The Science Behind Massage during Childbirth

Lena massaging a client during a home birth in Brooklyn, 2012.

Studies show that birthing parents who receive massage while they are in labor have shorter, less painful labors, less anxiety during labor, less likelihood of using pain medication, as well as shorter hospital stays and better mood following birth.

UPDATED May 2020

As a licensed massage therapist and certified birth doula with over a decade of experience supporting clients throughout the intensity of their labors and births, I have witnessed the incredible benefits of skilled hands on support during childbirth. But how does this work? Read on for physiological explanations for two mechanisms of action.

Lena applying counter-pressure to client’s sacrum, Brooklyn Birthing Center, 2011.

1.  Labor hormones. Childbirth involves a delicate hormonal orchestration that is vulnerable to disruption by even mild to moderate stress — mammals evolved this way so as not to give birth while in danger. The primary hormone of labor, oxytocin, is released by the pituitary gland in the brain and causes the uterus to contract. Oxytocin is also released in response to physical touch and massage, feelings of love, bonding/closeness, orgasm, and breastfeeding. Stress hormones such as cortisol have an antagonistic relationship to oxytocin – meaning they inhibit the action of oxytocin in labor. That’s why labor can stall or be prolonged under stress (and also why is it difficult to have an orgasm under stress). Massage and doula support reduce stress and anxiety during labor (reduce cortisol levels) which helps labor to move along more quickly and smoothly. Massage stimulates deep pressure receptors under the skin which stimulate vagal nerve tone, effectively switching the nervous system over to its parasympathetic branch (its relaxation response that is associated with slower deeper breathing, reduced blood pressure, less muscle tension, and less anxiety) - it is the nervous system state that our bodies are designed to labor in. It is well understood that stress and anxiety also increase our subjective experience of pain. I find that when I use soothing massage strokes on my laboring clients in between contractions it helps them drop into a more deeply relaxed state – allowing them to cope better with their labors.

“Childbirth involves a delicate hormonal orchestration that is vulnerable to disruption by even mild to moderate stress — mammals evolved this way so as not to give birth while in danger. ”

Home birth in Brooklyn, 2012.

2.  Pain pathways. Less stress, anxiety and fear equal less pain. But massage during labor can decrease your experience of pain in another way as well. The spinal nerves that exit from the sacrum (the bottom part of your spinal column) innervate your pelvic organs, including the uterus. Pain receptors in the uterus send pain messages through these nerves and up your spinal cord to your brain on a small pathway that is specific for pain signals. There is a separate pathway that sends messages to the brain that is specific for pleasurable (and neutral) sensations. The pleasure pathway is bigger so messages travel more quickly along this pathway effectively overriding simultaneous pain signals. This is known as the gate control theory of pain management. So, when I massage a client’s sacrum and low back while they are having a contraction, the pleasurable sensation from the massage gets to the brain faster than the pain sensation caused by the contraction – they still feel the pain of the contraction, but the pain is significantly drowned out by the massage. This is the same reason why rubbing or squeezing a stubbed toe reduces the pain. It is a very simple concept, and it works like a charm. During labor this often makes the difference between deciding to get pain medication or not.

Lena using the double hip squeeze to relieve pain during a contraction. Brooklyn Birthing Center, 2011.

Without skilled and caring support during labor, the two mechanisms described here can reinforce one another in what is known as the pain–tension–pain cycle leading to longer and more painful labors. Massage helps to break this cycle by turning on the parasympathetic branch of the nervous system (the relaxation response), relaxing specific tight muscles, and reducing the subjective experience of pain by modulating pain signalling pathways. This helps labor to progress smoothly by allowing the hormonal orchestration to proceed uninhibited as well as releasing any musculoskeletal restrictions around the pelvis that may inhibit the descent of the baby. If you wish to have an unmedicated birth, a doula who can offer skilled hands on support is indispensable in helping you cope with your labor using non-pharmacological methods.

References

Field, T., Diego, M., Hernandez-Reif, M., Schanberg, S., & Kuhn, C. (2004). Massage therapy effects on depressed pregnant women. Journal of Psychosomatic Obstetrics & Gynecology, 1-9. doi: https://doi.org/10.1080/01674820412331282231

Field, T., Hernandez-Reif, M., Taylor, S., & Quintino, 0., & Burman, I. (1997). Labor pain is reduced by massage therapy. Journal of Psychosomatic Obstetrics and Gynecology, 18, 286-291. doi: https://doi.org/10.3109/01674829709080701

Klaus, Marshal H., Kennell, John H., & Klaus, Phyllis H. (2002). The Doula Book. Perseus Publishing, 75-98.

Kovavisarach, E. (2004). Pain in labor. Journal of the Medical Association of Thailand, 87(Supp 3), S207-211.