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Question:  How do you set your fees?

[Ed. note - This is from a sheet of Frequently Asked Questions provided by a midwife who also offers labor support as a private-duty midwife.  Some of the details may not apply to doulas who work strictly in accordance with DONA guidelines.]

[Other people are completely welcome to borrow the text from this page and tailor it to their own needs.  Best wishes getting decent compensation for this vital work helping birthing families!]

Answer:  The economics of professional labor support work are a mystery to many people; I offer this information so that you'll have a better idea of what you're paying for:

Hours - Couples having a first baby may imagine that I'll only be spending a few hours with them during the labor and birth.  In reality, an eight-hour labor would be considered pretty zippy; most first labors last longer than 16 hours; the longest continuous time I've spent providing labor support is 38 hours.  Average time spent with a woman for her labor and birth is about 16 hours.  I spend another 10 hours in prenatal and postpartum meetings, and another hour or two in phone calls.  My fee translates to an hourly rate of about $35/hour, before expenses and self-employment taxes.

Clients per Week - When I make a commitment to be available to attend you in labor, I have to limit the number of clients I put on my calendar so as to avoid birth conflicts and to ensure that I am reasonably rested when you go into labor.  The rule of thumb for birth professionals providing in-home services is that one client per week is a full schedule.  Since most of my clients are first-time mothers, I find that three clients per month is a full-time workload.

Clients per Year - When I put your due date on my calendar, I commit to being available two weeks beforehand and two weeks after that date.  This means that when I schedule a two-week vacation, I have to add another four weeks during which I cannot accept clients.  A full calendar is 32 clients per year; in reality, there are some weeks where I have to turn clients away and then there are other weeks where I have no births on the calendar.

Consultant Factor - The rule of thumb is that a self-employed professional's income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, health insurance, and business expenses. As you may imagine, my communication expenses are high - business phone, pager, cell phone and computer connection; I also have routine professional and office expenses and unusual transportation and supplies expenses.  In addition, I bring several thousand dollars worth of equipment to your birth as part of providing midwifery care.

Putting It All Together - The annual income of someone providing labor support services with a responsible client load and a strong commitment to being available for your birth is 1/2 the number of clients per year times their fee per client.  This is about 16 times the fee per client, and, yes, that's before taxes, including extra self-employment taxes.  Although I am dedicated to this work, being on-call all the time requires a very high level of personal sacrifice, including a willingness to be beeped awake after half an hour of sleep to go attend a labor for the next 40 hours.  About 25% of my clients have some kind of early labor which starts and stops, resulting in two trips to their home and being beeped awake twice.  This past year, I spent most of my birthday at a labor, I spent Thanksgiving Day in a hospital, and I was beeped away from a big family gathering.  I cannot take weekend trips away from the area, and even day trips to Santa Cruz or San Francisco have to be planned around traffic conditions.  I never know what I'm going to encounter at a particular labor - I may end up wearing out my body supporting the woman in different birth positions; I may end up holding a vomit bowl for someone vomiting with every contraction during transition; I may end up with blood, meconium or worse on my clothes. Given all this, I'm sure you can understand why I bristled when someone once asked me why I charge "so much".

Bottom Line - Nobody's getting rich doing labor support work.  I wish I could offer my services at a rate than everyone can afford, but that would require that I make even greater financial sacrifices than I am already making to do this work.  I am a self-supporting professional, and my options are to earn a living wage working with birth or pursue more conventional employment, which would pay much more.  There are people offering doula services at significantly reduced prices.  They are either offering significantly reduced services, are still in training, or are basically offering charity.  If you need charity, I encourage you to get labor support however you can; otherwise, you are doing future birthing women a disservice by making labor support an underpaid profession that cannot attract or keep talented, skilled individuals.  If you end up selecting a doula who is undercharging for her services, I strongly encourage you to pay her more than she is asking; otherwise, she may not be around to help you with your next child.

Advocacy Suggestions - My services are covered by many health insurance plans because I'm a licensed provider; however, most non-midwife doula services are not.  You can talk with your Human Resources representatives to ask them to lobby to include all doula services as a covered option in your plan.  Additionally, you could talk with your midwife or doctor to encourage them to offer universal doula care to their clients.  By hiring several doulas to be on-call for their clients, they could substantially reduce the cost per birth, although the doula might be someone you've never met before.  You could also advocate for the hospital to provide universal doula care, so that it would be covered in the same way as their in-house lactation consultants are covered.

Massage Therapy Database

Choose from the following subjects:

Adolescents

Diego, M.A., Field, T., Hernandez-Reif, M., Shaw, J.A., Rothe, E., Castellanos, D., & Mesner, L. (2002). Aggressive adolescents benefit from massage therapy. Adolescence, 37, 597-607.

