This prospective, randomized controlled trial evaluates the effect of reflexology on maternal anxiety, labor duration, and pain in women undergoing labor induction with an extra-amniotic balloon (EAB). Eligible participants are women with a singleton, term pregnancy, cephalic presentation, intact membranes, and a Bishop score \<6, without prior cesarean delivery or contraindications to vaginal delivery. Participants will be randomized to two groups: an intervention group receiving reflexology by a certified practitioner following EAB placement, and a control group receiving standard care. Maternal anxiety will be assessed using the State-Trait Anxiety Inventory (STAI) before and after the intervention. Labor duration and pain scores will also be recorded. The study plans to enroll 84 participants over two years. Reflexology is a safe, non-invasive complementary therapy, and this study aims to determine whether it provides measurable benefits during labor induction.
Labor induction is a common obstetric procedure that can be associated with maternal anxiety, pain, and prolonged labor, potentially affecting the birth experience and maternal well-being. Complementary interventions may help reduce these effects and improve patient satisfaction. Reflexology is a non-invasive therapy involving targeted pressure on specific points of the feet, hands, or ears, which may promote relaxation and reduce stress and pain. Preliminary evidence suggests reflexology can decrease maternal anxiety and labor pain, but high-quality data in the context of mechanically induced labor are limited. This study evaluates reflexology during labor induced with an extra-amniotic balloon (EAB). Participants will be randomized to receive either reflexology by a trained practitioner after EAB placement or standard care without reflexology. Maternal anxiety, labor duration, pain, and patient satisfaction will be systematically assessed, using validated measures for anxiety and pain, along with routine clinical and neonatal data collected from hospital records. The study aims to enroll 84 participants over two years. All participants will provide informed consent, and data will be de-identified to ensure privacy. This trial seeks to provide evidence on the efficacy of reflexology as a complementary intervention during labor induction, informing clinical practice and enhancing maternal-centered care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
84
Reflexology, a complementary therapy rooted in ancient practices, involves applying pressure to specific points on the feet, hands, or ears thought to stimulate nerve pathways, potentially promoting relaxation and reducing stress. Evidence supporting reflexology's role in obstetrics is growing, with studies highlighting its ability to reduce anxiety, alleviate pain, and influence the duration of labor. Moreover, when reflexology was applied during the active phase of labor it was related to a significant reduction in labor pain intensity and improvements in maternal satisfaction.
Maternal anxiety during labor as perceived by the validated state-trait anxiety index
state-trait anxiety index (STAI-S) questionnaire
Time frame: first STAI questionnaire after recruitment and before induction initiation to assess baseline anxiety. Within 2-10 hours of EAB placement she will fill the second STAI form (similar) and delta STAI score will be calculated
Time from Extra-Amniotic Balloon (EAB) placement to balloon expulsion
The time in hours from the documented placement of the extra-amniotic balloon (EAB) to its spontaneous expulsion from the cervix, recorded by clinical staff or self-reported by the patient. This outcome is used to assess progression of cervical ripening during labor induction. Per developmental protocol, all EABs that do not spontaneously expel within 24 hours will be removed by a physician, and this will be recorded.
Time frame: From the time of EAB placement until the time of balloon expulsion, assessed up to 24 hours after placement.
Time from labor induction to delivery
Time (in hours) from the initiation of labor induction-defined as the time of extra-amniotic balloon (EAB) placement-to the time of delivery (vaginal or cesarean). This outcome will be used to assess the effect of reflexology on the overall duration of labor after induction.
Time frame: From the time of EAB placement until the time of delivery, assessed up to 72 hours after induction initiation.
rate of vaginal birth within 24 hours from induction
vaginal birth rate within the first 24 hours from induction initiation in both groups
Time frame: 24 hours from induction initiation to delivery
Pain during labor induction as measured by the Visual Analogue Scale (VAS)
Maternal perception of pain will be assessed using the Visual Analogue Scale (VAS), a 10 cm horizontal line ranging from 0 to 10, where 0 represents "no pain" and 10 represents "worst imaginable pain." Each participant will report her pain level at two time points: 1. Baseline (prior to reflexology or standard care), and 2. After the intervention (reflexology group) or within 2-10 hours after EAB placement (control group). The primary pain outcome will be the maximal reported VAS score during the induction process.
Time frame: Baseline before EAB placement and post-intervention or within 2-10 hours after EAB placement.
Mode of delivery
Mode of delivery categorized as spontaneous vaginal delivery, instrumental vaginal delivery, or cesarean section. Data will be obtained from delivery records.
Time frame: At delivery
Maternal satisfaction with the labor induction experience
Maternal satisfaction will be assessed using a scale ranging from 1 to 5, where 1 indicates "not satisfied at all" and 5 indicates "maximally satisfied." Participants will rate their satisfaction after the intervention (reflexology or standard care) and before delivery. Higher scores indicate greater satisfaction.
Time frame: up to 1 hour from intervention and prior to delivery
Intrapartum fever
Occurrence of maternal intrapartum fever, defined as body temperature ≥38.0°C measured during labor.
Time frame: During labor, up to delivery
Manual lysis of placenta
Need for manual lysis of placenta, defined as manual removal of the placenta following delivery.
Time frame: At delivery
Neonatal birthweight
Apgar score at 1 and 5 minutes, each ranging from 0 to 10, with higher scores indicating better neonatal condition.
Time frame: At 1 minute and 5 minutes after birth
Umbilical cord pH
Arterial umbilical cord pH measured immediately after birth.
Time frame: At birth
NICU admission
Rate of neonates admitted to the Neonatal Intensive Care Unit (NICU).
Time frame: Immediately after birth, assessed through hospitalization period (up to 28 days)
Respiratory distress syndrome (RDS)
Rate of neonatal respiratory distress syndrome as documented in the neonatal medical record.
Time frame: During initial hospitalization (up to 28 days of life)
Neonatal ventilation
Rate of neonates on mechanical or non-invasive ventilation support during the newborn's hospitalization.
Time frame: During initial hospitalization (up to 28 days)
Neonatal neurological morbidity
Rate of neonates with diagnosed neurological complications, including seizures or intraventricular hemorrhage (IVH), during neonatal hospitalization.
Time frame: During initial hospitalization (up to 28 days)
Neonatal hypoglycemia
Rate of neonates with documented blood glucose \<40 mg/dL within the first 24 hours of life.
Time frame: Within first 24 hours after birth
Neonatal blood transfusion
Rate of neonates requiring blood transfusion during neonatal hospitalization.
Time frame: During neonatal hospitalization (up to 28 days)
Neonatal phototherapy
Rate of neonates admitted for phototherapy for hyperbilirubinemia.
Time frame: During neonatal hospitalization (up to 28 days)
Neonatal death
Rate of dead neonates within the first 28 days of life.
Time frame: Up to 28 days after birth
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