Massage, reflexology and other manual methods for managing pain in labour

The pain of labour can be intense, with tension, anxiety and fear making it worse. Many women would like to labour without using drugs such as narcotics or  epidurals, and turn to complementary therapies to help them manage the pain of labour. Many complementary therapies are tried and in this review we have looked to see if massage, reflexology and other manual healing methods are effective. Other complementary therapies like acupuncture, mind-body techniques, hypnosis and aromatherapy have been studied in other reviews. Massage involves manipulating the body’s soft tissues and it can be done by the midwife or partner. It helps women relax and so reduces the tension which increases pain in labour. Reflexology is gentle manipulation or pressing on certain parts of the foot to produce an effect elsewhere in the body. Other manual healing methods include osteopathy, shiatsu and zero balancing etc.

We found six studies, with data available from five trials on 326 women, looking at the use of massage in labour for managing pain. There were no studies on any of the other manual healing methods. The six studies were of reasonable quality but more participants are needed to provide robust information. We found that women who used massage felt less pain during labour when compared with women given usual care during first stage. However, more research is needed.

Authors' conclusions: 

Massage may have a role in reducing pain, and improving women's emotional experience of labour. However, there is a need for further research.

Read the full abstract...

Many women would like to avoid pharmacological or invasive methods of pain management in labour, and this may contribute towards the popularity of complementary methods of pain management. This review examined currently available evidence supporting the use of manual healing methods including massage and reflexology for pain management in labour.


To examine the effects of manual healing methods including massage and reflexology for pain management in labour on maternal and perinatal morbidity.

Search strategy: 

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2 of 4), MEDLINE (1966 to 30 June 2011), CINAHL (1980 to 30 June 2011), the Australian and New Zealand Clinical Trial Registry (30 June 2011), Chinese Clinical Trial Register (30 June 2011), Current Controlled Trials (30 June 2011),, (30 June 2011) ISRCTN Register (30 June 2011), National Centre for Complementary and Alternative Medicine (NCCAM) (30 June 2011) and the WHO International Clinical Trials Registry Platform (30 June 2011).

Selection criteria: 

Randomised controlled trials comparing manual healing methods with standard care, no treatment, other non-pharmacological forms of pain management in labour or placebo.

Data collection and analysis: 

Two authors independently assessed trial quality and extracted data. We attempted to contact study authors for additional information.

Main results: 

We included six trials, with data reporting on five trials and 326 women in the meta-analysis. We found trials for massage only. Less pain during labour was reported from massage compared with usual care during the first stage of labour (standardised mean difference (SMD) -0.82, 95% confidence interval (CI) -1.17 to -0.47), four trials, 225 women), and labour pain was reduced in one trial of massage compared with music (risk ratio (RR) 0.40, 95% CI 0.18 to 0.89, 101 women). One trial of massage compared with usual care found reduced anxiety during the first stage of labour (MD -16.27, 95% CI -27.03 to -5.51, 60 women). No trial was assessed as being at a low risk of bias for all quality domains.