Accepted Manuscript

Effects of low back massage on perceived birth pain and satisfaction

Seda Unalmis Erdogan, Emre Yanikkerem, Asli Goker

PII: S1744-3881(17)30048-8
DOI: 10.1016/j.ctcp.2017.05.016
Reference: CTCP 738

To appear in: Complementary Therapies in Clinical Practice

Received Date: 31 January 2017

Revised Date: 19 May 2017
Accepted Date: 29 May 2017

Please cite this article as: Unalmis Erdogan S, Yanikkerem E, Goker A, Effects of low back massage on
perceived birth pain and satisfaction, Complementary Therapies in Clinical Practice (2017), doi: 10.1016/
j.ctcp.2017.05.016.

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 ACCEPTED MANUSCRIPT
Effects of Low Back Massage on Perceived Birth Pain and Satisfaction

Seda Unalmis Erdogan: Manisa Celal Bayar University School of Health,

sedaunalmis@gmail.com
Emre Yanikkerem: Associate Professor, Manisa Celal Bayar University School of Health,

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emrenurse@hotmail.com
Asli Goker: Associate Professor, Manisa Celal Bayar University Obstetrics and Gynecology,

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asligoker@gmail.com

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correspondence: Asli Goker: Associate Professor, Manisa Celal Bayar University Obstetrics
and Gynecology, asligoker@gmail.com
+90 532 471 31 96

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Effects of Low Back Massage on Perceived Birth Pain and Satisfaction
Abstract
Aim: The aim of the study was to evaluate the effect of low back massage on
perceived birth pain and delivery.
Method: This study was designed as a study-control experimental type. The study
sample consisted of 62 pregnant women (massage group=31, control group=31).

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Massage was applied to the study group in three phases during intrapartum period.
The massages were done at the end of latent, active and transition phases (at cervical

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dilatation 3-4 cm, 5-7 cm, 8-10 cm) correspondingly. The VAS scores were
evaluated three times during all phases.

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Results: The first mean VAS score was 5.2 ± 0.9 and 7.3 ± 1.3 for massage and
control groups, respectively. Second VAS score was found as 6.6 ± 1.6 in massage
group and 8.8 ± 1.0 in control group. The third VAS score was significantly higher in

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the control group than massage group during third evaluation (9.2 ± 2.4 vs 6.7 ± 2.7)
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(p<0.05). The mean duration of second stage was 24.6 ± 12.7 minutes in massage
group and 31.7 ± 20.9 minutes in control group (p>0.05). The mean scores of
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satisfaction about delivery were found as 8.8±0.7 in massage group and 6.9±0.8 in
control group (p<0.05).
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Conclusion: It was determined in the study that lower back massage has a significant
impact on reducing labor pain and increasing the satisfaction with birth. Health
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professionals, who work in the delivery unit, can use massage intervention for
decreasing pain, shortening delivery time and increasing satisfaction with birth
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experience.
Key words: labor pain, birth pain, delivery, birth, massage, non-pharmacologic pain
relief methods
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Introduction
The number of Cesarean section (CS) and intervention during childbirth has
increased in the world and in our country. The rate of CS was 21.1% in 2002,
whereas it has reached 51% in 2014 in Turkey (Ministry of Health statistics). The
most important factor in the increase of the interventions is fear and anxiety of the

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mothers during birth. Many women want to deliver by CS because of negative birth
experiences in the past and anxiety or belief about pain and fear during vaginal birth

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(Tschudin Okonkwo 2012 Dursun P).
Giving birth is one of the most painful procedures in a woman’s life. Labor pain

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should be addressed with a multi-dimensional point of view. According to Melzack’s
study, labor pain is the most painful event experienced after coxalgia (Melzack
1991).

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Labor pain is affected by neurophysiology, biochemistry, psychogenic, ethno-
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cultural, religious, cognitive, spiritual and many other environmental factors and is
defined as the defense mechanism of the body towards a stimulus from inside or
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outside (Can and Saruhan 2015;).

