The Effect of Foot Reflexology on the Anxiety Levels of Women in Labor

Abstract

Objectives:

This research was conducted to analyze the effect of foot reflexology on the anxiety levels of women during labor.

Design, Setting and Subjects:

The study was conducted as a semiexperimental study. It was conducted with 154 nulliparous pregnant women who applied to a maternity unit of a state hospital in the north-western part of Turkey to give birth.

Interventions:

Foot reflexology was applied once to the pregnant women in the experimental group when cervical dilation was 3–4 cm. The treatment was applied to the right foot and left foot reflex points for 15 min, for a total of 30 min. The data in the study were collected using the “Pregnant Women Introductory Information Form” and the “Spielberger State-trait Anxiety Inventory” (STAI TX-1). In evaluating the data, number, percentage, Chi-square, independent samples t-test, and repeated measure analysis of variance test were used.

Main outcome measures:

The mean scores of the STAI TX-1 were used to analyze the results.

Results:

The mean STAI TX-1 scores were measured before reflexology, in the latent and active phases of labor and early in postpartum period (four times in total). The mean STAI TX-1 scores were higher in the experimental group than in the control group (p < 0.001). The mean STAI TX-1 scores postreflexology application (when cervical dilation was 3–4 cm) and during the active phase of the labor (when cervical dilation was 6–8 cm) of the pregnant women in the experimental group were lower than those of the control group (respectively p = 0.010, p < 0.001). In the experimental group, there was no statistically significant difference between the mean STAI TX-1 scores pre- and postreflexology (p = 0.820). The mean STAI TX-1 scores in the early postpartum period were similar in the experimental and control groups (p = 0.080).

Conclusion:

Foot reflexology was found to have a positive effect in lowering the total anxiety scores of the pregnant women. Reflexology is a noninvasive and economical method, which may be used by health professionals to reduce problems during labor. A decrease in anxiety experienced at birth improves women's positive birth experiences, promotes a secure mother–infant attachment, and protects postpartum mental health.

Introduction

The meaning of the word “anxiety” is worry, fear, and curiosity. The process of labor causes anxiety in pregnant women as a result of a number of factors.¹ In particular, nulliparous pregnant women experience this anxiety to a greater extent. In the studies of Parvathi and colleagues, 51.66% of nulliparous women were found to have moderate anxiety about labor.²

Increased anxiety during birth affects maternal and fetal health negatively and leads to many obstetric and psychiatric problems. Women who have anxiety about labor show a decreased release of oxytocin and increased level of adrenaline. As a result, uterine contractions are irregular and ineffective. Labor becomes longer and more difficult. Anxiety also reduces the release of endorphins, and the pregnant women thus experience more pain.^3
–5 The stimulation of the sympathetic system due to pain, stress, and anxiety causes an increase in adrenocorticotropic hormone (ACTH), cortisol, epinephrine, and norepinephrine levels. The mother's uterine blood flow decreases and metabolic acidosis occurs. All of these cause severe fetal–obstetric complications such as reduced oxygenation of the fetus due to the prevention of uteroplacental circulation, fetal metabolic acidosis, preterm labor, fetal hypoxia, and meconium aspiration.^{4

–12} In addition, a high level of anxiety leads to the desire for a cesarean birth, postpartum depression, posttraumatic stress disorder, sexual dysfunction, inadequate mother–infant attachment, breastfeeding problems, and neonatal neglect.^7,8,10,13

Today, various methods are used to prevent adverse events related to birth anxiety and reduce the anxiety of women during delivery.³ One of these methods is reflexology. Reflexology is a practice that leads to the formation of electrochemical messages as a result of the stimulation of nerve points with specific techniques. In this practice, the organs associated with the neurons are stimulated to reduce tension, stress, and to maintain the balance of the body.^14
–16 In addition, reflexology opens the nerve pathways that are overloaded with sensory stimuli, leading to the release of endorphins and enkephalins, which are at least five times more analgesic than the morphine.^17

–22 In obstetric practice, it has been stated that reflexology is effective in the induction of oxytocin release, the initiation and regulation of uterine contractions, relaxation during contractions, in reducing the level of pain and anxiety, and in shortening the duration of delivery.^{14

