Revealing the

evidence behind
the magic of
The magic of touch
For centuries, women have instinctively known about the magic of touch. Midwives are
also familiar with the benefits of a back rub during labour or letting newborn babies nestle up
close to their mothers.

Many studies have already shown clinical benefits to mothers and their babies. This booklet
summarises these studies – published, peer-reviewed trials that show benefits such as:
• A general reduction in stress and anxiety
• Pain relief during pregnancy and labour
• Helping newborns to stay warm, to feed and (in pre-terms) gain weight

This guide has been produced by JOHNSON’S® Baby in conjunction with the Royal College of
Midwives. Our goal is that every mother-to-be should understand the many benefits of touch,
something that we can achieve only by working together. The evidence base and useful tips in
this booklet aim to support midwives in this, so that you can feel confident talking to mothers
about the magic of touch.

Of course, successful massage should be carried out in a safe, private environment.

To make massage safe, mothers-to-be and their partners need advice from trained individuals.

We hope this booklet will be a useful aid to your clinical practice.

Cathy Warwick Kate Hulatt

The Royal College of Midwives Johnson & Johnson
General Secretary Professional Communications Manager
Happier, more comfortable mothers-to-be
 Pregnancy
“Overall, the present findings suggest that massage therapy is
effective for reducing pregnant women’s anxiety levels, stress
hormones, sleep disturbance and back pain and for lessening
obstetric and postnatal complications.” Field, 1999

Massage during pregnancy can be calming and soothing for expectant mothers. Many practitioners are confident
it can relieve discomfort, promote restful sleep, reduce cramp and swelling in the legs and stimulate the circulation.

Field T et al. Field T et al.

Journal of Psychosomatic Obstetrics and Gynaecology, 1999. Infant Behaviour and Development, 2009.

Pregnant women received twice-weekly, 20-minute massage A study of 149 pregnant women diagnosed with major depression,
therapy or relaxation therapy. After five weeks, massaged 88 of whom received 12 weeks of twice-weekly massage therapy lasting
women reported reduced anxiety and back pain and improved 20 minutes. The placebo group received only standard treatment.
mood and sleep compared with women who received Massage not only helped significantly reduce depression and back pain,
relaxation therapy. Both groups reported reduced anxiety and it also led to significantly fewer premature births and low-birthweight
leg pain. Massaged women also had lowered urinary stress babies. Babies of massaged mothers had significantly lower cortisol levels
hormones and fewer labour complications than women and higher Brazelton Neonatal Behaviour Assessment Scale Scores for
receiving relaxation therapy. habituation, orientation and motor assessment.

For full references of all studies used in this booklet, please see the inside back page.
Helping couples stay close during pregnancy
Pregnancy massage is also a good way for expectant mothers to stay close and intimate with their partner. It helps
their partners feel involved in the pregnancy and brings couples closer together during a time of tremendous change.

Tips on massage during pregnancy:

• Massage should only be performed from the second trimester onward
• Mothers should be in a comfortable position before massage, such as on their side with good support
for the back and legs, or sitting down
• Head and neck massages have been shown to be effective – massaging the scalp in small circles
along the hairline, then kneading the neck from the base up
• Back massages are really effective too (with mothers on their side). There are several techniques, for example
massaging the lower back from the backbone across the waistline using the hands to make large circles
• A foot or hand massage is a good alternative to the head, back or torso and means mothers don’t
have to be lying down

Latisfes V et al. Field T et al.

Journal of Bodywork and Movement Therapies, 2005. Journal of Bodywork and Movement Therapies, 2008.
175 expectant fathers carried out 20 minutes of either massage Prenatally depressed women received twice-weekly massage
or relaxation therapy twice weekly for five weeks on their pregnant from their partners from 20 weeks’ gestation until term.
partners. A third group performed no intervention. Self-reported Compared with a control group, who received no intervention,
assessment revealed that massage lowered fathers’ self-reported massaged mothers reported significantly less back and leg pain.
anxiety levels and improved their sense of marital adjustment. There were also significant improvements in depression, anxiety,
anger and the relationship with their partners by the end of
the study. Their partners also felt significantly less depression
and an improved relationship than partners in the control group.
“Just being able to do something positive in this pregnancy
means a lot to me.”
Quote from a father who learnt how
to massage his pregnant partner, Latisfes, 2005
Making labour shorter and less painful
Labour
“In this study we found that massage therapy reduces
medical interventions and need for pain relief
during labour.” Khodakarami et al. 2006

Massage has been used for centuries during labour and you have probably witnessed its benefits first hand.
Many midwives also acknowledge that massage can give the birth partner an active and supportive role during labour.

