0003-2498-7658
forms. Consent form contains purpose of this study, Boon How Chew http://orcid.org/0000-0002-8627-6248
References and labor pain: a randomized controlled trial. Bull Fac Phys Ther
1 Gibson E. Women's expectations and experiences with labour pain in 2016;21:23–31.
medical and midwifery models of birth in the United States. Women 30 Chuang L-L, Lin L-C, Cheng P-J, et al. Effects of a relaxation training
Birth 2014;27:185–9. programme on immediate and prolonged stress responses in women
2 Beigi NMA, Broumandfar K, Bahadoran P, et al. Women's experience with preterm labour. J Adv Nurs 2012;68:170–80.
of pain during childbirth. Iran J Nurs Midwifery Res 2010;15:77–82. 31 Akbarzadeh M, Sharif F, Zare N. The reduction of anxiety and
3 Devilata T, Swarna S. Effectiveness of pre delivery preparation on improved maternal attachment to fetuses and neonates by relaxation
anxiety among primigravida mothers at maternal child health centre training in primigravida women. Women’s Heal Bull 2014;1:e18968.
Tirupati, AP, India. IOSR J Nurs Heal Sci 2015;4:19–24. 32 Nattah FM, Abbas WAK. Assessment of level of pain and its relation
4 Aksoy M, Aksoy AN, Dostbil A, et al. The Relationship between Fear with breathing exercise in the first stage of labour among Primi
of Childbirth and Women’s Knowledge about Painless Childbirth. mothers at Hilla teaching hospital. Eur J Sci Res 2016;135:121–8.
Obstet Gynecol Int 2014;2014:7. 33 Yuksel H, Cayir Y, Kosan Z, et al. Effectiveness of breathing exercises
5 Nystedt A, Hildingsson I. Diverse definitions of prolonged labour during the second stage of labor on labor pain and duration: a
and its consequences with sometimes subsequent inappropriate randomized controlled trial. J Integr Med 2017;15:456–61.
treatment. BMC Pregnancy Childbirth 2014;14:233. 34 Mathew AM, Francis F. Effectiveness of foot reflexology in reduction
6 Hanjani SM, Tourzani ZM, Shoghi M. The effect of foot reflexology on of labour pain among mothers in labour admitted at PSG Hospital,
anxiety, pain, and outcomes of the labor in primigravida women. Acta Coimbatore. Int J Nurs Educ 2016;8:11–15.
Med Iran 2014;53:507–11. 35 Cohen M. The effectiveness of massage therapy a summary of
7 Li W-hong, Zhang H-yu, Ling Y, et al. Effect of prolonged second evidence-based research. Melbourne: Australian Association of
stage of labor on maternal and neonatal outcomes. Asian Pac J Trop Massage Therapists, 2011.
Med 2011;4:409–11. 36 Dolatian1 M, Hasanpour A, Montazeri S, et al. The effect of
8 Neal JL, Lamp JM, Buck JS, et al. Outcomes of nulliparous women reflexology on pain intensity and duration of labor on primiparas. Iran
with spontaneous labor onset admitted to hospitals in Preactive Red Crescent Med J 2011;13:475–9.
versus active labor. J Midwifery Womens Health 2014;59:28–34. 37 Valiani M, Shiran E, Kianpour M, et al. Reviewing the effect of
9 Kjaergaard H, Olsen J, Ottesen B, et al. Incidence and outcomes reflexology on the pain and certain features and outcomes of
of dystocia in the active phase of labor in term nulliparous women the labor on the primiparous women. Iran J Nurs Midwifery Res
with spontaneous labor onset. Acta Obstet Gynecol Scand 2010;15:302–10.
2009;88:402–7. 38 Baljon K, Romli MH, Ismail AH, et al. The effectiveness of
10 Lowe NK. A review of factors associated with dystocia and complementary and alternative medicine of massage and reflexology
cesarean section in nulliparous women. J Midwifery Womens Health in managing pain and anxiety among primigravidas in labor: a
2007;52:216–28. systematic review.
11 Shields SG, Ratcliffe SD, Fontaine P, et al. Dystocia in nulliparous 39 Field T, Hernandez-Reif M, Diego M, et al. Cortisol decreases and
women. Am Fam Physician 2007;75:1671–8. serotonin and dopamine increase following massage therapy. Int J
12 Garthus-Niegel S, Knoph C, von Soest T, et al. The role of labor pain Neurosci 2005;115:1397–413.
and overall birth experience in the development of posttraumatic 40 Crowe K, von Baeyer C. Predictors of a positive childbirth
stress symptoms: a longitudinal cohort study. Birth 2014;41:108–15. experience. Birth 1989;16:59–63.
