Effects of Meridian Acupressure Massage on Body Composition,Edema,Stress,and Fatigue in Postpartum Women

Abstract

Objectives:

This study aims to investigate the effects of meridian acupressure massage on body composition, edema, stress, and fatigue in postpartum women.

Design:

A quasi-experimental design with a nonequivalent control group was utilized.

Settings/Location:

The Postpartum Care Center of Women's Hospital in Gwangju City, Republic of Korea.

Subjects:

The study group consisted of 39 postpartum women, 19 in the experimental group and 20 in the control group, recruited from the postpartum care center of Women's Hospital in Gwangju city, South Korea.

Interventions:

The experimental group was provided with meridian acupressure massage for 90 min daily over 5 days as an experimental therapy.

Outcome measures:

Body composition (body weight, BMI, total body water, ECW ratio, LBM, and body fat) Edema (subjective edema, average girth of the upper limbs, and average girth of the lower limbs), Stress (psychological stress and physical stress), and Fatigue.

Results:

The experimental group demonstrated a significantly larger decrease compared with the control group in measures of body composition, edema, total subjective stress, psychological stress, and subjective fatigue.

Conclusions:

Meridian acupressure massage can hasten the return to original body composition after childbirth.

Introduction

Postpartum women experience changes in body composition due to pregnancy. In particular, 68.6% of postpartum women report edema after childbirth.¹ In addition, they might experience obesity and its accompanying complications and emotional difficulties unless they watch their weight appropriately during the postpartum period.^2,3 Thus, to restore early postpartum women's body composition and alleviate their edema, the development of appropriate nursing intervention programs is needed.

During the postpartum period, women's bodies return to their original state, which involves a certain level of stress and anxiety caused by the drastic changes in hormone levels, pain due to sutures, hyperlactation, lack of sleep, and physical hardship related to nurturing babies.⁴ There are also psychological burdens, including the obligation to establish an emotional relationship with their newborn, integrate their new role as a mother into their life, cope with the increased economic burden, and adapt to the changes in family structure, and decreased leisure time. If they do not adapt to these stressful situations, it can affect their everyday function, which has negative effects on family life.⁵ In addition, postpartum women tend to feel tired more than when they were pregnant because of the added roles and responsibilities as mothers.⁶ The degree of fatigue in early postpartum women is high,⁷ and when this prevents them from adapting to their new roles as mothers, postpartum depression can result.⁸

To mitigate the effects of postpartum stress and fatigue, nursing intervention is required from the very beginning of the postpartum period.

Recently, much attention has been paid to complementary and alternative medical therapies. Massage using the meridian system and points (meridian acupressure massage) is one of the medical techniques that forms the foundation of Chinese medicine.⁹ The body of knowledge surrounding this style of massage has been accumulated and systematized from ancient Chinese practices. Meridian acupressure massage is a concept combining “meridian theory,” one of the basic theories in Oriental medicine, with “massage,” a manual skill in Western medicine. Meridian acupressure massage helps restore balance between the organs and maintains the body's equilibrium by massaging areas of acupressure points.¹⁰ This activates the parasympathetic nervous system and places the body in a relaxed state, which aids in the removal of waste by improving blood circulation.¹¹

Lee et al.¹² applied meridian acupressure massage to patients with Bell's palsy for 20 min, thrice weekly for 2 weeks, and found that it decreased facial paralysis, pain, and anxiety. Others have reported that meridian acupressure massage is effective in alleviating the facial paralysis, pain, and anxiety of patients with paralysis of the facial nerve, and relieving constipation in hospitalized elderly patients in a long-term care hospital.¹³ Choi and Lee¹⁴ reported that administering foot reflexology massage once a day for 3 days to postpartum mothers was effective in reducing fatigue, stress, and postpartum depression. Lee¹⁵ reported that massage therapy for cesarean section mothers was effective in alleviating the stress response. Furthermore, Kim and Ahn¹⁰ reported that abdominal massage was effective in decreasing waist–hip ratio, abdominal circumference, and hip circumference after childbirth.

