Maternity Reflexology – Zone Therapy

What is Maternity Reflexology?

Reflexology in some form has been known and practiced in countries as diverse as China, Ancient Egypt, and Rome for at least five thousand years: however, modern reflexology evolved from Zone Therapy, discovered by serendipity by Dr. W.H. Fitzgerald in America in the early twentieth century. He went on to divide the body into ten vertical zones (Fitzgerald 1917). Eunice Ingham (1938) further expanded the zones to map out the parts of the body and produced the first chart of the feet based on the theory that the human body is represented as a homunculus on the feet and hands; and that pressure applied to certain parts of the foot have an effect on the functioning of a remote part of the body (Horowitz 2004).

Reflexology reflex points have been compared to tsubo points in acupuncture (Enzer 2000, Tiran & Chummun 2005). Tsubo points are known to be precisely located, although it is not known how far away from the tsubo point effectiveness declines (Freeman 2001, White 2002).

The premise underpinning reflexology is that the chart of the feet can be used to locate various organs and glands within the body, detect those that are out of balance, and using compression massage with thumbs or fingers to stimulate the corresponding reflex point on the feet, rebalance the malfunctioning body part and restore homeostasis. (Association of Reflexologists (AoR) 2007).

Use of CAM by the general public.

According to Thomas, Nicholl and Coleman (2001) an estimated 13.6% of the adult population of the United Kingdom had used CAM, including reflexology in 1998. In 2006 Maha and Shaw found that 10% of the population of the United Kingdom use CAM in any twelve month period, and as many as 40% have used CAM to date. The NHS referred approximately 10% of these cases while the rest were privately funded at an estimated cost of £450 million. Garrow and Ernst (2007) believe that evidence for therapies funded by the NHS, should conform to Randomised Controlled Trials however Stone (2002) disagrees as CAM therapies are holistic in nature. The estimated cost per person for a course of reflexology in 1997 was estimated at £1000 in one year (Ernst & Koder 1997).

It is clear from these figures that although not fully recommended by conventional medical professionals the public is voting with its feet and using CAM in increasing numbers. Furthermore, pregnant women are turning to CAM in increasing numbers to fulfil their desire for a drug-free pregnancy and delivery (Tiran 1996).

The Changing Childbirth report (1993) highlighted limitations in care for mothers in pregnancy leading to patient dissatisfaction with conventional ante and post natal care packages.

Use of CAM by Midwives.

In a survey of Primary Care Groups 60% of those canvassed replied: with 58% of those supplying CAM to their patients; 10% supplying reflexology by a cross-trained health professional; and in 6% of groups a complementary therapist (DoH 2000). While 90% of Midwives polled believed it was important for CAM to be provided by the NHS (Mitchell et.al. 2006). The DoH (2000) advises G.P.’s that referral of a patient to a complementary therapist is within their remit; they need only to satisfy themselves of the efficacy of the therapy and competence of the therapist. It therefore becomes important for researchers to persuade G.P.’s of the efficacy of reflexology, so that they will feel secure in referring their patients, including pregnant women, when necessary.

As many pregnant women prefer not to use pharmacological assistance, they are turning to complementary and alternative medicine (CAM) for conditions associated with pregnancy (Tiran 1996). Leading on from the 1993 Changing Childbirth Report, which put forward a more woman focused maternity service in the United Kingdom (UK) the DoH and the Department for Education and Skills (DfES) committed to the National Service Framework for Children, Young People and Maternity, a ten year plan intended to promote health with a first class, integrated viewpoint to commence in pregnancy and continue through to adulthood. It states that women should all receive high quality health care provision during pregnancy, and be involved in the decision making on how and where they give birth.

The Smallwood Report (2005) promoted good quality research into CAM with a view to providing a framework for integrating CAM into mainstream medical care. Furthermore, in a recent survey of CAM use midwives, at 34%, were the highest proportion of NHS staff using CAM (Mitchell et.al. 2006). In line with the recommendations of National Service Framework for Children (2004) 64% of maternity units in the UK provide complementary therapies, with 46.2% of the CAM therapists in maternity units being midwives (Mitchell et.al. 2006).

Research Studies.