METHOD: Seventeen aggressive adolescents were randomly assigned to a massage therapy group or a relaxation group to receive 20-minute therapy sessions, twice a week for five weeks. The massaged adolescents had lower anxiety after the first and last sessions. By the end of the study, they also reported feeling less hostile and they were perceived by their parents as being less aggressive. Significant differences were not found for the adolescents who were assigned to the relaxation group.

Alzheimer’s

Rowe, M. & Alfred, D. (1999). The effectiveness of slow-stroke massage in diffusing agitated behaviors in individuals with Alzheimer’s disease. Journal of Gerontology and Nursing, 25, 22-34.

METHOD: Agitated behaviors of individuals with Alzheimer’s disease (AD), often endured or unsuccessfully treated with chemical or physical restraints, markedly increase the stress levels of family caregivers. The Theoretical Model for Aggression in the Cognitively Impaired guided the examination of caregiver-provided slow-stroke massage on the diffusion of actual and potential agitation for community-dwelling individuals with AD. Characteristics and frequency of agitation were quantified by two highly correlated instruments, the Agitated Behavior Rating Scale Scoring Guide and the Brief Behavior Symptom Rating Scale. RESULTS: Expressions of agitation of patients with AD increased in a linear pattern from dawn to dusk. Verbal displays of agitation, the most frequently cited form of agitation in community-dwelling individuals with AD, were not diffused by slow-stroke massage. However, more physical expressions of agitation such as pacing, wandering, and resisting were decreased when slow-stroke massage was applied.

Anorexia

Hart, S., Field, T. & Hernandez-Reif, M., Nearing, G., Shaw, S., Schanberg, S., & Kuhn, C. (2001). Anorexia nervosa symptoms are reduced by massage therapy. Eating Disorders, 9, 289-299.

METHOD: Women diagnosed with anorexia nervosa were given a massage twice per week for five weeks or standard treatment. RESULTS: The massaged women reported lower stress and anxiety levels and showed lower cortisol levels immediately following the massage. Over the five-week treatment period, they also reported decreased body dissatisfaction on the Eating Disorder Inventory and showed increased dopamine and norepinephrine levels. These findings support a previous study on the benefits of massage therapy for eating disorders.

Anxiety

McKechnie, A.A., Wilson, F., Watson, N. & Scott, D. (1983). Anxiety states: A preliminary report on the value of connective tissue massage. Journal of Psychosomatic Research, 27, 125-129.

METHOD: Five patients who presented with symptoms of tension and anxiety were subsequently referred to a physiotherapist and treated with Connective Tissue Massage. Psychophysiological recordings of heart rate, frontalis EMG, skin resistance and forearm extensor EMG were taken before and after treatment. RESULTS: All patients showed a significant response to treatment in one or more of the psychophysiological parameters. Results are discussed in relation to the hypothesis that each individual has a unique stress response pattern.

Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C. & Schanberg, S. Massage reduces anxiety in child and adolescent phychiatric patients. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 125-131.

METHOD: A 30-minute back massage was given daily for a 5-day period to 52 hospitalized depressed and adjustment disorder children and adolescents. RESULTS: Compared with a control group who viewed relaxing videotapes, the massage subjects were less depressed and anxious and had lower saliva cortisol levels after the massage. In addition, nurses rated the subjects as being less anxious and more cooperative on the last day of the study, and nighttime sleep increased over this period. Finally, urinary cortisol and norepinephrine levels decreased, but only for the depressed subjects.

Shulman, K.R. & Jones, G.E. (1996). The effectiveness of massage therapy intervention on reducing anxiety in the work place. Journal of Applied Behavioral Science, 32, 160-173.

METHOD: An on-site chair massage therapy program was provided to reduce anxiety levels of 18 employees in a downsizing organization. 15 control group Ss participated in break therapy. Subjects’ stress levels were measured with the State-Trait Anxiety Inventory, which was administered twice during pretest, post test, and delayed post test to achieve stable measures. RESULTS: Significant reductions in anxiety levels were found for the massage group.

Aromatherapy

Buckle, J. (1993). Aromatherapy. Nursing Times, 89, 32-35.

METHOD: A randomized, double-blind trial was conducted on two essential oils of two different species of lavender, topically applied on post-cardiotomy patients. The emotional and behavioral stress levels of 28 patients were evaluated pre- and post-treatment on two consecutive days. RESULTS: The therapeutic effects of the two lavenders appeared to be different: one was almost twice as effective as the other, thereby disproving the hypothesis that aromatherapy, using topical application of essential oils, is effective purely because of touch, massage or placebo.

Diego, M., Jones, N.A., Field, T., Hernandez-Reif, M., Schanberg, S., Kuhn, C., McAdam, V., Galamaga, R. & Galamaga, M. (1998). Aromatherapy positively affects mood, EEG patterns of alertness and math computations. International Journal of Neuroscience, 96, 217-224.