Tips on massage during labour:

• Slow, rhythmic long-stroke massages, primarily on the lower back, the upper and lower limbs can be effective

• These strokes can be combined and synchronised with slow, rhythmic breathing – massaging hands moving
upwards with inspiration and downwards with expiration
Khodakarami N et al. Field T et al.
European Journal of Pain, 2006. Journal of Psychosomatic Obstetrics
and Gynaecology, 1997.
Research midwives massaged the back and limbs of women in labour anticipating
a normal delivery. Visual analogue scale pain scores of women’s perception of their Women received 20 minutes of head,
pain during labour revealed significantly lower pain levels than non-massaged shoulder/back, hand and foot massage from
women. The duration of the first stage of labour was also reduced. their partners during labour every hour for
five hours. Massaged women reported
Yildirim G et al. significantly lower stress levels and labour
Pain Research and Management, 2004. pain than non-massaged women. They also
spent significantly shorter time in labour and
Nurse- and self-administered massage was conducted on women in labour; in hospital.
levels of pain were compared with non-massaged women at different phases
of labour. Pain levels at every phase of labour were significantly lower in massaged Kimber L et al.
women, compared with non-massaged women. Several common features of European Journal of Pain, 2008.
labour (such as crying, complaining and screaming) were also significantly reduced
in massaged women. A UK pilot study examined the effect of
30–45 minutes of regular massage, music or
no intervention in women from 35 weeks’
Chang M-Y et al.
gestation until they attended hospital in
Journal of Advanced Nursing, 2002.
labour/for induction. Although too small
Women received 30 minutes of massage from the primary researcher during the to reach statistical significance, the study
latent, active and transitional phase of labour. Compared with non-massaged observed trends for reduced self-reported
women, significantly lower pain intensity was reported by massaged women pain and more positive views of labour
during all three phases of labour. Anxiety was also reduced in the first labour phase. preparedness and sense of control from
87% of massaged women reported that massage was more than moderately helpful women in the massage group, compared
during their labour. with control groups.
Keeping baby warm and content
“ There is a large body of evidence supporting the
need to keep all babies warm immediately after birth.
Even vigorous newborn babies, exposed to cold delivery
rooms, may have a marked drop in temperature…
…skin contact with the mother will reduce this loss
of temperature.”

Newborn babies
RCM Midwifery Practice Guidelines,
‘Immediate Care of the Newborn’, May 2008

The first few hours after birth are recognised as an important time for the development of the relationship
between mothers and their new babies. RCM guidelines recommend early skin-to-skin contact between mothers
and their healthy newborn babies to help reduce loss of temperature. The guidelines also point to evidence
that this, along with early suckling, has a positive effect on breastfeeding success.
Tips on skin-to-skin contact following birth:

• Make sure the mother has sufficiently recovered from the birthing process to provide safe skin-to-skin contact

• Once informed consent has been sought, babies should have skin-to-skin contact within the first hour after birth,
while they are alert and willing to feed

• Following birth, baby should be dried with a warm towel, placed onto the mother’s chest and covered
with a blanket for warmth

• Non-essential procedures (like weighing or vitamin K administration) should be carried out after this first hour,
to let the mother and baby adjust to their new environment

• Check the personal or cultural preferences of mothers as this may affect whether their baby is cleaned
before placing it on their chest

• Another term for skin-to-skin contact is ‘kangaroo care’ where baby is placed in a frontal/prone position
directly against the mother’s skin

• Baby’s arms and legs should be flexed, in a frog-like position and the head turned upright to maintain
an open airway

• Babies are obligatory nose breathers and should be positioned to minimise obstruction to the nasal airways

• If partners are well prepared about skin-to skin contact before the birth they can step in when mothers
are unable to hold the baby immediately, for example after a particularly long or traumatic labour, or after
a Caesarean section

• Some guidelines recommend extended periods of skin-to-skin contact with pre-term or low birthweight babies
Tips for extended skin-to-skin contact (recommended for pre-term or low birthweight babies):

• Make sure mother has no negative effects from birth (like pain, fatigue, nausea, vomiting and pyrexia) that may
prevent optimal skin-to-skin contact (and place extra burden on the mother)

• Monitor and record baby’s temperature prior to feeding by comparing baby’s abdomen with arm or leg

• Baby should wear a nappy and hat, cocooned inside the mother’s clothing firmly and comfortably in a safe position

• The mother should not be lying flat when providing skin-to-skin contact (she should be upright and/or
walking around). This is in line with policy and reduces the incidence of sudden infant death

• Baby should be returned back to its cot in a supine position, hat removed and dressed in multiple layers
whenever the mother wishes to sleep

• For extended skin-to-skin contact, make sure mothers are aware of the behavioural language of the baby,
so that they can adapt their handling to minimise stress to the baby

