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Vibratory stimulation

Fetal activity following stimulation of the mother's abdomen, feet, and hands (Diego 2002)

Diego MA, Dieter JN, Field T, Lecanuet JP, Hernandez-Reif M, Beutler J, Largie S, Redzepi M, Salman FA. Fetal activity following stimulation of the mother's abdomen, feet, and hands. Developmental Psychobiology. 2002 Dec;41(4):396-406.

 

Abstract: Fetal activity during midgestation (M fetal age=19.8 weeks) was studied in response to vibratory stimulation of the mother's abdomen (at the height of the fetal head), foot massagehand massage, or control condition (no stimulation). Consistent with previous research conducted during midgestation, the fetuses of mothers who received two trials of 3-sec, 60-Hz vibratory stimulation did not show changes in movement. In contrast, the fetuses of mothers who received a 3-min foot massage showed greater movement than the control fetuses. However, stimulating the mother's hand (another highly innervated area) did not increase fetal activity. By late gestation (M fetal age=35.4 weeks), vibratory stimulation resulted in increased fetal activity. These findings replicate previous research indicating that vibratory stimulation to the mother's abdomen does not elicit fetal activity until later in gestation. Furthermore, our findings indicate that stimulating the mothers' feet, but not the hands, can evoke fetal activity in midgestation.

 

 

Why is fetal movement in response to vibration a good thing?

Vibratory stimulation has been shown to affect fetal activity, breathing, heart rate (Devoe, 1999; Gagnon, Hunse, Carmichael, Fellows, & Patrick, 1986; Kisilevsky, Muir, & Low, 1990; Smith, 1995), and behavioral state (Gagnon, Hunse, & Foreman, 1989; Kasahara, 1991). The ability of vibratory stimulation to elicit fetal activity has prompted its use in the antepartum assessment of fetal well-being (Devoe, 1999; Smith, 1995). Fetuses who respond to vibratory stimulation have better biophysical profiles (Inglis, Druzin, Wagner, & Kogut, 1993; Sarinoglu, Dell, Mercer, & Sibai, 1996), and fetal movement has been correlated with fetal well-being, (Sadovsky, 1981). Furthermore, vibratory stimulation has been used to test fetal hearing (Ke, Gu, & Wu, 1995), and procedures measuring habituation to vibratory stimulation have been suggested as a means to test fetal central nervous system function in utero (Devoe, 1999; Kuhlman, Burns, Depp, & Sabbagha, 1988).

 

Type of article

Controlled trial; apparently not randomized

 

PMID

12430163

Patient/client

  • 160 women (n=160)
    • Study 1: Mid-gestation vibratory stimulation
      • n=40
      • second trimester of pregnancy
    • Study 2: Late-gestation vibratory stimulation
      • n=40
      • third trimester of pregnancy
    • Study 3: Foot massage
      • n=40
      • second trimester of pregnancy
    • Study 4: Hand massage
      • n=40
      • second trimester of pregnancy

 

Condition

pregnancy

 

Inclusion criteria

  • attending prenatal clinic at university hospital
  • pregnancy
    • average gestation 19.8 weeks
    • fetus was normal on ultrasound evaluation

 

Exclusion criteria

  • nonsmoking
  • not drinking alcohol
  • not taking medications other than vitamins
  • no multiple pregnancies
  • no pregnancy complications

 

Control

  • Vibration: baseline readings from mothers during rest served as control
  • Massages:
    • mothers lie in the left lateral recumbent position
    • rest quietly for 3 min

 

Sign(s)/symptom(s)

N/A

 

Anatomy

...of the condition

  • Uterus

...of the sign(s)/symptom(s)

  • N/A

...of the treatment 

  • Abdomen or hand or foot

 

What was measured

  • Fetal movement in response to massage

 

Treatment location

  • Outpatient prenatal clinic at university hospital

Treatment routine: Study 1

The vibratory stimulation procedure consisted of placing a hand-held, commercially available vibrator (Conair HM11BT) on the mother’s abdomen via a bulb-shaped rubber probe with a 12.5 cm2 contact surface area. The vibrator produced a 60-Hz vibration and a 40-dB airborne sound level 1 m from the source. When the fetus showed no movement, the vibrator was placed at the height of the fetal head and activated for 3 sec. Two stimulation trials were conducted for all fetuses in Study 1 midgestation vibratory stimulation and Study 2 late-gestation vibratory stimulation.