In particular, early postpartum mothers reported that maternal postpartum stress, lack of wound healing, lack of sleep, and fatigue were high in childbirth.¹⁶ If the physical and psychological stresses of the postpartum period persist, they can have a negative impact on the mother and impair her adjustment to daily life, and negative feelings about the maternal experience are likely to lead to postpartum depression.¹⁴ Acupressure massage, which promotes the circulation of blood and lymph, mental stability, and relaxation of muscles, is thought to be effective in decreasing maternal obesity, edema, stress, and fatigue. However, there are few studies investigating the effects of acupressure massage in postpartum women.

Therefore, we attempted to examine the effects of meridian acupressure massage on the body composition, and measures of edema, stress, and fatigue in postpartum women. In doing so, we also investigated how it could be integrated into a postpartum management program in clinical practice.

Materials and Methods

Study design

In this study, a quasi-experimental design with a nonequivalent control group and pretest–posttest measurements were utilized to examine the effects of meridian acupressure massage on body composition, edema, stress, and fatigue. The interval between the pretest and posttest measurements was the same for both groups, but the control group did not receive any additional therapy in the intervening period.

Preliminary study

A preliminary study was conducted from February 2 to 13, 2015 to examine whether meridian acupressure massage was appropriate for postpartum women, and whether our experimental protocol required any modifications. For this purpose, we recruited 18 postpartum women who met the inclusion criteria and divided them equally into an experimental and a control group. We measured the subjects' parameters before and after administering meridian acupressure massage for 90 min daily, over 5 days. Participants in both groups were briefed on the meaning of their body composition readings, and given small gifts (baby goods and baby wipes). We confirmed the time required to complete the questionnaire, the reliability and validity of the selected tool, and whether the massage room and environment felt comfortable to the subjects.

Participants

The subjects of this study were postpartum women who had entered the postpartum care center of Women's Hospital in Gwangju city, South Korea after the birth in the same hospital.

To minimize the potential effect of the differences between different medical practitioners and environments, we only recruited women who had given birth in the same hospital. This study was carried out from February 23 to May 8, 2015. During this period, the mothers who were admitted to postpartum care centers and met the selection criteria were identified and recruited. All the subjects were informed of the intended effects of the intervention and submitted written consent in advance. All study participants received the normal program provided by the postpartum care center, and the experimental group was also provided with the acupressure massage intervention. The experimental protocol was conducted at separate times in the experimental group and the control group, to ensure that no diffusion took place between the groups.

The inclusion criteria were as follows: (1) women undergoing vaginal childbirth in weeks 38–41 of pregnancy; (2) women giving birth to a healthy baby that weighed >2500 g; (3) women aged between 20 and 40; (4) women who did not develop complications during the birth and postpartum period; and (5) women who understood the goal of this study and gave written consent.

The required number of subjects was calculated using G*Power version 3.14. In a preliminary survey, the mean total body water of the experimental group was 31.23 L before the test, and 29.98 L after the test. According to the difference (−1.25 L), the effect size was calculated as 1.01. Using a significance level of α = 0.05, a power of 0.80, and an effect size of 2, we calculated that 17 subjects would be needed in each group, for a total of 34 subjects. A total of 53 women were selected for participation in the study. A total of 14 women were withdrawn from the study (26.4%), 1 from the experimental group, and 13 from the control group. In the case of the experimental group, one participant dropped out due to the baby's health problems. In the control group, participants withdrew due to time constraints (seven cases), remorse (three cases), premature discharge (two cases), and disease exacerbation (one case). Finally, there were 19 participants in the experimental group and 20 in the control group. There was no statistically significant difference in the demographic characteristics and disease characteristics of the study participants and the dropouts.