Women experience pain, fear, exhaustion and many other feelings during
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intrapartum period. Labor pain is an acute pain, fluctuates rapidly and may
deteriorate a woman’s mood. Back pain is experienced in nearly 30% of women and
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this pain increases risk of CS. Primiparous women have more labor pain and this
increases CS rate by 22% when compared to multiparous women. Analgesics may be
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used to decrease this pain, but have some side effects on the mother and newborn.
Studies have shown that analgesics alone are ineffective in managing labor pain
(Hajiamini et al 2012;).
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Labor pain is a complex subject and the need for appropriate nursing approaches
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is undeniable. Both pharmacologic and non-pharmacologic interventions are used to

ease labor pain. Non-pharmacologic methods are not only an alternative but also a
contribution to pharmacologic methods and many women use both. Pharmacologic
methods may not be sufficient and women may prefer non-pharmacologic methods
to come over the pain. It is shown that non-pharmacologic interventions are harmless
for mother and newborn, as they do not slow down the birthing process, do not have
side effects or allergy risks, are effective in decreasing perceived labor pain and give
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the woman a sense of control ( smith , kamalifard 2001; Can and Saruhan 2015
Hajiamini 2012 ; 2009; Chaillet and ark. 2014).
Methods for the control of labor pain are classified into four: relaxation, mental
stimulation, somatic stimulation and breathing techniques (Simkin and Bolding
2004; Can and Saruhan 2015 Hajiemini 2012, ; Almeida 2005; Mamuk and Davas
2010; Madden et al 2012). Intervention that decrease fear and anxiety without any

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medication are music, aromatherapy, acupuncture, acupressure, yoga, hypnosis,
massage, intradermal injection, transcutaneous electrical stimulation (TENS) and

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warm application (Smith 2006). Somatic stimulations are massage that the woman
does herself, massage somebody else applies to the woman (foot, waist, back, neck,

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and effleurage), warm and cold application, TENS, intradermal injection,
hydrotherapy and aromatherapy (Smith 2006; Simkin and Bolding 2004; Can and
Saruhan 2015 hajiamini 2012 ; Mamuk and Davas 2010; Madden et al 2012).

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Massage is one of the preferred methods to decrease labor pain. It’s relaxing and
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pain easing effect is known in literature but little have been studied on its effect
intrapartum (Chang et al 2002; Karami et al 2007; Abasi and Abedian 2009;
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Taghinejad et al 2010; Smith et al 2012). Massage during delivery increases levels of

serotonin and dopamine while decreases norepinephrine and cortisol (Field 2005).
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The woman’s fatigue decreases, muscle spasms relax, physical activity increases, her
attention is distracted and anxiety decreases, thus the laboring woman can tolerate
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the pain better (Field et al 2008). Massage also strengthens the relationship between
the nurse and the laboring woman, increases the quality of care and patient
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satisfaction. Massage is an intervention that helps decreasing pain by increasing

courage, recognition, support and participation ( Simkin, janssen 2012;).
The aim of the study was to evaluate the effect of low back massage on
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perceived birth pain and process.

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Methods
Type of study
This study was designed as a study-control experimental type.
Sample of the study
The study population consisted of pregnant women who applied to Celal Bayar
University Hafsa Sultan Hospital, department of obstetrics and gynecology for

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delivery.
Women who had term, single fetus, cervical dilatation ≥4 cm, were expected to

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have spontaneous delivery, had no pregnancy complications or systemic disease,
cephalopelvic disproportion, placenta previa or ablation of placenta, no fetal distress

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were included in the study.
The study sample consisted of women who met the inclusion criteria and who
gave consent to participate. A total of 62 pregnant women between 1st November

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2013- 1st November 2014 have been included in the study (massage group=31,
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control group=31). Nine women left the study due to emergency CS (6 pregnant
women in massage, 3 pregnant women in control group).
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The dependent and independent variables of the study

The massage and control groups have been matched in accordance with the
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literature according to age, education, income level, working status, body mass
index, number of pregnancy and delivery, attending a birth preparation class and
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obtaining information from a health care professional (Chang et al 2002, Karami et al

2007, Abasi and Abedian 2009, Taghenijad et al 2010).
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Visual Analogue Scale (VAS) score in latent, active, transition phase, delivery
time, Apgar scores at minutes 1 and 5, evaluation of delivery time and pain by the
woman, satisfaction from birth were the dependent variables. Low back massage was
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the dependent variable.