Treatment routine: Study 2

same as Study 1 for 3rd trimester

 

Treatment routine: Study 3

Routine based on

not specified

Frequency

N/A: 2 successive trials

Position

  • therapist at the foot of the table
  • mother in a left recumbent position

Pressure

not specified

Sequence/Duration

  1. Stretching the feet by holding the ankle with one hand and pulling the top of the foot toward the therapist with the other hand (5 sec)
  2. Intermittently squeezing the feet starting at the heel and moving toward the toes by holding both feet with the thumb on the top and the other fingers on the soles of the feet (20 sec)
  3. Using both hands on one foot at a time, applying pressure to the arch with the thumbs and then using the thumbs to rub between each toe using an up (toward the web of the toe) and down (toward the end of the toe) motion (30 sec, two times)
  4. Kneading the bottom of each foot (20 sec, two times) and then the top of the foot, one foot at a time (20 sec, two times)
  5. Flexing and extending each foot and then flexing and extending all toes on one foot at a time (3 sec)
  6. Squeezing foot, moving from the heel to toes one foot at a time (5 sec)
  7. Finger stroking the entire top and bottom of foot with all five fingers one foot at a time (7 sec).

Support

not specified

 

Treatment routine: Study 4

Routine based on

not specified

 

Frequency

N/A: 2 successive trials

 

Position

  • therapist at the side of the table
  • mother in a left recumbent position

 

Pressure

not specified

 

Sequence/Duration

  1. Holding the wrist with one hand and with the hand pushing against the fingers and palm of the participant’s hand (5 sec)
  2. With both hands briskly stroking the top of the mother’s hand (10 sec)
  3. With the thumb on top of the hand and the other fingers on the palm intermittently compressing both hands at the same time starting at the pinky and moving toward the thumb (10 sec)
  4. Finger stroking the entire back of the hand from the fingers to the wrist (10 sec)
  5. Using the thumb and the forefinger to squeeze each finger (20 sec)
  6. Stretching each finger by completely encircling each finger with the therapists’ fingers and gently pulling fingers away from the hand (20 sec)
  7. Intermittently applying pressure to one hand at a time from the center to the edge of the hand (10 sec)
  8. Holding the wrist with the left hand and with the right hand, gently pulling the hand away from the wrist (5 sec).
 

Support

not specified

 

Therapist training

not specified

 

Therapist experience

not specified

 

Other therapist factors

not specified

 

Other factors

not specified

 

Research question/hypothesis

  • Vibratory abdominal stimulation, hand massage, and foot massage will cause fetal movement in normal pregnancy.

 

Findings/results

  • All the mothers showed decreased anxiety, which the authors state is probably due to reassurance about the pregnancy gained from the ultrasound evaluation.
  • Vibratory stimulation to the abdomen caused movement in fetuses in later pregnancy, but not in early pregnancy.
  • Foot massage caused increased fetal movement, but hand massage did not.

 

Specialty

  • Obstetrics
  • Neonatology

 

Affiliation

  • Touch Research Institute, University of Miami School of Medicine, Miami, Florida, USA

 

Funding

  • NIMH Senior Research Scientist Award (MH 00331);
  • NIMH merit award (MH 46586) to Tiffany Field;
  • funding from Johnson & Johnson
 

MeSH terms

Abdomen/physiology*

Adult

Analysis of Variance

Anxiety/psychology

Female

Fetal Movement/physiology*

Foot/physiology*

Hand/physiology*

Humans

Male

Massage*

Physical Stimulation

Pregnancy

Relaxation/psychology

Vibration*

 

Background

Understanding the response of a fetus to stimulation before birth is important for two reasons—for one, the fetus may be affected by the stimulation, and for that reason, knowing what effect (positive or negative) the stimulus has on the fetus can be useful in determining whether a particular intervention on the mother is helpful or harmful to the fetus.