METHOD: EEG activity, alertness, mood and cortisol levels were assessed in 40 adults given 3 minutes of aromatherapy using two aromas, lavender (considered a relaxing odor) or rosemary (considered a stimulating odor). Participants were also given simple math computations before and after the therapy. RESULTS: The lavender group showed increased beta power suggesting increased drowsiness, they had less depressed mood (POMS) and reported feeling more relaxed and they performed the math computations faster and more accurately following aromatherapy. The rosemary group, on the other hand, showed decreased frontal alpha and beta power, suggesting increased alertness. They also had lower state anxiety scores, reported feeling more relaxed and alert and they were only faster, not more accurate, at completing the math computations after the aromatherapy session.

Fernandez, M., Hernandez-Reif, M., Field, T., Sanders, C., Diego, M., & Roca, A. (2002). EEG during lavender and rosemary exposure in infants of depressed and non-depressed mothers. British Journal of Psychology. In Review.

METHOD: This study investigated whether exposure to pleasant odors would change electroencephalographic (EEG) activity in infants of depressed and non-depressed mothers. Twenty newborns were exposed to a 10% v/v concentration of rosemary oil or lavender oil and their EEG was recorded for 2-minutes each at baseline and during odor exposure. Group inclusion (depressed versus non-depressed) was based on mothers' CES-D scores. RESULTS: Results revealed that the groups did not differ at baseline and that the two odors did not differentially affect the EEG. However, the infants of depressed mothers showed increased relative left frontal EEG activation while infants of non-depressed mothers showed increased relative right frontal EEG activation from baseline to the odor exposure phase. Relative left frontal EEG activation has been associated with an approaching pattern of behavior and response to positive stimuli, while relative right frontal EEG activation has been associated with a withdrawing pattern of behavior and response to negative stimuli. These results suggest that infants of depressed and non-depressed mothers respond differently to odors.

Arthritis

Yurtkuran, M. & Kocagil, T. (1999). TENS, electropuncture and ice massage: Comparison of treatment for osteoarthritis of the knee. American Journal of Acupuncture, 27, 133-140.

METHOD: The purpose of this study was to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), electroacupuncture (EA), and ice massage with placebo treatment for the treatment of pain. Subjects (n = 100) diagnosed with osteoarthritis (OA) of the knee were treated with these modalities. The parameters for evaluating the effectiveness of treatment included pain at rest, stiffness, 50 foot walking time, quadriceps muscle strength, and knee flexion degree. RESULTS: The results showed (a) that all three methods could be effective in decreasing not only pain but also the objective parameters in a short period of time; and (b) that the treatment results in TENS, EA and ice massage were superior to placebo.

Field, T., Hernandez-Reif, M., Seligman, S., Krasnegor, J. & Sunshine, W. (1997). Juvenile rheumatoid arthritis: Benefits from massage therapy. Journal of Pediatric Psychology, 22, 607-617.

METHOD: Children with mild to moderate juvenile rheumatoid arthritis were massaged by their parents 15 minutes a day for 30 days (and a control group engaged in relaxation therapy). RESULTS: The children’s anxiety and stress hormone (cortisol) levels were immediately decreased by the massage, and over the 30-day period their pain decreased on self-reports, parent reports, and their physician’s assessment of pain (both the incidence and severity) and pain-limiting activities.

Asthma

Field, T., Henteleff, T., Hernandez-Reif, M., Martinez, E., Mavunda, K., Kuhn, C. & Schanberg, S. (1997). Children with asthma have improved pulmonary functions after massage therapy. Journal of Pediatrics, 132, 854-858.

METHOD: Thirty-two children with asthma (16 4- to 8-year-olds and 16 9- to 14-year-olds) were randomly assigned to receive either massage therapy or relaxation therapy. The children’s parents were taught to provide one therapy or the other for 20 minutes before bedtime each night for 30 days. RESULTS: The younger children who received massage therapy showed an immediate decrease in behavioral anxiety and cortisol levels after massage. Also, their attitude toward asthma and their peak air flow and other pulmonary functions improved over the course of the study. The older children who received massage therapy reported lower anxiety after the massage. Their attitude toward asthma also improved over the study, but only one measure of pulmonary function (forced expiratory flow 25% to 75%) improved. The reason for the smaller therapeutic benefit in the older children is unknown; however, it appears that daily massage improves airway caliber and control of asthma.

Attention Deficit Hyperactivity Disorder

Field, T., Quintino, O., Hernandez-Reif, M. & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence, 33, 103-108.

METHOD: Twenty-eight adolescents with attention deficit hyperactivity disorder were provided either massage therapy or relaxation therapy for 10 consecutive school days. RESULTS: The massage therapy group, but not the relaxation therapy group, rated themselves as happier and observers rated them as fidgeting less following the sessions. After the 2-week period, their teachers reported more time on task and assigned them lower hyperactivity scores based on classroom behavior.

Hernandez-Reif, M., Field, T., & Thimas, E. (2001). Attention deficit hyperactivity disorder: benefits from Tai Chi. Journal of Bodywork and Movement Therapies, 5, 120-123.