Measures

Body composition

An InBody 770 scanner (Biospace Co., Ltd., Korea), which analyzes body composition by multiple frequency electrical impedance analysis, was used to measure the subjects' body weight, body–mass index (BMI), total body water, extracellular water to total body water ratio (EBW), lean body mass (LBM), and body fat before and after the experimental period.

Edema

The degree of subjective edema was measured using a visual analogue scale. Participants indicated the degree of edema they felt, along a 10-cm horizontal line with 0 representing no edema and 10 representing extremely serious edema. The distance to the marked point was measured in centimeters.

The degree of objective edema was derived by measuring the average girth of the upper limbs (the right and left arms) and the average girth of the lower limbs (the right and left thighs) were measured using the InBody 770 scanner. We compared the measurements at different times to calculate the change in edema; the greater the change in the score, the greater was the change in edema.

Stress

We used the stress measuring tool developed by Park,¹⁷ which has 30 questions in total. There were 15 psychological items for the participants to rate, for example, “I was very nervous at minor things” and “I could not concentrate on everything,” along with 15 physical items, including “headache” and “heart throbbing.” The degree of stress is measured on a scale of 4 points from 0 to 3, with higher scores indicating a higher degree of stress. The overall degree of psychological and physical stress was indicated by the total score in each category, as follows: 0–5 (below average) means there is no specific problem, 6–12 (average) is the average stress level of working adults, 13–19 (above average) means the subject should start paying attention to their stress levels, and scores above 20 (caution level) indicate that the subject is in need of considerable attention or specialist consultation. The reliability of this scale at the time of development was Cronbach's α = 0.88 for psychological stress and Cronbach's α = 0.89 for physical stress. In this study, Cronbach's α = 0.92.

Fatigue

We used a tool originally developed by Pugh¹⁸ and translated by Choi et al.⁸ to measure the levels of fatigue in our participants. This tool consists of 30 questions in total, across three domains of physical fatigue, psychological fatigue, and nervous system fatigue (10 questions each). The responses to each question are scored on a scale of 1 to 4, so the total scores can range from 30 to 120. A total score of under 38.5 represents low fatigue levels, 38.6 to 64.4 represents average fatigue levels, and scores of 64.5 and higher represent high fatigue levels.

Data collection procedure

Prestudy preparation

In this study, one expert nurse provided the meridian acupressure massage intervention. This nurse is a nationally recognized masseur certified by the Ministry of Health and Welfare, and had >5 years of experience administering acupressure massage. The researchers completed a training course to participate as an assistant in the acupressure massage intervention. The acupressure massage protocol was developed in consultation with one oriental doctor, one maternal nursing professor, and one postpartum massage specialist to develop a protocol suitable for postpartum mothers.

The body composition measurements and questionnaires were carried out by a nurse with >5 years' experience in obstetrics and gynecology. A researcher explained the program to this nurse, including the knowledge, attitude, and cautions necessary for the process. To prevent information bias, the staff who administered the experimental treatments were different from those that collected data.

Pretest and posttest measurements

We measured the general and obstetric characteristics, edema, stress, and fatigue of the participants with the previously detailed self-report questionnaires, and measured their body composition parameters with the InBody 770 scanner. These measurements were collected from the control group from February 23 to March 13, 2015, and from the experimental group from March 16 to May 8, 2015, before they received the meridian acupressure massage therapy. In the experimental group, the pretest measurements were collected 1 day before the start of therapy, and the posttest measurements were collected 1 day after the final massage session. The measurements from the control group had an equal intervening period between them. All participants had their body composition results explained to them, and received small gifts.

Intervention

Considering the average length of postpartum care center stay for postpartum women (1 week) and the time needed to perform a whole-body massage, we decided to apply meridian acupressure massage once a day for 90 min, over 5 days. Each meridian acupressure massage session consisted of a 5-min preparatory stage, an 80-min principal stage (1. abdomen, 2. upper limbs, 3. chest, abdomen, and lower limbs, 4. side, 5. back, and 6. back and lower limbs), and a 5-min finishing stage. To prevent experimental diffusion, the experimental group was provided with meridian acupressure massage from March 16 to May 8, after all participants from the control group had been discharged.