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Questionnaires
A five part questionnaire was used for the data collection. The first part
consisted of questions about the women’s sociodemographic and obstetric history
such as age, education, occupation, body mass index, social insurance, income level,
obstetric history, having seen a birth, having listened to birth stories, attending birth
preparation classes, methods to ease pain and feelings towards childbirth etc. The
second part included questions about time of entering the delivery room, progress of
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delivery, dilatation and effacement, VAS scores, delivery time, weight, gender and
Apgar scores of newborn and vital signs of mother.
Visual Analog Scale was the third part. The VAS score was evaluated three
times during delivery (latent phase: cervical dilatation 3-4 cm, active phase: cervical
dilatation 5-7 cm and transition phase: cervical dilatation 8-10 cm). The woman was
asked to score the most intense pain on a scale from 0 to 10.

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The fourth part consisted of evaluation for women’s behaviors during delivery
using Delivery Room Observation Form which was developed by Yıldırım (Yıldırım

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2001). This form has been filled out by the observer and evaluates emotions of the
woman such as agitation, communication, crying, screaming. The last part was an

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interview part and comprised questions about the perception of delivery time, labor
pain and the woman’s thoughts about childbirth and the massage. The fifth
evaluation was done at least two hours after delivery to assess mothers’ opinions

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about delivery and massage.
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Data collection method

The questionnaires were administered by means of face to face interview.

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Pregnant women have been followed during the intrapartum period and after birth.
The first stage of data collection was made during the intrapartum period; the second
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stage was performed at least two hours after birth. The average follow-up period of a
pregnant was found as nine hours.
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Massage Implementation Phase

In the study Linda Kimber’s massage protocol have been used (Kimber 1999). In
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the first step of the massage, the nurse places both hands on the sides of the spine in
the sacral region. The woman is instructed to breathe audibly at the beginning of the
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contraction, so that the nurse can hear. During inspiration the nurse leans forward
and her hands go up to the waist level. With the beginning of the expiration, the
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fingers of both hands turn inwards and both elbows turn outwards to massage
outwards across the back towards the hips moving smoothly down the sides. The
whole move should be performed simultaneously with the breathing, without losing
contact with the woman. These movements repeat throughout the contraction. When
the contraction ends, the nurse continues up the back to the upper back, around the
shoulders and down each side of the body on the arms back to the starting point. The
circular hip massage can be added to this massage if the woman needs more comfort.
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The principles are acting slow, rhythmic, firm and in harmony with the breathing.
The palm of the hand firmly moves over the sacral area, in a clockwise or
anticlockwise direction depending on the hand used (Figure1). If needed, the sacral
pressure massage can be added at the end of the contraction (Kimber 1999).
Massage for pregnant women during intrapartum period was implemented in
three phases. The first massage was done at the end of the latent phase when

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contractions began at 3-4 cm cervical dilatation. It started with the circular hip
massage. Sacral massage was done at the end of contraction and lower back massage

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after performing the first phase was complete. The second and third massage was
applied during 5-7 cm and 8-10 cm cervical dilatation, respectively; when

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contractions started.
All massages were applied for 30 minutes each time at the beginning of the
contractions in every phase of the intrapartum period by the first author of this

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manuscript who is also a practioning nurse at the obstetric department. After the
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massage was applied, the most severe contractions experienced were evaluated by
VAS. Satisfaction was determined by asking the women to score their satisfaction
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level on a scale of 1 to 10 with 1 being the least satisfied. Contractions and fetal heart
rate were monitored during intrapartum period and there no deviation from normal
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has been recorded.

Pregnant women in the control group received standard care in their clinic and
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their VAS score was also evaluated during the same phases.
Ethics of the research
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Ethical approval was obtained from the Local Ethical Committee of Celal
Bayar University, Faculty of Medicine. Written informed consent was obtained from
all women.
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Analysis
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Socio-demographic characteristics of massage and control groups were

compared by chi-square and Fisher’s exact test. The VAS scores of massage and
control groups during latent, active and transition phase, blood pressure, pulse, time
of birth, the average weight of babies, Apgar scores, birth satisfaction mean scores
were compared using student t test and Kruskal Wallis by using SPSS version 17.0.
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RESULTS

Characteristics of pregnant women

The mean age of the women were found as 24.3 ± 4.2 and 26.0 ± 5.7 for the
massage and control groups, respectively. In the study, 61.3% of the women had
graduated from primary school, 75.8% were housewives and 71% of them were
primiparous. There was no statistical significant difference between control and

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massage groups in regard to socio-demographic variables and data was shown in
Table 1.