METHOD: Thirteen adolescents with Attention Deficit Hyperactivity Disorder (ADHD) participated in Tai Chi classes twice a week for 5 weeks. Teachers rated the children's behaviour on the Conners Scale during the baseline period, after the 5 week Tai Chi session period and 2 weeks later. RESULTS: After the 10 Tai Chi sessions the adolescents displayed less anxiety, improved conduct, less daydreaming behaviours, less inappropriate emotions, and less hyperactivity. These improved scores persisted over the 2-week follow up (no Tai Chi period).

Abrams, S.M. (2000). Attention-deficit/hyperactivity disordered children and adolescents benefit from massage therapy. Dissertation Abstracts International- Section-B: The Sciences and Engineering, 60, 5218.

METHOD: The present study involved 30 children and adolescents between the ages of 7 and 18 (M = 13) diagnosed with attention-deficit/hyperactivity disorder (ADHD). The children were randomly assigned to a wait-list control and a massage group. The latter group received massage therapy for 20 minutes twice per week over the course of one month. RESULTS: Mood state improved for the massage but not the control group based on smiley face and thermometer scales. The massage group also improved in classroom behavior in the areas of the Conners Teacher Rating Scales on anxiety, daydreaming and hyperactivity. The wait-list control group did not show these gains. In sum, the results revealed that massage therapy benefited children and adolescents with ADHD by improving short-term mood state and longer-term classroom behavior.

Autism

Field, T., Lasko, D., Mundy, P., Henteleff, T., Talpins, S., & Dowling, M. (1986). Autistic children's attentiveness and responsitivity improved after touch therapy. Journal of Autism and Developmental Disorders, 27, 329-334.

METHOD: This study investigated the effects of touch therapy on three problems commonly associated with autism including inattentiveness (off-task behavior), touch aversion, and withdrawal. RESULTS: Results showed that touch aversion decreased in both the touch therapy and the touch control group, off task behavior decreased in both groups, orienting to irrelevant sounds decreased in both groups, but significantly more in the touch therapy group, and stereotypic behaviors decreased in both groups but significantly more in the touch therapy group.

Escalona, A., Field, T., Singer-Strunk, R., Cullen, C., & Hartshorn, K. (2001). Improvements in the behavior of children with autism. Journal of Autism and Developmental Disorders, 31, 513-516.

METHOD: Twenty children with autism ranging in age from 3 to 6 years were randomly assigned to massage therapy and reading attention control groups. Parents in the massage therapy group were trained by a massage therapist to massage their children for 15 minutes prior to bedtime every night for one month while the parents of the attention control group read Dr. Seuss stories to their children on the same time schedule. Conners Teacher and Parent scales, classroom and playground observations and sleep diaries were used to assess the effects of therapy on various behaviors including hyperactivity, stereotypical and off-task behavior, as well as sleep problems. RESULTS: Results suggested that the children in the massage group exhibited less stereotypic behavior and showed more on-task and social relatedness behavior during play observations at school, and they experienced fewer sleep problems at home.

Back Pain

Degan, M., Fabris, F., Vanin, F., Bevilacqua, M., Genova, V., Mazzucco, M. & Negrisolo, A. (2000). The effectiveness of foot reflexotherapy on chronic pain associated with a herniated disk. [Italian] Professioni Infermieristiche, 53, 80-7.

METHODS: A group of 40 persons suffering almost exclusively from a lumbar-sacral disc hernia received three treatments of reflexology massage for a week. RESULTS: 25 persons (62.5%) reported a reduction in pain, (rating at 0.75 on a scale of 0-4).

Hernandez-Reif, M., Field, T., Krasnegor, J., Theakston, H. & Burman, I. (2000). Chronic lower back pain is reduced and range of motion improved with massage therapy. International Journal of Neuroscience, 99, 1-15.

METHOD: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and their serotonin and dopamine levels were higher.

Pope, M. H., Phillips, R. B., Haugh, L. D., Hsieh, C. Y., MacDonald, L., & Haldeman, S. (1994). A prospective randomized three-week trial of spinal manipulation, trans- cutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine, 19, 2571-2577.

METHOD: A randomized prospective trial of manipulation, massage, corset and transcutaneous muscle stimulation (TMS) was conducted in patients with subacute low back pain. Patients were enrolled for a period of 3 weeks. They were evaluated once a week by questionnaires, visual analog scale, range of motion, maximum voluntary extension effort, straight leg raising and the Biering-Sorensen fatigue test. RESULTS: The dropout rate was highest in the muscle stimulation and corset groups and lowest in the manipulation group. Rates of full compliance did not differ significantly across treatments. A measure of patient confidence was greatest in the manipulation group. After 3 weeks, the manipulation group scored the greatest improvements in flexion and pain while the massage group had the best extension effort and fatigue time, and the muscle stimulation group the best extension. None of the changes in physical outcome measures (range of motion, fatigue, strength or pain) were significantly different between any of the groups.