13 Peeler S, Stedmon J, Chung MC, et al. Women's experiences of 41 Ma X, Yue Z-Q, Gong Z-Q, et al. The effect of diaphragmatic
living with postnatal PTSD. Midwifery 2018;56:70–8. breathing on attention, negative affect and stress in healthy adults.
14 Boryri T, Noori NM, Teimouri A, et al. The perception of primiparous Front Psychol 2017;8:1–12.
mothers of comfortable resources in labor pain (a qualitative study). 42 Bordoni B, Purgol S, Bizzarri A, et al. The influence of breathing on
Iran J Nurs Midwifery Res 2016;21:239–46. the central nervous system. Cureus 2018;10:1–8.
15 Størksen HT, Garthus-Niegel S, Adams SS, et al. Fear of childbirth 43 ElFattah AH, Metwaly S, Khedr N. Outcomes of foot reflexology on
and elective caesarean section: a population-based study. BMC the pain and certain features of the labor for the primiparous women.
Pregnancy Childbirth 2015;15:221. Life Sci J 2015;12:206–16.
16 Stoll KH, Hauck YL, Downe S, et al. Preference for cesarean section 44 Vigotsky AD, Bruhns RP. The role of descending modulation in
in young nulligravid women in eight OECD countries and implications manual therapy and its analgesic implications: a narrative review.
for reproductive health education. Reprod Health 2017;14:116. Pain Res Treat 2015;2015:292805.
17 El-Aziz SNA, Mansour SE, Hassan NF. Factors associated with fear 45 Kaada B, Torsteinbø O. Increase of plasma beta-endorphins in
of childbirth: It’s effect on women’s preference for elective cesarean connective tissue massage. Gen Pharmacol 1989;20:487–9.
section. J Nurs Educ Pract 2017;7:133–45. 46 Tiran D, Chummun H. The physiological basis of reflexology and
18 Lowe NK. The pain and discomfort of labor and birth. J Obstet its use as a potential diagnostic tool. Complement Ther Clin Pract
Gynecol Neonatal Nurs 1996;25:82–92. 2005;11:58–64.
19 Rayburn WF, Zuspan FP. Drug therapy in obstetrics and gynecology. 47 Embong NH, Soh YC, Ming LC, et al. Revisiting reflexology: concept,
3rd edn. St. Louis: Mosby, 1992. evidence, current practice, and practitioner training. J Tradit
20 Ullman R, Smith LA, Burns E, et al. Parenteral opioids for maternal Complement Med 2015;5:197–206.
pain relief in labour. Cochrane Database Syst Rev 2010:CD007396. 48 Levy I, Attias S, Stern Lavee T, et al. The effectiveness of foot
21 Pereira RR, Kanhai H, Rosendaal F, et al. Parenteral pethidine for reflexology in reducing anxiety and duration of labor in primiparas: an
labour pain relief and substance use disorder: 20-year follow-up open-label randomized controlled trial. Complement Ther Clin Pract
cohort study in offspring. BMJ Open 2012;2:e000719. 2020;38:101085.
22 Smith LA, Burns E, Cuthbert A. Parenteral opioids for maternal 49 Yılar Erkek Z, Aktas S. The effect of foot reflexology on the anxiety
pain management in labour. Cochrane Database Syst Rev levels of women in labor. J Altern Complement Med 2018;24:352–60.
2018;6:CD007396. 50 Tappan FM, Benjamin PJ. Tappan’s handbook for healing massage
23 Simkin P. Reducing pain and enhancing progress in labor: a guide techniques. Classic, holistic, and emerging methods. 3rd edn.
to nonpharmacologic methods for maternity caregivers. Birth Stamford, US: Appleton & Lange, 1998.
1995;22:161–71. 51 Taheri H, Naseri-Salahshour V, Abedi A, et al. Comparing the effect
24 Cook A, Wilcox G. Pressuring pain. alternative therapies for labor of foot and hand reflexology on pain severity after appendectomy: a
pain management. AWHONN Lifelines 1997;1:36–41. randomized clinical trial. Iran J Nurs Midwifery Res 2019;24:451–6.