Ethical issues

This study was approved by the Bioethics Review Committee of St. Carollo General Hospital (IRB No: SCH 2014-070). The participants were fully informed of the study methods, expected results, and possible effects, after which they gave their written consent. They were also informed that they could drop out at any time, with no consequences.

Data analysis

The data analysis was conducted using version 22.0 of the SPSS software package (IBM Corp., NY). The subjects' data are presented as absolute values and percentages. Homogeneity between the two groups was examined using the chi-square test and Fisher's exact test. The Kolmogorov–Smirnov test was used to test the normality of the measured body composition parameters (body weight, BMI, total body water, extracellular water [ECW] ratio, LBM, and body fat), and edema, stress, and fatigue levels. An independent samples t-test was used to assess the homogeneity and difference between the two groups. p < 0.05 was considered statistically significant.

Results

Homogeneity analysis

There were 19 subjects in the experimental group, and 20 in the control group. The homogeneity analysis revealed no significant differences between the participants' demographic characteristics (Table 1), or their pretest measurements (Table 2).

Table 1.

Homogeneity Test of General Characteristics (n = 39)

		Exp. (n = 19)	Cont. (n = 20)
Characteristics	Categories	M ± SD or n (%)	M ± SD or n (%)	t or x²	p
Age (years)		32.42 ± 4.07	31.40 ± 4.85	0.710	0.482
Height (cm)		160.0 ± 4.79	159.1 ± 4.34	0.580	0.566
Employed	Yes	7 (36.8)	12 (60.0)	2.092	0.205
	No	12 (63.2)	8 (40.0)
Education^a	High school graduate	3 (15.8)	4 (20.0)		0.682
	College graduate	15 (78.9)	13 (65.0)
	Graduate student	1 (5.3)	3 (15.0)
Religious affiliation	Yes	13 (68.4)	10 (50.0)	1.367	0.333
	No	6 (31.6)	10 (50.0)
Monthly income^a	<3.0 million won	6 (31.6)	4 (20.0)		0.123
	3.1–4.0 million won	7 (36.8)	4 (20.0)
	4.1–5.0 million won	2 (10.5)	9 (45.0)
	>5.0 million won	4 (21.1)	3 (15.0)
Gestation weeks^a	38–39 weeks	9 (47.4)	8 (40.0)		0.416
	39¹⁺–40 weeks	3 (15.8)	4 (20.0)
	40¹⁺–41 weeks	7 (36.8)	8 (40.0)
Number of birth	1 time	8 (42.1)	10 (50.0)	2.251	0.475
	2 times	9 (47.4)	10 (50.0)
	3 times	2 (10.5)	0 (0.0)
Attended antenatal classes^a	Yes	4 (21.1)	2 (10.0)		0.407
	No	15 (78.9)	18 (90.0)
Postpartum caretaker	Yes	19 (100)	18 (90.0)	2.003	0.487
	No	0 (0.0)	2 (10.0)
Breastfeeding	Exclusive	5 (26.3)	5 (25.0)	0.009	1.000
	Partial	14 (73.7)	15 (75.0)
Health issues for postpartum women	Yes	1 (5.3)	2 (10.0)	0.308	1.000
	No	18 (94.7)	18 (90.0)
Health issues for the new born baby	Yes	1 (5.3)	0 (0.0)	1.080	0.487
	No	18 (94.7)	20 (100.0)

Data are expressed as mean ± standard deviation or number (percentage). p < 0.05 was considered statistically significant.

Fisher's exact test.

Exp., experimental group; Cont., control group.

Table 2.