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VAS scores of pregnant women during intrapartum period
Statistical significant differences have been found between the groups according

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to average VAS scores in all three phases. The first mean VAS score was found as
5.2 ± 0.9 in massage group and 7.3 ± 1.3 in control group. Second VAS score were

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6.6 ± 1.6 and 8.8 ± 1.0 for massage and control groups, respectively. The third VAS
score was significantly higher in the control group than massage group during third
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evaluation (9.2±2.4 and 6.7±2.7) (p<0.05) (Table 2).
Duration of second stage of labor according to massage and control group
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The mean duration of second stage was 24.6 ± 12.7 minutes in massage group
and 31.7 ± 20.9 minutes in control group (p>0.05) (Table 2). Overall, 45.2% of
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women in the massage group defined delivery as “shorter than I expected”, 64.5%
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of women in the control group said delivery was “longer than I expected” and there
was a statistically significant difference between groups for evaluation of length of
labor (p<0.05) (Table 3).
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It was asked to pregnant women “How did you perceive the labor pain?”, 61.3%
of women in the massage group said “as expected”, 87.1% of women in the control
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group stated “More painful than expected” (Table 3).

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Behaviors of women during labor according to massage and control groups

Women in the massage group clenched their fists (96.8%), were anxious
(32.3%), made grimace (38.7%) or cried quietly (25.8%). Women in the control
group clenched anything (77.4%), cried quietly (45.2%), were anxious (41.9%), and
screamed (38.7%). There was statistically no significant difference between
behaviors of women during labor and groups except for clenching fists (Table 4).
Apgar scores of baby according to massage and control groups
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Mean Apgar scores of the babies in massage and control groups taken at first
minute were 7.9±0.2 and 7.8±0.3, respectively. There was statistically no significant
difference between the massage and control group (p>0.05) (data not shown).
Thoughts and satisfaction of women about vaginal delivery
Two hours after delivery women were asked about their satisfaction about
delivery and mean satisfaction scores were found as 8.8±0.7 in massage group and

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6.9±0.8 in control group (p<0.05) (Table 2).
Overall, 71% of women (n=22) in massage group said labor was “a very nice

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wonderful feeling”, four women (12.9%) stated that labor was “a very nice feeling
despite labor pain”, four women (12.9%) defined labor as “a difficult experience but

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happy in the end” and one women (3.2%) said “I am happy not to have a cesarean”
(data not shown).
About half of women in control group (48.4%, n=15) stated that giving birth was

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very painful and difficult, but being a mother was very nice, 32.3% of them (n=10)
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said giving birth was a very exhausting and painful thing. Four women (12.9%)
stated that “labor is a happy and nice feeling”, one woman (3.2%) declared labor
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was a short but painful thing and one of them said “I do not wish to experience labor
pain again” (data not shown).
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When the women were asked about their opinion about massage during labor all
of them stated that they were satisfied with massage and would recommend massage
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to other women. Massage was defined as distracting the women’s attention and
letting them feel control over delivery by 93.5% of the massage group and 96.8%
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stated that massage had helped them cope with pain and they had felt themselves
safe. All of the women in the control group reported that they would like to receive
massage during intrapartum period (data not shown).
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DISCUSSION
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In this study the VAS score was evaluated three times during intrapartum period.
The mean VAS score in the massage group was determined lower than those of the
control group. Tzeng and Su’s (2008) study evaluated severity of back pain in 93
Taiwanese pregnant women using VAS during cervical dilatation of 2-4 cm, 5-7 cm,
8-10 cm. Their study showed that 75.3% of pregnant women experienced lower back
pain and as cervical dilatation advanced this pain increased towards the sacral region
and pain was relieved by massage (65.3%) and change of position (61.1%) (Tzeng
and Su 2008). A study done with 62 primiparous women in Iran showed that 30
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minutes of massage during latent, active and transition phase decreased level of
exhaustion in latent and transition phase (Abasi and Abedian 2009). Another Iranian
study compared massage (n=51) and musical therapy (n=50) in over 100 women and
applied lower abdominal, back and shoulder massage and pubic pressure during
contractions together with deep inspiration when cervical dilatation was 3-4 cm.
Women in the musical therapy group listened to traditional music during active

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phase for 30 minutes. After intervention, lower scores of pain were recorded in the
massage group than musical therapy group (Taghinejad et al 2010).