25 Jones LV. Non-pharmacological approaches for pain relief during 52 Tiran D, Evans M. Theoretical background to structural reflex zone
labour can improve maternal satisfaction with childbirth and reduce therapy. In: Tiran D, ed. Reflexology in pregnancy and childbirth.
obstetric interventions. Evid Based Nurs 2015;18:70. London: Elsevier, 2010: 1–22.
26 Busch V, Magerl W, Kern U, et al. The effect of deep and slow 53 Poole H, Glenn S, Murphy P. A randomised controlled study of
breathing on pain perception, autonomic activity, and mood reflexology for the management of chronic low back pain. Eur J Pain
processing--an experimental study. Pain Med 2012;13:215–28. 2007;11:878–87.
27 Thomas ME, Dhiwar MS. Effectiveness of patterned breathing 54 Keet L. The reflexology bible. 1st edn. London: Octopus publishing
technique in reduction of pain during first stage of labour among group, 2008.
Primigravidas. Sinhgad E-Journal Nurs 2011;1:6–8. 55 Roudaut Y, Lonigro A, Coste B, et al. Touch sense: functional
28 Kaur K, Rana AK, Gainder S. Effect of video on ‘ breathing exercises organization and molecular determinants of mechanosensitive
during labour ’ on pain perception and duration of labour among receptors. Channels 2012;6:234–45.
primigravida mothers. Nurs Midwifery Res Journa 2013;9:1–9. 56 Goats GC. Massage--the scientific basis of an ancient art:
29 El-Refaye G, El Nahas E, Ghareeb H. Effect of kinesio taping Part 2. Physiological and therapeutic effects. Br J Sports Med
therapy combined with breathing exercises on childbirth duration 1994;28:153–6.
57 Basbaum AI, Fields HL. Endogenous pain control mechanisms: pain (nrs pain), mcgill pain questionnaire (mpq), short‐form mcgill
review and hypothesis. Ann Neurol 1978;4:451–62. pain questionnaire (sf‐mpq), chronic pain grade scale (cpgs), short
58 Weerapong P, Hume PA, Kolt GS. The mechanisms of massage form‐36 bodily pain scale (sf‐36 bps), and measure of intermittent
and effects on performance, muscle recovery and injury prevention. and constant osteoarthritis pain (icoap). Arthritis Care Res
Sports Med 2005;35:235–56. 2011;63:S240–52.
59 Morhenn V, Beavin LE, Zak PJ. Massage increases oxytocin and 76 Taghinejad H, Delpisheh A, Suhrabi Z. Comparison between
reduces adrenocorticotropin hormone in humans. Altern Ther Health massage and music therapies to relieve the severity of labor pain.
Med 2012;18:11–18. Womens Health 2010;6:377–81.
60 Li Q, Becker B, Wernicke J, et al. Foot massage evokes oxytocin 77 Jensen MP, Karoly P, Braver S. The Measurement of Clinical
release and activation of orbitofrontal cortex and superior temporal Pain Intensity : a Comparison of Six Methods. Pain Res Manag
sulcus. Psychoneuroendocrinology 2019;101:193–203. 1986;27:117–26.
61 Bell AF, Erickson EN, Carter CS. Beyond labor: the role of natural 78 Durat G, Çulhacik GD, Doğu Özlem, et al. The development of an
and synthetic oxytocin in the transition to motherhood. J Midwifery anxiety assessment scale for pregnant women in labor. Saudi Med J
Womens Health 2014;59:35–42. 2018;39:609–14.
62 Hu J, Brettle A, Jiang Z, et al. A systematic review and meta-analysis 79 Wei CK, Leng CY, Siew Lin SK. The use of the visual analogue scale
of the effect of massage therapy in pain relief during labor. J Nurs for the assessment of labour pain: a systematic review. JBI Libr Syst
2017;6:1–14. Rev 2010;8:972–1015.
63 Huntley AL, Coon JT, Ernst E. Complementary and alternative 80 Harvey S, Rach D, Stainton MC, et al. Evaluation of satisfaction with
medicine for labor pain: a systematic review. Am J Obstet Gynecol midwifery care. Midwifery 2002;18:260–7.