–17,23

–27} Smitha and Bindu found that foot reflexology reduced birth pain,²⁵ McNeill et al. found that the need for analgesia is lower in primiparous pregnant women who have had reflexology¹⁷ and Dolation et al. found that it shortens labor pains and the duration of labor.¹⁵ Hanjani et al. and Mirzaee and Kaviani found that foot reflexology during delivery significantly reduces the anxiety levels of the pregnant women.^23,24 Controversially, some studies found that reflexology had no significant effect on the process of giving birth.^27,28

Reflexology is cheap and noninvasive. The widespread use of this practice at birth by all health professionals, especially by midwives, has the potential to contribute to the reduction of maternal anxiety and fear of pregnancy, to decrease the need for analgesia in parallel to this, to increase intrapartum and postpartum well-being and to decrease the per capita cost burden. At the same time, the contact experienced during reflexology also has a therapeutic effect by establishing a bond between the pregnant woman and health professionals.^29,30

In the literature, it has been emphasized that the level of evidence in studies on reflexology in the field of obstetrics is not sufficient and that more studies with higher quality evidence are needed.^27,31 This study was designed to meet this need. It was conducted to analyze the effect of foot reflexology on the anxiety felt by women during labor.

Materials and Methods

Study design

The study was a semiexperimental study with no invasive intervention. Foot reflexology was given to the pregnant women in the experimental group, while foot reflexology was not given to the pregnant women in the control group. The study was conducted in the delivery room and obstetrics ward of a state hospital in the northwestern part of Turkey. There were two rooms with two beds and two obstetric tables in the obstetrics ward. Twelve midwives and six obstetrics doctors were working in this ward at the time of the study. Vaginal deliveries of low-risk pregnant women were mostly performed by midwives.

Ethical statement

Before the study, written approval was obtained from the Ethics Committee (No: 14-KAEK-188) and written permission was obtained from the hospital, in which the study was to be conducted. In addition, both verbal and informed written consent were obtained from the participants.

Participants: universe and sample of the study

According to the sample power analysis, two independent groups with 95% confidence interval, alpha = 0.05, 80% power and medium-effect size were created for the independent samples t-test. A total of 154 nulliparous women, 77 in the experimental group and 77 in the control group, were included in the sample of the study.

Inclusion criteria

Women with a low-risk pregnancy, no complications in the present or previous pregnancies, no maternal medical illness, no previous maternal morbidity or history of mortality, no deficiencies in fetal developmental, and no abnormal results in the laboratory and screening tests throughout the pregnancy.³² In the hospital in which the study was conducted, the “Pregnancy Risk Determination Form”, which is recommended by the Turkish Ministry of Health, was used.

Exclusion criteria

Women who had had any complications related to pregnancy or labor, including edema in the feet and ankle regions, varicosis, wounds, lesions, masses, callus and tinea pedis; and pregnant women who took narcotic analgesics or sedatives. In addition, the “Pregnant Women Introductory Information Form” asked for information about situations of risk which could affect the anxiety levels of the pregnant women during labor, such as sexual abuse, physical violence, a known psychiatric disorder, substance dependence, and vaginismus. Pregnant women with one or more of these risks were excluded.

Study protocol

The pregnant women were randomly selected to provide objectivity in the inclusion of subjects into the experimental (n = 77) and control (n = 77) groups. Pregnant women who applied to the hospital on Mondays, Wednesdays, and Fridays were included in the experimental group, while the pregnant women who applied to the hospital on Tuesdays, Thursdays, and Saturdays were included in the control group. A maximum of three pregnant women were analyzed in one day.

The study was conducted with a total of 188 pregnant women who were in conformity with the study criteria. During the application, 34 pregnant women (18 of them in the experimental group, 16 of them in the control group) were excluded for different reasons (fetal distress, cesarean section, prolonged delivery, development of complications, a request to leave the study, and cervical dilation by hand). The number of samples was then maintained as 154 by the inclusion of new subjects in the place of those who had left (Fig. 1).

FIG. 1.

Flowchart of pregnant women participating in the survey.

Measurements

The “Pregnant Women Introductory Information Form’ and “Spielberger State-Trait Anxiety Inventory” (STAI TX-I) were used in the study. The data collection forms prepared were given to the sample group after a trial application with 10 pregnant women who fitted the research criteria to determine the functioning of the data collection forms.

Personal information form

The “Pregnant Women Introductory Information Form” was developed by the researchers based on the related literature and expert opinion. This form contained nine questions, including sociodemographic characteristics (age, education, marital status, etc.) and pregnancy and obstetrical history. The form was given to the pregnant women when they felt well using the face-to-face interview technique during the latent phase of birth (1–3 cm dilation) in the delivery room. Forms were filled in by the pregnant women.