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In a study from Tehran, women were classified into three groups as receiving
massage (n=30), having a supporting person during intrapartum period (n=30) and

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considering as a control group (n=30). Sacral massage was preferred by 91.7% of the
women in the massage group and pain scores in massage group in second and third
phase of labor were found lower than control group. Satisfaction levels were higher

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in groups receiving massage and having a supporting person (Mortazavi et al 2012).
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A meta-analysis of five studies has been done by The Cochrane Collaboration
Review on the effect of reflexology and massage on labor pain (n=326). This meta-
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analysis stated that the group who had been applied massage during the first phase of
labor had less pain, stress and anxiety. Moreover, it was pointed out that massage has
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an important role in relieving pain, enhancing emotional stability of the laboring

woman and more studies are needed on this subject (Smith et al 2012). In a study
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women were divided into three groups. First group were applied ice massage, second
group applied acupuncture and the third group considered as placebo. It was
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observed that either ice massage or acupuncture were effective in decreasing labor
pain (Hajihamini et al 2012). These studies show that intrapartum massage is
important in decreasing VAS scores, therefore perceived labor pain may be
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overcome by massage. Nursing skills in the delivery room are of great importance
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and health care providers should all be able to offer this non-pharmacologic pain
relief.
In a study from Canada, 37 women received massage during intrapartum and pain
was evaluated using Mc Gill pain scale. Although the pain score was found lower
and need of epidural was delayed in massage groups, there was statistically no
difference, however Janssen et al comment that decrease in scores and delay of
epidural is still worth taking into account (Janssen et al 2012).
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In another study, massage was applied by effleurage technique to sacrum, back,
shoulders, ankles and wrists to 60 pregnant women in Tehran and there was
statistically significant difference massage and control groups both for duration and
for level of pain in first phase of delivery (Karami et al 2007).
Another study showed that head, shoulder and back massage done by the partner
of the woman significantly decreased perception of labor pain (Field et al 1997).

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A study from Taiwan (n=60) found that women who had massage from her
partner declared the pain and anxiety decreased and they described delivery as a

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perfect experience. This study stresses the fact that somatic stimulation (massage,
sacral pressure) helps the women to compete with labor pain and decreases perceived

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pain in all three phases and decreases anxiety in latent phase (Chang et al 2002).
In the present study, the duration of total labor was 7.1 minutes shorter in the
study group but this result was statistically insignificant. Another study found that

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the massage done by partner decreases anxiety, shortens duration of labor and stay at
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hospital and lowers risk of postpartum depression (Field et al 1997). The study from
Tehran found the mean of active phase time as 2.6 hours in the massage, 5.7 hours in
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supporting and 7.5 hours in the control group (Hamideh et al 2012). Women were
randomized into the massage (n=23) and control groups (n=23) in San Paulo Brazil
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and massage were applied at 4-5 cm cervical dilatation. Labor duration was found to
be 1.1 hours longer in the study group than control group. Nevertheless, massage did
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not change location or form of pain in active phase (Gallo et al 2013). Another study
by Yildirim found first period of delivery time as 7.1 hours in both study and control
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groups (Yıldırım 2001). Similarly, Chang et al found average delivery time as 10.9
hours for study and 9.6 hours for control group without statistically significant
difference between the groups (Chang et al 2002). As can be seen, some studies have
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evaluated the duration of active phase while some others have investigated duration
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of first stage of labor.

We have examined the behaviors of women during labor and have observed that
more than half of women in study group seemed to be excited (51.6%), their majority
clenched their fists (96.8%) and one third seemed to be restless (32.3%). These rates
were 35.5%, 71.0% and 41.9%, respectively for control group. In the study, except
for clenching fists, there was statistically no significant difference between groups
for the behaviors of laboring women. Contrary to our findings, Yildirim et al found
that women in the control group cried outloud, changed their facial expression,
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complained and screamed more often than the study group. Expression of fear,
sensitiveness and clenching an object was observed more often in the control group,
a difference between groups was found statistically significant. Moreover, in the
same study behaviors such as avoiding being alone, difficulty in controlling herself,
crying quietly, biting lips, self-damaging, continually walking were found similar
between the control and study groups (Yıldırım 2001).

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Similar to our study findings, in a study in Brazil, Apgar scores of babies born
from women in the control and massage groups were similar (Gallo et al 2013).