Goldstein Ferber S & Makhoul IR. Paediatrics, 2004. Erlandsson K et al. Birth, 2007.
The study investigated the effects of an hour of `kangaroo care’ The effect of skin-to-skin contact between newborn babies
between mothers and their newborn babies 15–20 minutes and their fathers was investigated following Caesarean section.
after birth, compared with keeping the newborn in the nursery. Compared with newborn babies kept in a cot near their fathers,
Between four and five hours’ postnatal age, babies who had infants with skin-to-skin contact cried significantly less, with
undergone `kangaroo care’ slept longer, were in a quieter positive impacts on wakefulness and rooting behaviour.
sleep state, exhibited more flexor movements and postures and
showed less extensor movements. Moore ER et al. Cochrane Database of systematic reviews, 2007.
A systematic review of 30 studies into the benefits of early
Johanson RB et al. Acta Paediactrica, 1992. skin-to-skin contact for mothers and their newborn babies.
Temperature was maintained in 300 deliveries by one of The plain-language summary stated that skin-to-skin contact
three methods – `kangaroo care’, oil massage or a plastic between mother and baby at birth reduces crying, improves
swaddler. All three were effective at maintaining neonatal mother-baby interaction, keeps the baby warmer and helps
body temperatures. women breastfeed successfully.
Healthier, happier babies
Baby massage
“ These findings support previous studies showing
that massage therapy promotes weight gain and
alters the distribution of sleep/awake states in
preterm neonates.” Dieter, 2003

There is plenty of anecdotal evidence to show regular baby massage helps babies recover from birth, develop good
sleep patterns, obtain relief from colic and even, in the case of pre-term babies, gain weight. Many mothers also
believe that massaging their baby helps them to form a relationship more quickly and see it as part of their
baby’s daily routine. Fathers can participate in baby massage too and many say it helps them feel more involved,
particularly during the early months if the mother is breastfeeding.

Many midwives acknowledge the benefits of baby massage and touch in the bonding process as well as helping
to establish a good bedtime routine and sleep pattern. With fathers increasingly enjoying a more hands-on
approach to parenting, baby massage can help paternal bonding too.
Tips on baby massage:
• Babies should be massaged in a warm, draught-free room
• Oil or lotion, suitable for baby massage, should be warmed in the parent’s hands first
• Encourage parents to make plenty of eye contact and talk to their baby during a massage
• Remind parents to avoid the stomach area straight after feeding
• Sticking to a set massage routine is reassuring for babies because they know what to expect
• Other carers (like grandparents) can be involved in baby massage, bringing their own massage techniques

Dieter JNI et al. Journal of Paediatric Psychology, 2003. Lahat S et al. Journal of the American College of Nutrition, 2007.
Pre-term hospitalised babies received thrice-daily, 15-minute A crossover study examining five days of massage followed
massages for five days. Compared to the control group by five days of no massage (or vice-versa). Massage comprised
(that received no massage) massaged babies gained 53% more three 15-minute sessions per day. During the period of massage,
weight every day. energy expenditure was significantly lower than when massage
therapy did not occur.
Field T. Current Directions in Psychological Science, 2001.
A review paper discussing how massage increases weight gain Mendes EW. Procianoy RS. Journal of Perinatology, 2008.
in pre-term infants. Includes prior data showing significant Mothers massaged their very pre-term (≤32 weeks, ≥750 g and
weight gain in massaged pre-term infants, versus unmassaged ≤1500 g) babies for 15 minutes, four times a day. Compared with
babies. The evidence for potential underlying mechanisms unmassaged babies, massaged babies had significantly lower
(including protein synthesis, increased motor or vagal activity incidences of late-onset sepsis and were discharged from hospital
or involvement of oxytocin and IGF-1) are reviewed. a median of seven days sooner than non-massaged babies.
Caloric intake did not differ between the two groups.
Field T et al. Journal of Developmental and Behavioural
Paediatrics, 2008. Guzetta A et al. The Journal of Neuroscience, 2009.
The effects of thrice-daily 15-minute massages on pre-term Pre-term neonates received 15 minutes of massage three times
infant weight gain were investigated. Despite similar calorie a day from postnatal day ten for ten days (with two non-massage
intake, massaged babies had significantly higher weight gain, days). Massage accelerated maturation of EEG activity, particularly
insulin and IGF-1 levels than non-massaged babies. visual acuity. It also increased circulating IGF-1 levels.
The final word on the magic of touch
The studies included here are all from published, peer-reviewed journals. Their overwhelming conclusion is that
massage and touch can bring many benefits to pre- and postnatal women, their partners and babies, including:

• reduced stress and anxiety at all stages (Field, 1999 & 2007)

• relief from pain during pregnancy and labour (Chang, 2002; Field, 1997; Khodakarami, 2006; Yildrim, 2004)

• reduction in prematurity and low birth weight (Field, 2009)