State-Trait Anxiety Inventory

This is a Likert-type scale, developed by Spielberger et al. in 1964 to measure the state-trait anxiety levels of normal and abnormal individuals. The adaptation of the scale to Turkish was done by Öner and LeCompte.³³ The STAI TX-1 contains 20 items and statements which require that the individual describe how he/she feels in a particular situations. The individual is asked to answer considering his/her own feelings about the condition experienced. The scale has ordered and reversed statements. The minimum score that can be gained from the scale is 20, while the highest score is 80. Anxiety level is said to increase with an increase in score. In evaluating the scale, it is accepted that there is no anxiety for a score below 36, mild anxiety for a score between 37 and 42, and high anxiety for a score of 42 or above.^33,34

Interventions

Application of reflexology

Foot reflexology was performed by one of the researchers after 42 h of foot reflexology training. The content of the training consisted of theoretical and practical information. The researcher had also completed a study about reflexology.³⁵

The necessary information about the application of reflexology was explained to the pregnant women beforehand. The technique was applied in the delivery room where the pregnant woman was. During the reflexology, the women lay on their left sides in the bed. The back and extremities were supported with pillows to provide a comfortable position. Foot reflexology was given when cervical dilation was 3–4 cm and was consistently applied to each leg for 15 min, for a total of 30 min. If a woman did not want to continue the application or any maternal (change in vital signs, pain, cramping, etc.) or fetal complications (tachycardia, bradycardia, increased fetal movements) were encountered, the application was terminated. Manual reflex points on the feet for anxiety are as follows: (1) solar plexus; (2) pituitary gland and hypothalamus reflex points; (3) shoulders and back reflex spots; (4) heart; (5) large intestine reflex points; (6) heel (sciatic); and (7) spinal cord (Fig. 2).^{14,15,18,19,36}

FIG. 2.

Anxiety reflex points (figure organized by researchers in computer environment). Manual reflex points on the feet for anxiety; (1) solar plexus, (2) pituitary gland and hypothalamus reflex points, (3) shoulders and back reflex points, (4) heart, (5) large intestine reflex points, (6) heel (sciatic), and (7) spinal cord.^{14,15,18,19,34}

Spielberger State-Trait Anxiety Inventory

The STAI TX-1 was first applied to pregnant women in the experimental group who were in the latent phase (cervical dilation 3–4 cm). The second application was made immediately after the foot reflexology, the third application was made in the active phase (cervical dilation 6–8 cm), and the fourth application was made in the early postpartum period (postpartum second hour). In the control group, the second application was made 30 min after the first application. Other applications were made in the same time frame with the experimental group. The STAI TX-1 was used in the study, because the cause of anxiety in the birth is usually specific to that situation. Mc Vicar et al. analyzed anxiety, cortisol, and melatonin levels after reflexology therapy and found that reflexology significantly reduced state anxiety but did not alter persistent anxiety (anxiety without an objective cause).³⁷ The steps in applying the STAI TX-1 in the control and experimental groups are shown in Figure 3.

FIG. 3.

Application steps of STAI TX-I. STAI TX-I, Spielberger State-Trait Anxiety Inventory.

In the study, the experimental group and the control group were treated equally by the researcher at every stage of labor, except for the use of foot reflexology. Healthcare professionals (the midwife and obstetrician) in the hospital provided standard care and interventions for both groups. These include treatments and activities such as induction, enema, amniotomy, vaginal examination, fetal monitorization, follow-up of vital signs, fundal pressure, episiotomy, perineal care, fundus massage, and education for the mother and infant. During pregnancy no analgesia was given to the pregnant women.

In the study, follow-up of the labor and the delivery itself were carried out by the midwives. All pregnant women (experimental and control groups) were nursed by a single midwife (vaginal examination, enema application, etc.) until cervical dilation was 4 cm. After cervical dilation had reached 4 cm, the pregnant woman was transferred to another room in the same ward and was followed up by another midwife until the first 2 h after birth. During labor, all follow-up and care of the pregnant women were provided by two midwives (one midwife for before cervical dilation was 4 cm, one midwife for after cervical dilation was 4 cm). However, a doctor intervened the process if a complication developed in the pregnant woman or fetus during labor. Pregnant women who required the intervention of a doctor were excluded from the scope of the study.