Homogeneity Test of Pretest-Dependent Variables (n = 39)

	Exp. (n = 19)	Cont. (n = 20)
Variables	M ± SD	M ± SD	t	p
Body composition
Body weight (kg)	64.68 ± 10.25	62.03 ± 9.18	0.853	0.399
BMI (kg/m²)	25.29 ± 3.68	24.51 ± 3.02	0.730	0.470
Edema
Subjective edema	04.05 ± 2.93	04.05 ± 1.85	0.003	0.997
Average girth of the upper limbs (cm)	30.03 ± 2.69	29.48 ± 2.76	0.633	0.530
Average girth of the lower limbs (cm)	51.82 ± 4.16	51.14 ± 3.16	0.580	0.565
Stress
Total subjective stress	21.00 ± 8.29	21.60 ± 13.76	−0.166	0.869
Psychological stress	09.58 ± 4.90	08.60 ± 7.03	0.502	0.619
Physical stress	11.42 ± 4.56	13.00 ± 8.94	−0.699	0.490
Fatigue	56.63 ± 9.52	55.70 ± 19.75	0.189	0.851

Data are expressed as mean ± standard deviation. p < 0.05 was considered statistically significant.

BMI, body mass index.

Body composition

After the meridian acupressure massage therapy, the decrease in mean body weight in the experimental group was significantly larger than in the control group (2.25 kg vs. 0.61 kg; t = −2.830, p = 0.007). There were also significantly larger reductions in mean BMI (0.91 kg/m² vs. 0.24 kg/m²; t = −2.982, p = 0.005), total body water (1.23 L vs. 0.24 L; t = −3.988, p = 0.001), and LBM (1.37 kg vs. 0.36 kg; t = −2.369, p = 0.026) in the experimental group, compared with the control group. The mean body fat was reduced in both groups, but the difference in the magnitude of the reductions was not significant (0.87 kg vs. 0.27 kg; t = −1.037, p = 0.306). The measurements are detailed in Table 3.

Table 3.

Differences in Body Composition, Edema, Stress, and Fatigue Before and After the Meridian Acupressure-Focused Postpartum Care Program (n = 39)

		Pretest	Posttest	Difference of pre-post test
Variables	Group	M ± SD	M ± SD	M ± SD	t	p
Body composition
Body weight (kg)	Exp. (n = 19)	64.68 ± 10.25	62.43 ± 10.05	−2.25 ± 1.53	−2.830	0.007
	Cont. (n = 20)	62.03 ± 09.18	61.42 ± 8.79	−0.61 ± 2.04
BMI (kg/m²)	Exp. (n = 19)	25.29 ± 3.68	24.38 ± 3.55	−0.91 ± 0.58	−2.982	0.005
	Cont. (n = 20)	24.51 ± 3.02	24.27 ± 2.82	−0.24 ± 0.80
Total body water (L)	Exp. (n = 19)	31.95 ± 4.10	30.72 ± 4.02	−1.23 ± 1.30	−3.043	0.005
	Cont. (n = 20)	29.65 ± 3.45	29.42 ± 3.40	−0.24 ± 0.61
ECW ratio	Exp. (n = 19)	0.393 ± 0.007	0.386 ± 0.007	−0.007 ± 0.007	−3.988	0.001
	Cont. (n = 20)	0.391 ± 0.007	0.391 ± 0.007	−0.00 ± 0.00
LBM (kg)	Exp. (n = 19)	43.25 ± 5.52	41.87 ± 5.43	−1.37 ± 1.70	−2.369	0.026
	Cont. (n = 20)	39.61 ± 4.66	39.25 ± 4.64	−0.36 ± 0.80
Body fat (kg)	Exp. (n = 19)	21.43 ± 6.75	20.56 ± 6.46	−0.87 ± 1.46	−1.037	0.306
	Cont. (n = 20)	22.43 ± 6.59	22.17 ± 6.00	−0.27 ± 2.10
Edema
Subjective edema	Exp. (n = 19)	04.05 ± 2.93	01.79 ± 1.44	−2.26 ± 2.47	−3.461	0.002
	Cont. (n = 20)	04.05 ± 1.85	03.85 ± 1.98	−0.20 ± 0.83
Average girth of the upper limbs (cm)	Exp. (n = 19)	30.03 ± 2.69	29.95 ± 2.63	−0.08 ± 0.60	0.005	0.996
	Cont. (n = 20)	29.48 ± 2.76	29.40 ± 2.55	−0.08 ± 0.81
Average girth of the lower limbs (cm)	Exp. (n = 19)	51.82 ± 4.16	50.41 ± 3.69	−1.41 ± 1.40	−2.218	0.033
	Cont. (n = 20)	51.14 ± 3.16	50.73 ± 3.35	−0.41 ± 1.43
Stress
Total subjective stress	Exp. (n = 19)	21.00 ± 8.29	16.74 ± 9.92	−4.26 ± 4.75	−2.368	0.025
	Cont. (n = 20)	21.60 ± 13.76	22.80 ± 13.34	01.20 ± 9.09
Psychological stress	Exp. (n = 19)	09.58 ± 4.90	05.74 ± 4.95	−3.84 ± 3.42	−2.270	0.029
	Cont. (n = 20)	08.60 ± 07.03	7.95 ± 06.13	−0.65 ± 5.14
Physical stress	Exp. (n = 19)	11.42 ± 04.56	11.00 ± 05.54	−0.42 ± 3.39	−1.304	0.203
	Cont. (n = 20)	13.00 ± 08.94	14.85 ± 08.10	−1.85 ± 6.97
Fatigue	Exp. (n = 19)	56.63 ± 09.52	49.95 ± 11.43	−6.68 ± 7.92	−2.579	0.014
	Cont. (n = 20)	55.70 ± 19.75	58.55 ± 20.25	2.85 ± 14.14