For another, even if it is not in direct response to a stimulus, fetal activity can be another indicator of the well‐being and development of the fetus—since we cannot measure those factors directly before birth, we measure them indirectly through the movement and activity of the fetus, which we observe through the mother’s perceptions, and through imaging and other technologies.

As the fetus grows and develops, activity should continue to increase; nurse-midwives, obstetricians, and other birth professionals look at that activity as an indirect indicator of how the fetus is progressing.

Summary

In order to better understand fetal response to stimulation, the authors designed a study that looked at the effects of four kinds of maternal stimulation on the fetus:

  1. vibration with a mechanical hand‐held vibrator held at the level of the fetus’ head in early pregnancy,
  2. the same vibration treatment in later pregnancy,
  3. massage to the mother’s feet, and
  4. massage to the mother’s hands.

They found that vibration in early pregnancy did not stimulate fetal movement, while in later pregnancy it did.

The hand and foot massage produced surprising results. The foot massage stimulated fetal activity, while hand massage did not stimulate fetal activity.

Discussion

An interesting aspect of this study is that, unlike in most of the studies we review, there are actually 2 different client/patients here—the massage is performed on the mother, yet the effect of the massage is demonstrated by the fetus. For this reason, while most of the studies we classify will be clearly under “pregnancy massage” or under “infant massage”, because of who the patient is, we classify this one under both categories for both client/patients.

This study is intriguing because, in massage school, we are often taught that certain strokes or areas of the body are to be avoided, because of the possibility of inducing premature contractions. This study relates to that topic by demonstrating that certain massage stimulation to the mother can indeed directly cause response by the fetus. It does not fully connect the dots on what we are taught, but it indicates that the question is possible to study.

The authors review possible mechanisms involving neurohormones and neurotransmitters in studies on fetal response to maternal stimulation, including acupuncture and exercise, as well as anecdotal/empirical observations by midwives. They state "Massage therapy has been shown to affect maternal cortisol and cathecholamine [sic] levels (see Field, 1998, for review) and may have similar physiological effects to certain forms of exercise.".

In light of the new evidence by Moyer 2011 (click here to see it reviewed in Journal Club), however, the claim about cortisol has been shown to have been the result of a non-standard analysis. When the data is analyzed in the standard way, the effect that massage is supposed to have on cortisol disappears. Although the effect of massage on catecholamines has not be analyzed in the same way, it is safe to assume that the evidence for this outcome is a result of the same type of non-standard analysis, and remains to be demonstrated with standard methodology.

They admit that they find their results “perplexing”, as a 3‐minute foot massage to the mother caused significant fetal movement, while the mother’s hands, although containing a similar number and density of nerves as the feet, did not show a significant effect, contrary to their expectation that the result would be similar. The difference in results is not due to a difference in position of the mother during the massage, as they specified that the women lay on their left side for both the hand and foot massages.

In order to explain these results, they discuss their power analysis, which they used to determine how many mother‐fetus pairs to study, and conclude that a larger sample, or a longer massage, with a different type of study design, may have been more accurate at determining

Similarly, they differentiate the effects of vibratory stimulation in younger and older fetuses, and point out that this may have a confounding effect on the study design. They propose future studies directly observing the effects of hand and foot massage on the mothers’ physiology, to determine whether there are direct biochemical changes in the mothers which would account for the observed effects, as well as to determine whether, in a larger study sample, the hand massage would indeed show a similar effect as the foot massage did--whether there really was no effect from the hand massage, or whether there was one, which was missed.

 

 

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