Statistical analysis

The data were analyzed using the SPSS 22.0 package program. The comparison of the introductory and obstetric characteristics of the pregnant women in the experimental and control groups was made by the Chi-Square test. It was found that the mean scores of STAI TX-1 were parametric as a result of the Kolmogorov–Smirnov Test. Comparisons between the groups were made by the Student t and, two-way analysis of variance (ANOVA) tests (for independent groups) and repeated measure ANOVA test in groups (for dependent groups). All analyses were made for a 95% confidence interval and p < 0.05 was accepted as statistically significant.

Results

As shown in Table 1, it was found that the majority of the pregnant women in the experimental and control groups were middle school graduates, housewives, had a median income, had been married for 9–18 months, had become pregnant willingly, and were at 40th week of their pregnancies. The pregnant women were found to be similar in terms of their introductory characteristics (p = 0.852, p = 0.550, p = 0.193, p = 0.470, p = 0.483, p = 0.642, p = 0.100, and p = 0.810 respectively) except for residence (p = 0.050) (Table 1).

Table 1.

Comparison of the Experimental and Control Groups According to Descriptive Characteristics

	Experimental group (n = 77)		Control group (n = 77)
Characteristics	Number	%	Number	%	Test and p-value
Age					χ ² = 0.03
18–23	56	72.7	55	71.4	df = 1
24–29	21	27.3	22	28.6	p = 0.852
Education status
Primary school graduate	21	27.3	20	26.0
Middle school graduate	31	40.3	33	42.9	χ ² = 2.09
High school graduate	21	27.3	16	20.8	df = 3
University graduate	4	5.1	8	10.4	p = 0.550
Profession					χ ² = 1.71
Housewife	74	96.1	70	90.9	df = 1
Officer	3	3.9	7	9.1	p = 0.193
Residence
Village	18	23.4	32	41.5	χ ² = 5.81
Province	27	35.1	21	27.3	df = 2
County	32	41.5	24	31.2	p = 0.050^*
Financial status perception
Poor	6	7.8	10	13.0	χ ² = 1.46
Medium	49	63.6	43	55.8	df = 2
Good	22	28.6	24	31.2	p = 0.470
Duration of marriage					χ ² = 0.49
9–18 Months	52	67.5	56	72.7	df = 1
19 Months ↑	25	32.5	21	27.3	p = 0.483
Willingness to pregnancy					χ ² = 0.20
Will	75	97.4	74	96.1	df = 1
Not will	2	2.6	3	3.9	p = 0.642
Gestational week
37 Weeks	6	7.8	9	11.7	χ ² = 7.68
38 Weeks	18	23.4	12	15.6	df = 4
39 Weeks	9	11.7	21	27.3	p = 0.100
40 Weeks	29	37.7	24	31.2
41 Weeks	15	19.5	11	14.2
Abortus status					χ ² = 0.05
Yes	10	13.0	11	14.2	df = 1
No	67	87.0	66	85.8	p = 0.810

p < 0.05.

When the mean STAI TX-1 scores of the experimental and control groups were analyzed, it was found that the mean scores of the experimental group were 47.57 ± 9.68 before the application, 47.77 ± 9.38 after the application, 54.64 ± 9.45 in the active phase, and 33.89 ± 7.37 in the early postpartum period. The total anxiety score was found to be 45.97 ± 6.43. The mean scores of the control group were 47.81 ± 9.33 before the application, 51.72 ± 9.99 after the application, 60.32 ± 8.14 in the active phase, and 35.92 ± 7.23 in the early postpartum period. The total anxiety score was determined to be 48.94 ± 6.05. There was no significant difference between mean STAI TX-1 scores before the application and in the early postpartum period in the experimental and control groups (before application p = 0.870, postpartum period p = 0.080). Furthermore, the difference between the experimental and control groups was statistically significant in terms of the means of the total STAI TX-1 scores (p < 0.001) (Table 2).

Table 2.

Comparisons of Spielberger State-Trait Anxiety Inventory Point Scales in Groups

	Experimental group	Control group
Measure time	Mean ± SD^c	Mean ± SD^c	Test ^d and p-value
Preapplication (latent phase)	47.57 ± 9.68	47.81 ± 9.33	t = 0.16, p = 0.870
Postapplication	47.77 ± 9.38	51.72 ± 9.99	t = 2.52, p = 0.010^a
Active phase	54.64 ± 9.45	60.32 ± 8.14	t = 3.39, p<0.001^b
Early postpartum period	33.89 ± 7.37	35.92 ± 7.23	t = 1.72, p = 0.080
Total^f	45.97 ± 6.43	48.94 ± 6.05	t = 2.95, p<0.001^b
	F = 109.21^e	F = 149.3^e
	p < 0.001^b	p < 0.001^b

The statistical difference was found significant p < 0.05.