Ernst, E. (1999). Massage therapy for low back pain: a systematic revierw [In Process Citation]. Journal of Pain Symptom Management, 17, 65-69.

Massage therapy is frequently employed for low back pain. The aim of this sytematic review was to find the evidence for or against its efficacy in this indication. Four random clinical trials were located in which massage was tested as a monotherapy for low back pain. All were burdened with major methodological flaws. One of these studies suggests that massage is superior to no treatment. Two trials imply that it is equally effective as spinal manipulation or transcutaneous electrical stimulation. One study suggests that it is less effective than spinal manipulation. It is concluded that too few trials of massage therapy exist for a reliable evaluation of its efficacy. Massage seems to have some potential as a therapy for low back pain.

Hernandez-Reif, M., Field, T., Krasnegor, J., & Theakston, H. (2001). Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience, 106, 131-145.

METHOD: A randomized between-groups design evaluated massage therapy versus relaxation for chronic low back pain. Treatment effects were evaluated for reducing pain, depression, anxiety and stress hormones, and sleeplessness and for improving trunk range of motion associated with chronic low back pain. Twenty-four adults (M age= 39.6 years) with low back pain of nocioceptive origin with a duration of at least 6 months participated in the study. The groups did not differ on age, socioeconomic status, ethnicity or gender. Twenty-four adults (12 women) with lower back pain were randomly assigned to a massage therapy or a progressive muscle relaxation group. Sessions were 30 minutes long twice a week for five weeks. On the first and last day of the 5-week study participants completed questionnaires, provided a urine sample and were assessed for range of motion. RESULTS: By the end of the study, the massage therapy group, as compared to the relaxation group, reported experiencing less pain, depression, anxiety and improved sleep. They also showed improved trunk and pain flexion performance, and serotonin and dopamine levels were higher.

McNamara, M.E., Burnham, D.C., Smith, C., & Carroll, D.L. (2003). The effects of back massage before diagnostic cardiac catheterization. Alternative Therapies, 9, 50-57.

METHOD: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization. A randomized clinical trial design was used. Data were compared in a repeated measures design before massage, immediately following the back massage or standard care, and 10 minutes later. Forty-six subjects admitted from home for a diagnostic cardiac catheterization were included in the study. Heart rate, heart rate variability, blood pressure, respiration, peripheral skin temperature, pain perception, and psychological state were the main outcome measures. RESULTS: There was a significant difference between subject effect for group, with a reduction in systolic blood pressure in the treatment group. In addition, main effects were noted for time for diastolic blood pressure, respiration, total Profile of Mood States score and pain perception in both groups.

Behavior Problems

Escalona, A., Field, T., Cullen, C., Hartshorn, K., & Cruz, C. (In review). Behavior problem preschool children benefit from massage therapy. Early Child Development and Care.

METHOD: Twenty preschool children with behavior problems were randomly assigned to a massage group or a story reading attention control group. The sessions occurred for 15-minutes twice a week for a month. Pre and post session ratings were made on the first and last days of the study by teachers who were blind to the child’s group assignment. RESULTS: These revealed that the children in the massage therapy group: 1) were more drowsy, less active, less talkative and had lower anxiety levels after the sessions; and 2) were less anxious and more cooperative by the end of the study.

Blood Flow

Agarwal, K.N., Gupta, A., Pushkarna, R., Bhargava, S.K., Faridi, M.M., & Prabhu, M.K. (2000). Effects of massage & use of oil on growth, blood flow & sleep pattern in infants. Indian Journal of Medical Research, 112, 212-7.

METHODS: The present study was undertaken to investigate if massage with oils commonly used in the community for massage in infancy is beneficial. 125 full term healthy infants were randomly assigned to five groups: (i) herbal oil, (ii) sesame oil, (iii) mustard oil, or (iv) mineral oil for massage daily for 4 wk. The fifth group did not receive massage and served as control. RESULTS: Massage improved the weight, length, and midarm and midleg circumferences as compared to infants without massage. The femoral artery blood velocity, diameter and flow also improved as did their sleep.

Hovind, H., & Nielsen S.L. (1974). Effect of massage on blood flow in skeletal muscle. Scandinavian Journal of Rehabilitation Medicine, 6, 74-77.

METHOD: Skeletal muscle blood flow was measured before, during and after short application of different forms of massage using the local Xenon washout method for determination of blood flow. RESULTS: During maneuvers with tapotement (pounding) an increase in blood flow comparable to exercise hyperemia was observed, and this increase was ascribed to repetitive contractions. During and after petrissage (kneading) the tissue perfusion did not change significantly.

Shoemaker, J. K., Tidus, P. M., & Mader, R. (1997). Failure of manual massage to alter limb blood flow: Measures by Doppler ultrasound. Medicine and Science in Sports and Exercise 1, 610-14.