Data are expressed as mean ± standard deviation. p < 0.05 was considered statistically significant.

ECW, extracellular water ratio; LBM, lean body mass.

Edema

After the meridian acupressure massage therapy, the decrease in the subjective edema scores in the experimental group was significantly larger than those in the control group (2.26 vs. 0.20; t = −3.461, p = 0.002). The decrease in the average girth of the lower limbs was also significantly larger in the experimental group (1.41 cm vs. 0.41 cm; t = −2.218, p = 0.033), but the decrease in the average girth of the upper limbs was not (0.08 cm in both groups; t = 0.005, p = 0.996). The measurements are detailed in Table 3.

Stress

After the therapy, there was a significantly larger decrease in the overall subjective stress scores in the experimental group than in the control group (a decrease of 4.26 vs. an increase of 1.20; t = −2.368, p = 0.025). Within the subcategories, there was a significantly larger decrease in the psychological stress scores in the experimental group, compared with the control group (3.84 vs. 0.65; t = −2.270, p = 0.029). However, there was no significant difference between the changes to physical stress scores between the experimental and control group (a decrease of 0.42 vs. an increase of 1.85, respectively; t = −1.304, p = 0.203). The measurements are detailed in Table 3.

Fatigue

There was a significant difference in the changes to fatigue scores between the experimental and control group (a decrease of 6.68 vs. an increase of 2.85, respectively; t = −2.579, p = 0.014). The measurements are detailed in Table 3.

Discussion

Acupressure massage is a combination of the concept of “meridian theory,” which is one of the basic theories of Oriental medicine, and “massage,” which is a technique of Western medicine. Acupressure massage is a method of promoting the natural regulation of physiological function, and reversing pathological changes.¹¹ Postpartum healthcare is one of the major issues in women's lives. This study was conducted to investigate the benefits of acupressure massage for postpartum women.

We found that the decrease in mean body weight, BMI, total body water, ECW, and LBM was significantly larger in postpartum women who underwent a regimen of meridian acupressure massage, compared with a control group, who received no additional therapy. However, the decrease in body fat was not significantly different between the two groups. A study by Park¹⁹ found no significant change in the weight, girth of thigh, or girth of calf in postpartum women who received a daily foot reflexology massage for 2 weeks. However, the weight, BMI, body fat, and waist–hip ratio of postpartum women were significantly decreased after receiving abdominal massage twice a week.¹⁰ These results are similar to those of the present study. The body weight, BMI, total body water, ECW, and LBM were significantly decreased by the acupressure massage.