The statistical difference was found significant, p < 0.001 (p = 0.000 was evaluated as p < 0.001).

Standard deviation.

Student t test.

Repeated measures ANOVA (analysis of variance).

It is the sum of the mean STAI TX-1 (Spielberger State-Trait Anxiety Inventory TX-1) scores measured four times in the latent and active phases of birth, in the first second hour of the postpartum period and before reflexology.

To determine the origin of statistical difference, a binary comparison was made with the paired sample t test with the Table 2 not being seen. In the control group, the difference between the mean STAI TX-1 scores for the pre- and postapplication periods (t: −5.85, p < 0.001), for the postapplication period and active phase (t: −7.93, p < 0.001), and the active phase and early postpartum period (t: 18.12, p < 0.001) were statistically significant. In the experimental group, there was no statistically significant difference between pre- and postapplication (t: −0.227, p = 0.820), there was a statistically significant difference between postapplication and the active phase (t: −6.80, p < 0.001), and there was a statistically significant difference between the active phase and early postpartum period after application (t: 15.86, p < 0.001) in terms of mean STAI TX-1 scores.

Discussion

The purpose of the study was to analyze the effect of applying foot reflexology in the latent phase of labor. In this study, mean STAI TX-1 scores were similar in the experimental and control groups before the application of reflexology (p = 0.870) (Table 2). This result was predicted, because the sociodemographic and obstetric characteristics of the pregnant women in two groups (Table 1) and the times at which anxiety levels were measured were similar. These aspects of the experimental and control groups are homogeneous, and they are therefore important in showing the effects of reflexology on anxiety.

Extreme anxiety at birth triggers a “fight or flight” reaction. This response strengthens the painful stimuli from the uterus and cervix and makes the pain more intense. This pain and anxiety may be reduced with the positive effects of reflexology. Reflexology alleviates muscle spasms, gives a feeling of relaxation, and stops the neural transmission of the pain message to the brain. Thus, the level of pain decreases. Reduced severity of pain leads to decreased anxiety.^14

–17,38 The alleviation of the anxiety of a pregnant women during birth ensures that she can effectively cope with labor pains and experience birth as a positive experience.

In this study, the STAI TX-1 scores of the pregnant women were measured four times: in the prereflexology period, the latent phase of birth, the active phase of birth, and at the second hour of the postpartum period. The mean STAI TX-1 scores as the sum of the four measurements were lower in the experimental group compared with the control group. This decrease was statistically significant (p < 0.001) (Table 2). According to this finding, it can be suggested that foot reflexology applied in the latent phase has a positive effect on lowering the total anxiety score. Hanjani et al.²³ found that foot reflexology applied to primiparous women for 40 min at birth decreased their level of anxiety compared with that of the control group (p < 0.05). Mirzaee and Kaviani²⁴ found that the anxiety levels of the pregnant women who were given reflexology at labor were lower compared with those of the control group (p < 0.05). Smith et al.³⁹ compared six meta-analytical studies on massage, reflexology, and other manual methods in pain management at birth, and it was found that massage and reflexology were effective in decreasing the labor pain and reducing women's anxiety and that they had a positive birth experience (p < 0.05). The findings of these studies are similar to the findings of our study. However, only one session of reflexology was applied to the experimental group (in the latent phase) and the effect of this on anxiety was measured in three steps (after application, in the active phase and at the first 2 h postpartum) in this study.

In this study, the mean scores of the STAI TX-1 changed according to the stages of labor and the research group (experimental or control). The mean STAI TX-1 scores of the subjects in the experimental group did not change after reflexology (p = 0.820), but they increased after application of the reflexology in the active phase (p < 0.001) (Table 2). The increase in the pregnant women's anxiety after reflexology is thought-provoking. This result indicates that the increase in medical interventions (induction, frequent vaginal examination, electronic fetal monitoring [EFM], the restriction of oral intake, and movement, etc.) given to the pregnant women may increase their anxiety and reduce the efficacy of reflexology as labor progresses. Induction, EFM, and vaginal touch during vaginal birth are often performed as a routine in nulliparas in Turkey.⁴⁰ These applications, the nearness of giving birth, and nulliparity in the study group may have further increased the anxiety.