METHOD: The ability of manual massage to alter muscle blood flow through three types of massage treatments in a small (forearm) and a large (quadriceps) muscle mass was tested in 10 healthy individuals. A certified massage therapist administered effleurage, petrissage, and tapotement treatments to the forearm flexors (small muscle mass) and quadriceps (large muscle mass) muscle groups in a counterbalanced manner. Limb blood flow was determined from mean blood velocity (MBV) (pulsed Doppler) and vessel diameter (echo Doppler). MBV values were obtained from the continuous data sets prior to treatment, and at 5, 10, and 20 s and 5 min following the onset of massage, Arterial diameters were measured immediately prior to and following the massage treatments; these values were not different and were averaged for the blood flow calculations. RESULTS: The MBV and blood flows for brachial and femoral arteries, respectively, were not altered by any of the massage treatments in either the forearm or quadriceps muscle groups. Mild voluntary handgrip and knee extension contractions resulted in peak blood velocities and blood flow for brachial and femoral arteries, respectively, which were significantly elevated from rest. The results indicated that manual massage did not elevate muscle blood flow irrespective of massage type or the muscle mass receiving the treatment.

Blood Pressure

Kurosawa, M., Lundeberg, T., Agren, G., Lund, I., & Uvnas-Moberg, K. (1995). Massage-like stroking of the abdomen lowers blood pressure in anesthetized rats: influence of oxytocin. Journal of the Autonomic Nervous System, 56, 26-30.

METHOD: The aim of this study was to determine how massage-like stroking of the abdomen in rats influences arterial blood pressure. The participation of oxytocinergic mechanisms in this effect was also investigated. The ventral and/or lateral sides of the abdomen were stroked in pentobarbital anesthetized, artificially ventilated rats. Arterial blood pressure was recorded with a pressure transducer via catheter in the carotid artery. RESULTS: Stroking of the ventral or both ventral and lateral sides of the abdomen for 1 minute caused a marked decrease in arterial blood pressure (approx. 50 mmHg). After cessation of the stimulation blood pressure returned to the control level within 1 min. The maximum decrease in blood pressure was achieved at frequencies of 0.083 Hz or more. Stroking only the lateral sides of the abdomen elicited a significantly smaller decrease in blood pressure (approx. 30 mmHg decrease) than stroking the ventral side. The decrease in blood pressure caused by stroking was not altered by an oxytocin antagonist. In contrast, the administration of oxytocin diminished the effect, which was antagonized by a simultaneous injection of the oxytocin antagonist. These results indicate that the massage-like stroking of the abdomen decreases blood pressure in anesthetized rats. This effect does not involve intrinsic oxytocinergic transmission. However, since exogenously applied oxytocin was found to diminish the effect of stroking, oxytocin may exert an inhibitory modulatory effect on this reflex arc.

Breast Cancer

Hernandez-Reif, M., Ironson, G., Field, T., Katz, G., Diego, M., Weiss, S., Fletcher, M., Schanberg, S. & Kuhn, C. (In Review). Breast cancer patients have improved immune functions following massage therapy.

METHOD: Thirty-four women (M age= 53) diagnosed with Stage I or II breast cancer were randomly assigned post surgery to a massage therapy group (to receive 30-minute massages three times per week for 5 weeks) or a standard treatment control group. On the first and last day of the study, the women were assessed on 1) immediate effects measures of anxiety, depressed mood, and vigor, and 2) longer term effects on depression, anxiety and hostility, functioning, body image and avoidant versus intrusive coping style, in addition, to urinary catecholamines (norepinephrine, epinephrine, and dopamine), and serotonin levels. A subset of 27 women (n= 15 massage) had blood drawn to assay immune measures. The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer-term massage effects included reduced depression and hostility, increased urinary dopamine, serotonin values, natural killer cell number and lymphocytes. RESULTS: Avoidance coping was associated with greater NK cell number and intrusive coping with lower dopamine levels. Women with stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety and anger and for enhancing dopamine, serotonin and natural killer cell number and lymphocytes.

Breast Massage

Yokoyama, Y., Ueda, T., Irahara, M., & Aono, T. (1994). Releases of oxytocin and prolactin during breast massage and suckling in puerperal women. European Journal of Obstetrics, Gynecology & Reproductive Biology, 53, 17-20.

METHOD: The responses of prolactin and oxytocin to suckling and breast massage were examined in lactating women. RESULTS: The suckling group showed an increase in frequency of pulsatile release of oxytocin and an increase in the plasma prolactin level. In contrast, the breast massage group showed a significant, but not a pulsatile increase in the plasma oxytocin level and no increase in the plasma prolactin level. These findings suggest that suckling causes both milk production and milk ejection, while breast massage causes only ejection of milk already stored, and that prolactin release is not related to an increase of the oxytocin level itself, but to its pulsatile release.