We found significant differences in the reduction of subjective edema scores and average lower limb girth between the experimental and control groups, but not in the average upper limb girth. The reason for the significant decrease in edema was thought to be the enhanced circulation of blood and lymph resulting from the massage therapy, which promotes the smooth supply of nutrients and oxygen, and removes waste products. Meridian acupressure massage is considered to be more effective for edema of the lower limbs. It is thought that the effect of massage on lower extremity edema was more significant than that on upper extremity edema due to an increase in blood volume, hormone change, and blood flow from the lower extremity to the pelvis. These findings suggest that the meridian acupressure massage is suitable for the management of edema in postpartum women.

Although physical stress was not significantly affected by meridian acupressure massage, the decrease in psychological stress scores was significantly larger in the experimental group, compared with the control group. These results were similar to those of a study that reported positive effects on the maternal psychological stress response by providing a 3-day postpartum massage program to cesarean section mothers,¹⁵ and another study that provided a 2-week meridian massage program to facial nerve paralysis patients.¹² Furthermore, massage is a mediated technique that provides psychological and mental relaxation; it is a technique that is performed through contact. It facilitates the trust relationship between the patient and the nurse and supports interpersonal relationships.²⁰ The intimacy and relaxation that arises from the physical contact might alleviate the subjects' psychological stress. Indeed, both physical and psychological stresses were reduced in a study that provided massage for adult women²⁰ and a study that provided foot reflexology massage for middle-aged women.²¹

Subjective fatigue was decreased (−6.68) in the experimental group after applying meridian acupressure massage, and increased (+2.85) in the control group. This finding strongly suggests that meridian acupressure massage was effective for relieving fatigue in postpartum women. These findings are in agreement with the results of other Korean studies using complementary therapies to reduce postpartum fatigue through foot reflexology,¹⁴ aromatherapy,²² and laughter therapy.⁵ These findings are probably because, by facilitating blood and lymph circulation, meridian acupressure helps recovery from muscle fatigue by removing waste and providing nutrition and oxygen.²³ Pretest fatigue scores were measured 3 days after birth (day 1 after entering the postpartum care center). It should be noted that our participants' fatigue scores were 55.70–56.63, which is within the range of average fatigue levels. Previous findings indicate that fatigue levels during the early postpartum period are higher than in other postpartum periods and postpartum fatigue is the most important factor in the quality of life that postpartum women perceive.⁸ Therefore, efforts to improve postpartum women's quality of life should focus on reducing the perceived levels of fatigue.

The present study had some limitations. First, it was a single-center study with a relatively small sample size, which limits the generalizability of our findings. Second, because of the nature of the therapy, we were unable to use a double-blind method, and could not completely eliminate the Hawthorne effect.

A previous study found that maternal fatigue is higher than postpartum fatigue after 14 days.²⁴ However, the program in the present study only lasted for 5 days. This suggests that an ideal acupressure massage program might include sessions that last beyond the mothers' stay in the postpartum care center. Therefore, further research is needed to measure the effects of different periods of application, frequency, and other dependent variables before acupressure massage can become a standard practice.

In conclusion, through quantitative measurements of physiological parameters, this study identified that meridian acupressure massage produces positive impacts on body composition and edema, by controlling the functions of internal organs and improving the circulation of blood and lymph. When provided with meridian acupressure massage, the subjects develop a feeling of trust in the providers, which causes physical, psychological, and mental relaxation, and reduces their stress and fatigue. This study provides useful data on how meridian acupressure massage can be incorporated into postpartum management programs in clinical practice.

Footnotes

Acknowledgment

The authors especially thank the postpartum women who participated in this study.

Author Disclosure Statement

No competing financial interests exist.

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