2004;191:36–44. 81 Bublitz MH, Bourjeily G, D'Angelo C, et al. Maternal sleep quality
64 Ranjbaran M, Khorsandi M, Matourypour P, et al. Effect of massage and diurnal cortisol regulation over pregnancy. Behav Sleep Med
therapy on labor pain reduction in primiparous women: a systematic 2018;16:282–93.
review and meta-analysis of randomized controlled clinical trials in 82 Larsson CA, Gullberg B, Råstam L, et al. Salivary cortisol differs with
Iran. Iran J Nurs Midwifery Res 2017;22:257–61. age and sex and shows inverse associations with WHR in Swedish
65 Smith CA, Levett KM, Collins CT, et al. Massage, reflexology and
women: a cross-sectional study. BMC Endocr Disord 2009;9:16.
other manual methods for pain management in labour. Cochrane
83 Sundaram L, Swaminathan S, Ranjakumar T, et al. Intraocular
Database Syst Rev 2018;3:CD009290.
pressure variation in pregnancy: a prospective study. Int J Reprod
66 Kirkham M. The Midwife-Mother relationship. 2nd edn. Hampshire:
Contracept Obstet Gynecol 2017;5:1406–9.
Red Globe Press, 2000.
84 Romano A, Tempesta B, Micioni Di Bonaventura MV, et al. From
67 Levett KM, Smith CA, Bensoussan A, et al. The Complementary
autism to eating disorders and more: the role of oxytocin in
Therapies for Labour and Birth Study making sense of labour and birth
- Experiences of women, partners and midwives of a complementary neuropsychiatric disorders. Front Neurosci 2015;9:497.
medicine antenatal education course. Midwifery 2016;40:124–31. 85 Uvnäs-Moberg K, Ekström-Bergström A, Berg M, et al. Maternal
68 Ministry of Health Saudi Arabia. Maternity and children Hospital plasma levels of oxytocin during physiological childbirth – a
Makkah, 2013. Available: http://www.testonserver.com/mch/ systematic review with implications for uterine contractions
[Accessed 27 Nov 2018]. and central actions of oxytocin. BMC Pregnancy Childbirth
69 Altaweli RF, McCourt C, Baron M. Childbirth care practices in 2019;19:285.
public sector facilities in Jeddah, Saudi Arabia: a descriptive study. 86 Faul F, Erdfelder E, Lang A-G, et al. G*Power 3: a flexible statistical
Midwifery 2014;30:899–909. power analysis program for the social, behavioral, and biomedical
70 Farine D, Seaward PG. When it comes to pregnant women sleeping, sciences. Behav Res Methods 2007;39:175–91.
is left right? J Obstet Gynaecol Can 2007;29:841–2. 87 Snyder M, Wieland J. Complementary and alternative therapies: what
71 Bonnel AM, Boureau F. Labor pain assessment: validity of a is their place in the management of chronic pain? Nurs Clin North
behavioral index. Pain 1985;22:81–90. Am 2003;38:495–508.
72 Chang M-Y, Wang S-Y, Chen C-H. Effects of massage on pain and 88 Sekhavat L, Behdad S. The effects of meperidine analgesia during
anxiety during labour: a randomized controlled trial in Taiwan. J Adv labor on fetal heart rate. Int J Biomed Sci 2009;5:59.
Nurs 2002;38:68–73. 89 Reynolds F. The effects of maternal labour analgesia on the fetus.
73 Mårtensson L, Bergh I. Effect of treatment for labor pain : Verbal Best Pract Res Clin Obstet Gynaecol 2010;24:289–302.
reports versus visual analogue scale scores - A prospective 90 Whitburn LY, Jones LE, Davey M-A, et al. The nature of labour pain:
randomized study. Int J Nurs Midwifery 2011;3:43–7. an updated review of the literature. Women Birth 2019;32:28–38.
74 Bahammam MA, Hassan MH. Validity and reliability of an Arabic 91 Woo AKM. Depression and anxiety in pain. Rev Pain 2010;4:8–12.
version of the modified dental anxiety scale in Saudi adults. Saudi 92 Turner JA, Deyo RA, Loeser JD, et al. The importance of placebo
Med J 2014;35:1384. effects in pain treatment and research. JAMA 1994;271:1609–14.
75 Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: 93 Brook CA, Schmidt LA. Social anxiety disorder: a review of
visual analog scale for pain (vas pain), numeric rating scale for environmental risk factors. Neuropsychiatr Dis Treat 2008;4:123–43.