Bulimia

Field, T., Schanberg, S., Kuhn, C., Field, T., Fierro, K., Henteleff, T., Mueller, C., Yando, R., Shaw, S. & Burman, I. (1998). Bulimic adolescents benefit from massage therapy. Adolescence, 33, 555-563.

METHOD: Twenty-four female adolescent bulimic inpatients were randomly assigned to a massage therapy or a standard treatment (control) group. RESULTS: The massaged patients showed immediate reductions in anxiety and depression (both self-report and behavior observation). In addition, by the last day of the therapy, they had lower depression scores, lower cortisol (stress) levels, higher dopamine levels, and showed improvement on several other psychological and behavioral measures.

Burn

Field, T., Peck, M., Krugman, S., Tuchel, T., Schanberg, S., Kuhn, C., & Burman, I. (1998). Burn injuries benefit from massage therapy. Journal of Burn Care and Rehabilitation, 19, 241-244.

METHOD: Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. RESULTS: State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations, and anxiety improved after the massage therapy sessions on the first and last days of treatment. Longer-term effects were also significantly greater for the massage therapy group including decreases in depression and anger, and decreased pain on the McGill Pain Questionnaire, Present Pain Intensity Scale, and Visual Analogue Scale. Although the underlying mechanisms are not known, these data suggest that debridement sessions were less painful after the massage therapy sessions due to a reduction in anxiety, and that the clinical course was probably enhanced as a result of a reduction in pain, anger, and depression.

Field, T., Peck, M., Hernandez-Reif, M., Krugman, S., Burman, I., & Ozment-Schenck, L. (2000). Postburn itching, pain, and psychological symptoms are reduced with massage therapy. Journal of Burn Care & Rehabilitation, 21, 189-93.

METHOD: Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks. RESULTS: The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.

Hernandez-Reif, M., Field, T., Largie, S., Hart, S., Redzepi, M., Nierenberg, B., & Peck, M. (2001). Childrens’ distress during burn treatment is reduced by massage therapy. Journal of Burn Care and Rehabilitation, 22, 191-195.

METHOD: Before dressing changes, 24 young children (mean age = 2.5 years) hospitalized for severe burns received standard dressing care or massage therapy in addition to standard dressing care. The massage therapy was conducted to body parts that were not burned. RESULTS: During the dressing change, the children who received massage therapy showed minimal distress behaviors and no increase in movement other than torso movement. In contrast, the children who did not receive massage therapy responded to the dressing change procedure with increased facial grimacing, torso movement, crying, leg movement and reaching out. Nurses also reported greater ease in completing the dressing change procedure for the children in the massage therapy group. These findings suggest that massage therapy attenuates young children's distress responses to aversive medical procedures and facilitates dressing changes.

Cancer

Stephenson, N.L., Weinrich, S.P., & Tavakoli, A.S. (2000). The effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. Oncology Nursing Forum, 27, 67-72.

METHODS: To test the effects of foot reflexology on anxiety and pain in patients with breast and lung cancer. RESULTS: Following the foot reflexology intervention, patients with breast and lung cancer experienced a significant decrease in anxiety. One of three pain measures showed that patients with breast cancer experienced a significant decrease in pain.

Grealish, L., Lomasney, A., & Whiteman, B. (2000). Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer. Cancer Nursing, 23, 237-43.

METHODS: This article describes the findings of an empirical study on the use of foot massage as a nursing intervention in patients hospitalized with cancer. RESULTS: In a sample of 87 subjects, a 10-minute foot massage (5 minutes per foot) was found to have a significant immediate effect on the perceptions of pain, nausea, and relaxation when measured with a visual analog scale.

Ferrell-Torry, A. T. and Glick, O. J. (1973). The use of therapeutic massage as a nursing intervention to modify anxiety and the percep

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Some of the most precious memories I had as a new mother were giving my baby massages. I recall cradling my daughter in my lap while leaning back in my rocking chair with soft, melodic music playing in the background, and gently massaging her soft skin. While massaging her, I could feel her entire body relax as I felt my own body and spirit fall into a quiet peace, letting my tension and stress disappear.

Benefits for Baby

Touch is a primal need, and the first important mode of communication between a mother and her new baby. Nurturing touch communicates love, the main ingredient for physical and emotional growth and well-being. The one-on-one interaction of infant massage promotes health on all levels – psychologically, emotionally, developmentally and physiologically. Massage improves circulation, strengthens immunity, enhances neurological development, and stimulates digestion, providing relief of gas and colic. Massage can also raise a child's sense of self and worth, which is tied to developing self-esteem.

When babies are upset, a soothing massage can lessen their tension and irritability and help them to feel more secure. In our culture, babies are born into a fast-paced, technologically advanced world with many unknown situations. This environment can create stress for a newborn. Without relief, this stress can accumulate and may cause a baby to shut down or block sensory intake and learning. Massage is a great buffer against stress. When we give our babies massage, we teach them how to relax. When relaxation is learned this early in life, they can have a lifetime tool for dealing with stress.