• reduction in loss of temperature in newborn babies (RCM guidelines, 2008)

• increased breastfeeding success (RCM guidelines, 2008)

• faster weight gain in preterm babies (Field, 2001 & 2008; Dieter, 2003)

• accelerated brain and visual development in newborn babies (Guzetta, 2009)

• reduced sepsis and hospital stay in very preterm newborn babies (Mendes, 2008)

Acknowledgements:
The Royal College of Midwives.
Stephanie Michaelides for advice on skin-to-skin contact.
Linda Kimber, Mary McNabb and Anne Haines from Childbirth Essentials (www.childbirthessentials.co.uk)
Any questions?
Frequently asked questions
Which oils should be used for baby massage?
Many oils used for baby massage, such as olive oil and other vegetable oils, have a very high oleic acid content
(up to 85%). Oleic acid has been shown to disrupt the structure of skin cells which weakens the skin barrier,
and may actually damage the skin. For that reason, it is better to choose oils with a very low oleic acid content,
such as jojoba oil (10–13%), coconut oil (5%) or mineral oil (0%).1 In babies and adults, mineral oil penetrates
and is absorbed as effectively as vegetable oils (like sweet almond and jojoba oil).2

Are there any handouts about touch and massage that I can give to expectant mothers?
There is a tear-off hand-out pad to accompany this booklet that has been designed for you to use with mothers.

Where can mothers go for more information on baby massage?

There are often local massage groups in your area, some which you may already be aware of. For general advice,
tips and techniques on baby massage visit www.johnsonsbaby.co.uk

Where can healthcare professionals find out more about JOHNSON’S® Baby products?
Email JOHNSON’S® Baby at [email protected], or call 0845 606 6091. A qualified midwife, who is also
an expert on the JOHNSON’S® Baby range of products, is on hand to help with your query.

1. Johnson & Johnson, data on file.

2. Stamatas G et al. Lipid intake and skin occlusion following topical application of oils on adult and infant skin. J Derm Sci 2008; 50: 135–42.
Where can I find more information on the studies cited in this booklet?

Chang M-Y et al. Effects of massage on pain and anxiety during labour: a randomised controlled trial in Taiwan. J Adv Nursing 2002; 38: 68–73.
Dieter J et al. Stable preterm infants gain more weight and sleep less after five days of massage therapy. J Ped Psychol; 28: 403–11.
Erlandsson K et al. Skin-to-skin care with the father after Caesarean birth and its effect on newborn crying and prefeeding behaviour.
Birth 2007; 34: 105–14.
Field T et al. Labour pain is reduced by massage therapy. J Psychosom Obstet Gynecol 1997; 18: 286–91.
Field T et al. Pregnant women benefit from massage therapy. J Psychosom Obstet Gynecol 1999; 20: 31–8.
Field T et al. Massage therapy facilitates weight gain in preterm infants. Curr Dir Psycholog Sci 2001; 10: 51–4.
Field T et al. Massage therapy reduces pain in pregnant women, alleviates prenatal depression in both parents and improves their relationships.
J Bodywork Movement 2008; 12: 146–50.
Field T et al. Insulin and insulin-like growth factor 1 (IGF-1) increased in preterm neonates. J Dev Behav Pediatr 2008; 29: 463–6.
Field T et al. Pregnancy massage reduces prematurity, low birth weight and postpartum depression. Infant Behav Devel 2009; 32: 454–60.
Goldstein Ferber S et al. The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of
the term newborn: a randomised, controlled trial. Paeditrics 2004; 113: 858–65.
Guzzetta A et al. Massage accelerates brain development and the maturation of visual function. J Neurosci 2009; 29: 6042–51.
Khodakarami N et al. The effects of massage therapy on labour pain and pregnancy outcome. J Pain 2006; 10 (Suppl 1): E05–822.
Kimber L et al. Massage or music for pain relief in labour: A pilot randomised placebo controlled trial Eur J Pain 2008; 12: 961–9.
Lahat, Sharon et al. Energy expenditure in growing preterm infants receiving massage therapy. J Am Coll Nutri; 26: 356–9.
Latifses V et al. Fathers massaging and relaxing their pregnant wives lowered anxiety and facilitated marital adjustment.
J Bodywork Movement Ther; 9: 277–82.
Mendes EW et al. Massage therapy reduces hospital stay and occurrence of late-onset sepsis in very preterm neonates. J Perinatol; 28: 815–20.
Moore ER et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2007 Jul 18: CD003519.
Royal College of Midwives Midwifery Practice Guidelines, evidence-based guidelines for midwifery-led care in labour, 4th edition, May 2008.
Yildirim G et al. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manage; 9: 183–7.
Revealing the
evidence behind
the magic of

Date of preparation: June 2010