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Women in the control group of our study defined the duration of labor as “longer
than expected” twice as more than the massage group. Women in the control group

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of our study defined labor pain as more intensive than those in the massage group. A
study from Manisa concluded that 80.5% of women in the vaginal and 40.6% of
women in the cesarean birth group defined delivery as “more painful than expected”

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(Uçum et al 2010).
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In the current study, the scores of satisfaction with birth experience were found
higher in the massage group than the control groups. As result with that from Tehran
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where women recommended massage to others and said that they would like to have
massage in a subsequent pregnancy (Karami et al 2007). Chang et al’s study from
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Taiwan emphasized the fact that appropriate massage performed at proper time helps
women control their bodies, physical touch of the care giver affects the woman’s
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response to pain, helps the woman to feel more safe, calm and well and also
strengthen the bond between the laboring woman and the nurse (Chang et al 2002).
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Massage done by the partner was found to decrease stress and made the laboring
process better (Field et al 1997). Pain and anxiety were found less and satisfaction
with delivery was found higher in massage group of the study by Hamideh from
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Tehran (Hamideh et al 2012). Brazilian women found massage useful in decreasing

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pain, anxiety and stress and would like to have massage in a subsequent delivery
(Gallo et al 2013).
All women in the massage group were satisfied with the procedure, said that they
would recommend massage to other women; massage contributed to the positive
interaction with the delivery team, they felt better and giving birth was easier. Most
of the pregnant women stated that massage helped easing the pain, they felt safe,
massage distracted their attention and they felt control over their bodies. All women
in the control group said they would like to have massage during intrapartum period
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in the next delivery. Both the present and other studies findings show that women
who receive nursing support during labor have more positive feelings about birth
experience.
Massage had provided a positive interaction between their selves and the
delivery team; women had had better feelings and massage had helped for delivery.
Massage is important in the delivery room as a using intervention for decreasing

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pain, shortening delivery time and increasing satisfaction with birth experience.
We propose that further studies with larger groups should be conducted in order

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to show the importance of relaxation of the woman on a better birth experience. We
recommend that nurses and midwives who deal with pregnant women can develop

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their skills by attending courses and improve their health care giving program. We
suggest that nonpharmacological pain relief methods should be added to the
curriculum of nursing studies.

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Conclusion
This study has found that lower back massage has a significant effect on
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reducing labor pain and increasing the satisfaction with birth. Positive feedback from
women about massage and the request for massage shows that non-pharmacologic
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pain relief is important and useful for easing the pain, feeling self-confidence and
developing positive interactions with surrounding people.
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Table 1 Descriptive characteristics of massage and control groups
Socio-demographic Massage Control Total **Test
characteristics *n (%) * n (%) * n (%)

Age group
25 and younger 20 (64.5) 16 (51.6) 36 (58.1) p= 0.440
26 and older 11 (35.5) 15 (48.4) 26 (41.9)
Educational status

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Primary school 16 (51.6) 22 (71.0) 38 (61.3) p= 0.192
Higher education 15 (48.4) 9 (29.0) 24 (38.7)
Working status
Yes

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9 (29.0) 6 (19.4) 15 (24.2) p=0.554
No 22 (71.0) 25 (80.6) 47 (75.8)
Multiparous 6 (19.4) 12 (38.7) 18 (29) p= 0.161

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Nulliparous 25 (80.6) 19 (61.3) 44 (71)
Body mass index
Normal (19.8-26.0) 9 (29.0) 7 (22.6) 16 (25.8) X2= 0.500

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High (26.1-29.0) 7 (22.6) 9 (29.0) 16 (25.8) p=0.779
Obese (≥29.1) 15 (48.4) 15 (48.4) 30 (48.4)
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Social insurance
Yes 30 (96.8) 31 (100.0) 61 (98.4)
No 1 (3.2) 0 (0.0) 1 (1.6) p= 1.000
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Income status
High 9 (29.0) 9 (29.0) 18 (29.0)
Middle-bad 22 (71.0) 22 (71.0) 44 (71.0) p= 1.000
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Delivery status
Multiparous 6 (19.4) 12 (38.7) 18 (29.0)
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Primiparous 25 (80.6) 19 (61.3) 44 (71.0) p= 0.161

History of spontaneous
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Yes 0(0.0) 3 (9.7) 3 (4.8) p= 0.238