On the contrary, it is also an important finding that the level of anxiety after application and in the active phases was lower in the experimental group compared with the control group (p = 0.010 and p < 0.001 respectively) (Table 2). This finding suggests that reflexology decreases the anxiety of pregnant women in the active and latent phases when compared with the women in the control group. This effect of reflexology is pleasing.

At a look at Table 2 in the study, it is seen that in the active phase of the pregnant women in the experimental group, the anxiety scores increased after reflexology, but the anxiety scores were lower than those of the control group. This result suggests that reflexology may have positively contributed to the prevention of an increase in anxiety in the active phase.

A high level of maternal anxiety during labor decreases the release of endorphin, prolactin, and oxytocin hormones, and increases the cortisol and ACTH levels of the mother. This condition affects mother–infant attachment, breastfeeding, and the mental state of mothers in the early postpartum period.⁴¹ Coates et al. reported that mothers with high maternal stress and anxiety did not welcome their babies and that they had more postpartum distress.⁴² The reduction of the anxiety of the pregnant woman at labor contributes to an improved state of health of both the mother and the infant in the postpartum period. This study investigated the effect of reflexology applied in the latent phase on maternal anxiety in early postpartum period (first 2 h). In the early postpartum period, the mean STAI TX-1 scores of the mothers in both the experimental and control groups were lower compared to those in the active phase of labor (p = 0.080) (Table 2).

In the study, the anxiety of the mothers in the postpartum period decreased in both the experimental and control groups compared to the active phase of labor. This suggests that reflexology has no effect at this period (for the experimental and control groups p < 0.001). The completion of the birth process, reduced pain, the bonding of mother and infant, and the relationship between them may decrease the mothers' anxiety levels. This is an expected positive result. Reflexology that is only given once in the latent phase may not be very effective in reducing anxiety in the postpartum period and the effect of this practice may weaken over time. Hattan et al.⁴³ reported that only one application of relaxation methods is not as effective as regular sessions and that such interventions should be repeated in individuals. There are limited studies in the literature that show the effect of reflexology⁴⁴ or the ineffectiveness of reflexology on the anxiety in the postpartum period.⁴⁵

There are very few studies in the literature that analyze the effect of foot reflexology on anxiety during labor. For this reason, this discussion was performed in a limited manner.

Strengths and limitations of the study

The originality of the study, the similarity of the sociodemographic and obstetric characteristics of the pregnant women in the experimental and control groups, the sample containing low-risk pregnant women, the standard care and follow-up for both groups, and the limited studies on the subject are strong aspects of this study. In addition, it is thought that this study will make contribution to facilitating the transition from the intrapartum to the postpartum period and motherhood by decreasing the anxiety of the pregnant women during labor.

The limitations of the study are that all the pregnant women were nulliparous and the reflexology was applied only once to the experimental group. In addition, the possible effect of some individual characteristics of the pregnant women and their histories (e.g., trauma) on their anxiety was not sufficiently excluded.

Recommendations for clinical practice

• Applying reflexology not only in the latent phase of labor but also in the later phases of labor (active phase, transition phase, etc.) may be more effective in reducing anxiety.

• Reducing and eliminating factors that may negatively affect the anxiety of the pregnant women increases the effect of reflexology. These factors can be divided into two groups: factors regarding health professionals (their attitudes and behaviors, etc.), and factors regarding the delivery environment (number of people in the labor room, noise, etc.).

• It is recommended that reflexology should be widely practiced by midwives and obstetricians working in delivery wards.

• Reflexology should be used as an evidence-based independent midwifery practice after specific training has been given.

Suggestions for further studies

• It is recommended that qualitative studies be conducted involving the emotions, thoughts, and attitudes of pregnant women/mothers about receiving reflexology during labor.

• Studies should be conducted with larger populations.

• It is recommended that monitoring studies for reflexology be conducted.

Conclusion

Foot reflexology given to pregnant women had the positive effect of reducing the total anxiety score in the experimental group compared with the control group. When reflexology was used to try to reduce the anxiety scores of the experimental group in the latent and active phases, there was no effect. However, the anxiety scores of the experimental group in the latent and active phases were lower than those of the control group.

According to all these results, foot reflexology during labor can be used to reduce anxiety in pregnancy. A more widespread use of this practice and at different stages of labor may increase the effectiveness of this intervention.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

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