• Caroline A Smith, Kate M Levett, Carmel T Collins, and Leanne Jones.
• Centre forComplementaryMedicine Research,University ofWestern Sydney, Penrith SouthDC, Australia. caroline.smith@uws.edu.au
• Cochrane Db Syst Rev. 2012 Jan 1;2:CD009290.

BackgroundMany 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.ObjectivesTo examine the effects of manual healing methods including massage and reflexology for pain management in labour on maternal and perinatal morbidity.Search MethodsWe 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), ClinicalTrials.gov, (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 CriteriaRandomised 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 AnalysisTwo authors independently assessed trial quality and extracted data. We attempted to contact study authors for additional information.Main ResultsWe 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.Authors' ConclusionsMassage may have a role in reducing pain, and improving women's emotional experience of labour. However, there is a need for further research.

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