The benefits of infant massage are continually unfolding in scientific research. The Touch Research Institute at the University of Miami conducts research on the benefits of nurturing touch. They have published studies that suggest that touch deprivation negatively affects the immune system and massage can stimulate immunity. In studies on touch deprivation among preschool children who were separated from their mother, they noted more frequent illnesses, particularly upper respiratory infections, diarrhea and constipation. A suppressed immune response has also been noted in several studies that monitored the separation of monkeys from their mothers. In a study on human infants (10 weeks old) the opposite effects were noted when the mothers provided extra tactile stimulation. The infants whose backs were massaged by their mothers experienced fewer colds and fewer occurrences of diarrhea.

Other studies involved preterm infants who, upon receiving daily massages, averaged 47% more weight gain than infants in the control group. The studies suggest that the tactile deprivation that many preterm infants experience in intensive care may delay their recovery. Massage therapy helps preterm neonates grow more quickly and leave the hospital sooner.

The benefits of massage are carried into adulthood. Recent findings indicate that the secure attachments with primary caregivers formed in infancy produce adults more capable of healthy, happy, and trusting relationships. When the attachment bonds are not formed, children grow up being less sympathetic to others, and relationships lack trust and intimacy. Love, trust, compassion, warmth, openness and respect are conveyed through massage. The attachment bond of being held and touched helps make children more compassionate, loving, relaxed and natural. Studies have demonstrated that in societies where people are breastfed, massaged, carried and held as babies, the adults are less aggressive and violent, and more cooperative and compassionate.

Benefits for Parents

Massage is a pleasurable way to develop trust and intimacy with your baby and strengthen the bond between the two of you. It can promote a strong sense of confidence in parenting, since you can receive a great deal of feedback about your baby. Through massage, you can become more aware of how your baby communicates. You can also discover her threshold for stimulation by watching her body language and noticing how she looks and feels when she is tense or relaxed. Parents can also find relaxation, peace, and calming for themselves through infant massage. Fathers can be wonderful at infant massage.

Giving massage can give them positive interaction and a special bond with their baby at a time when a father can easily feel left out.

Origins of Infant Massage

Infant massage is fairly new in the United States and other western countries. However, massaging babies has been a parenting tradition in many cultures for centuries. In India, mothers regularly massage everyone in their families and pass this knowledge on to their daughters. After studying and working in India in the early 1970s and learning how mothers massaged their babies, Vimala McClure brought the practice of infant massage to the west in her book, Infant Massage: A Handbook for Loving Parents. She developed a curriculum that includes Swedish strokes, reflexology, and yoga, along with Indian massage strokes, and shared her discoveries with other parents. Interest in the art of infant massage continues to grow, and Vimala’s organization, the International Association of Infant Massage Instructors, has trained hundreds of massage instructors all over the world.

Giving a Massage

Choose a place that is warm, quiet and comfortable for your baby’s massage. For massage oil, the best choices are light, organic, cold-pressed vegetable oils, such as safflower, apricot kernel or almond. Commercially produced mineral-type baby oils have a nonorganic, nonfood petroleum base and are not a good choice. All of your massage strokes should be soft and gentle, long, slow and rhythmic, with just enough pressure to be comfortable but stimulating. Listen to and watch your baby's reactions and respond accordingly. Let your baby set the pace. You can learn infant massage techniques by reading Infant Massage: A Handbook for Loving Parents, by Vimala Schneider McClure (available in bookstores or at Amazon.com) or by taking an infant massage class. To find an instructor in your area, contact the International Association of Infant Massage Instructors. Many Certified Infant Massage Instructors have developed specialized programs for special needs, premature babies and teen parents.

Your massages will have to be adapted as your baby grows into a child. When a baby begins crawling or walking, there are just too many exciting things to explore and the baby may crawl or walk away from the massage, making it harder or impossible to do. It’s never a good idea to force a child to receive a massage. Just wait until the child is ready again. Preschoolers usually love massage, and they can stay still for a longer period of time. My preschooler continues to love her massages and even likes to give me massages now. You can include rhymes and games along with the massage to keep it fun. School-age children may also love massage and benefit from it, but don’t try to push it on them if they don’t want it. Massage can be very beneficial to adolescents, who are usually concerned about body image and facing a lot of emotional challenges. You can always ask them if they’d like their neck and shoulders massaged when they are doing their homework. If they’ve experienced massage from an early age, they may even ask you periodically for a massage. Again, never try to force a massage on your children. Always ask permission first.

Your entire family can benefit from the loving art of massage. Give your children this gift of love and security. You will be participating in helping to create a future generation that is nonviolent, compassionate, caring, and able to cope with the stresses of a hectic world.

Use the information provided in this database as an educational resource for determining your options and making your own informed choices. It is not intended as medical advice or to diagnose, prescribe, or treat any specific illness. If there is any chance your child is seriously ill, take him or her to a qualified health professional for evaluation.