• A trial project into the effects of reflexology on labour outcome: the magic of reflexology in pregnancy (Motha & McGrath 1994).
• Single-blind trial addressing the different effects of two reflexology techniques versus rest, on ankle and foot oedema in late pregnancy (Mollart 2003).
• A retrospective cohort study exploring the relationship between antenatal reflexology and intranatal outcomes (McNeill, Alerdice, & McMurray 2006).

Motha and McGrath (1994) looked at….

• Hypertension in pregnancy.
• Labour outcomes.

Motha and McGrath (1994).

This study was prompted by the results of a preliminary study into the effects of reflexology on hypertension in pregnancy, as many such studies are started (Field 2002). An unexpected outcome in reduction of active labour times in the group studied prompted a further trial into intranatal outcomes following a course of reflexology treatments (Motha & McGrath 1994).

The study was run by obstetrician and reflexologist, Dr. Gotha and G.P. Dr. McGrath in the latter’s G.P. clinic. The course was offered to women who were over 20 weeks gestation, who had already had a scan to confirm the pregnancy was following a normal course. The area, in an underprivileged part of London, was partly chosen because of the lack of knowledge about reflexology. A total of 64 pregnant women volunteered for a course of 10 free reflexology treatments out of a total of 120 pregnant women attending the antenatal clinic.

The ethnicity of the participants was recorded as well as the presenting complaints associated with pregnancy; which included musculo-skeletal at 24.3% as the largest cause of discomfort to migraines and nose bleeds at 5.4% and 2.7% respectively, as the least bothersome. There was a small percentage of 5.4% without any reported condition. Hypertension was declared to be the only condition that was medically recognised and treated and affected 13.5% of the group.

Three reflexologists treated the participants over the full 10 treatments, with a drop out rate of 42% due to lack of baby sitters, apprehension over any reactions to reflexology, and non-attendance. The results of the trial reported a reduction in labour times with some mothers having labour times of 2 – 3 hours. An average first stage labour for 20 year olds was 5 – 6 hours and this figure included first time mothers who also reported labour times of 5 – 6 hours. Second time mothers of 26-30 years of age had longer labours, but age did not seem to have an impact, neither did the fact of previous pregnancies, as there was little difference between the labour times of mothers at 30 years of age and 40 years of age with some reporting labour times of 2 – 3 hours. The study concluded that “reflexology helps pregnant women of all ages”.

In Mollart (2003)

• Foot oedema
• Ankle oedema

Mollart (2003) looked at…..
A single-blind randomised controlled trial carried out over a two year period at ante natal units of the Gosford and Wyong hospitals in Australia. The aim of the trial was to compare reflexology techniques with rest in order to discover the best protocol to aid heavily pregnant women suffering ankle and foot oedema.

A total of ninety six women from several antenatal clinics associated with the two hospitals were invited to join the trial, and randomly placed into one of three groups. Group one used traditional reflexology, group two used a lymphatic reflexology technique, while group three were assigned to rest.

The treatments were of fifteen minutes duration during a normal antenatal visit, and self-administered questionnaires were filled out to obtain qualitative information, such as previous knowledge of reflexology, demographic information and levels of stress. Quantatative information was gathered by measurements of the feet and ankles, and blood pressure readings taken pre and post treatment.

In McNeill et.al. (2006).

• Onset of labour
• Duration of labour

McNeil at.al. 2006 looked at…..
This study used a comparative retrospective cohort study as time constraints and lack of available subjects prevented the randomised controlled trial, which the authors considered the ideal research model. The aim was to compare three aspects of labour: the onset of labour; the duration of labour; and the analgesia and mode of delivery used. In addition the study analyses the statistics concerning the onset and duration of labour, the number of reflexology treatments at what stage of gestation, and the mode of delivery.

The 150 participants chosen by convenience sampling at a local hospital antenatal unit were all considered to be low risk primagravidae; the first group of 50 received reflexology treatments while the second control group of 100 were chosen from a computer database and their details analysed without being seen. The study made reference to the potential bias due to the construction of the study and made efforts to reduce this by ensuring that all participants were primagravidae, with no pre-existing medical conditions.