No 31(100.0) 28(90.3) 59 (95.2)
History of elective
abortion
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Yes 3 (9.7) 4 (12.9) 7 (11.3)

No 28 (90.3) 27 (87.1) 55 (88.7) p= 1.000
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Cervical dilatation at
admission
3 cm X2=6.215
2 (6.5) 6 (19.4) 8 (12.9)
4 cm 17 (54.8) 20 (64.5) 37 (59.7) p=0.102
5 cm 6 (19.4) 4 (12.9) 10 (16.1)
6 cm 6 (19.4) 1 (3.2) 7 (11.3)
Attending a birth
preparation class
Yes 2 (6.5) 0 (0.0) 2 (3.2)
No p= 0.492
29 (93.5) 31 (100.0) 60 (96.8)
Total 31 (100.0) 31 (100.0) 62 (100.0)
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*Percentage of colon **Fisher exact test

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Table 2 Mean VAS score, duration of second phase and satisfaction scores of
delivery according to massage and control groups
Massage Control
Mean VAS score Mean ± SD Mean ± SD Test
t= -7.98
1.VAS df=60
(3-4 cm) 5.2±0.9 7.3±1.3 p= 0.000
t= -8.089

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df=59
2.VAS
6.6±1.6 8.8±1.0 p= 0.000
(5-7 cm)

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t= -3.864
df=60
3.VAS
6.7±2.7 9.2±2.4 p= 0.000
(8-10 cm)

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Mean duration of t= -1.612
second phase df= 60
24.6±12.7 31.7±20.9
(minutes) p= 0.112

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Mean t=9.2
satisfaction df= 60
8.8±0.7 6.9±0.8
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scores of delivery p= 0.000

Table 3 Perception of delivery time and pain in massage and control groups
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How would you define Massage Control Test

delivery time? n (%) n (%)
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Longer than expected 9 (29.0) 20 (64.5) X2=13.231

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As expected 8 (25.8) 9 (29.0) df=2

Shorter than expected 14 (45.2) 2 (6.5) p=0.001
Total 31 (100.0) 31 (100.0)
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How would you define Massage Control Test

labor pain? n (%) n (%)
More painful than expected 8 (25.8) 27 (87.1) X2=24.0
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As expected 19 (61.3) 4 (12.9) df=2

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Less painful than expected 4 (12.9) 0 (0.0) p=0.000

Total 31 (100.0) 31 (100.0)
*Colon percentage
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Table 4 Behaviors of women during labor according to massage and control
groups

Massage Control ** Test

Observed Not observed Observed Not

Behavior of n (%) n (%) n (%) observed
women

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n (%)
during labor
16 (51.6) 15 (48.4) 11 (35.5) 20 (64.5) p= 0.306
Agitation

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Avoiding being
0 (0.0) 31 (100.0) 1 (3.2) 30 (96.8) p= 1.000
alone
10 (32.3) 21 (67.7) 13 (41.9) 18 (58.1) p= 0.600
Anxiousness

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Difficulty
controlling
2 (6.5) 29 (93.5) 6 (19.4) 25 (80.6) p= 0.255
herself
Avoiding
3 (9.7) 28 (90.3) 2 (6.5) 29 (93.5) p= 1.000

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communication
5 (16.1) 26 (83.9) 11 (35.5) 20 (64.5) p= 0.146
Crying out lout
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8 (25.8) 23 (74.2) 14 (45.2) 17 (54.8) p= 0.184
Crying quietly
Change in facial
12 (38.7) 19 (61.3) 9 (29.0) 22 (71.0) p= 0.592
expression
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30 (96.8) 1 (3.2) 22 (71.0) 9 (29.0) p= 0.012

Clenching fists
Clenching
28 (90.3) 3 (9.7) 24 (77.4) 7 (22.6) p= 1.000
anything
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9 (29.0) 22 (71.0) 10 (32.3) 21 (67.7) p= 1.000

Biting lips
1 (3.2) 30 (96.8) 6 (19.4) 25 (80.6) p= 0.104
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complain
5 (16.1) 26 (83.9) 12 (38.7) 19 (61.3) p= 0.086
Shouting
2 (6.5) 29 (93.5) 2 (6.5) 29 (93.5) p= 1.000
Wandering
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*Row percentage ** Fisher exact test

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