Journal of Midwifery and Reproductive Health

Journal of Midwifery and Reproductive Health

The Effect of Foot Reflexology on Pain and Anxiety in Pregnant Women Candidates for Amniocentesis: A Randomized Clinical Trial

Document Type : Original Research Article

Authors
Mahla Salarfard 1
Marzieh Samieean 2
Zahra Abedian 3
Seyed Reza Mazlom 4
Hoda Azizi 5
Fatemeh Tara 6
1 PhD Student of Reproductive Health, Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
2 MSc of Midwifery, Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
3 Lecturer, Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
4 Lecturer, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
5 Associate Professor, Department of Acupuncture, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad Iran
6 Associate Professor, Department of Obstetrics & Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/jmrh.2025.82570.2479
Abstract
Background & aim: Most pregnant women have anxiety regarding screening tests such as amniocentesis. The current research was carried out to examine the effect of foot reflexology on pain and anxiety in pregnant women candidates for amniocentesis.
Methods: This randomized clinical trial included 60 pregnant women candidates for amniocentesis at a training hospital in Mashhad , Iran. The participants included in the study were randomly allocated to intervention (N=29) and control (N=31) groups . The participants in the intervention group performed 20 minutes of foot reflexology (10 minutes on each foot), daily in the solar plexus area for 10 consecutive days. The control group received no additional intervention beyond routine care. Data were collected using demographic and obstetrics questionnaires, the Spielberger State-Trait Anxiety Inventory, and the Visual Analogue Scale. The data were analyzed using SPSS 16 software with independent t-tests, chi-square tests, and covariance analysis.
Results: The reflexology group had significantly lower mean state anxiety scores than the control group immediately and 10 days after amniocentesis (P<0.001 and P<0.001, respectively). The mean trait anxiety scores in the foot reflexology group were significantly lower at 10 days after amniocentesis (P<0.001). The reflexology group had significantly less pain intensity immediately after amniocentesis (P=0.001).
Conclusion: Reflexology is an effective method to reduce pain and anxiety in pregnant women who underwent amniocentesis.
Keywords
Reflexology
Amniocentesis
Anxiety
Pain
Subjects
1.     Alfirevic Z, Navaratnam K, Mujezinovic F. Amniocentesis and chorionic villus sampling for prenatal diagnosis. Cochrane Database of Systematic Reviews. 2017; (9): CD003252.
2.     Tara F, Lotfalizadeh M, Moeindarbari S. The effect of diagnostic amniocentesis and its complications on early spontaneous abortion. Electron Physician. 2016; 8(8): 2787-2792.
3.     Mojahed S, Tabatabaei RS, Reihani F, Dehghani A, Khavari F. The effect of education on anxiety of pregnant mothers before amniocentesis. Journal of Education and Health Promotion. 2021; 10: 61.
4.     Klages K, Kundu S, Erlenwein J, Elsaesser M, Hillemanns P, Scharf A, et al. Maternal anxiety and its correlation with pain experience during chorion villus sampling and amniocentesis. Journal of Pain Research. 2017; 10: 591-600.
5.     Mousavi FS, Golmakani N, Saki A. The relationship between postoperative pain after cesarean section with pre and postoperative anxiety. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2016; 19(24): 1-10. [In Persian]
6.     Karimi N, Bahadori F, Khalkhali HR, Rabiepoor S. Evaluation of anxiety and perceived stress in mothers undergoing amniocentesis. Nursing and Midwifery Journal. 2017; 15(4): 292-300.  [Persian]
7.     Silva MMdJ, Nogueira DA, Clapis MJ, Leite EPRC. Anxiety in pregnancy: prevalence and associated factors. Revista da Escola de Enfermagem da USP. 2017; 51.
8.     Nakić Radoš S, Košec V, Gall V. The psychological effects of prenatal diagnostic procedures: maternal anxiety before and after invasive and noninvasive procedures. Prenatal Diagnosis. 2013; 33(12): 1194-1200.
9.     Bais B, Molenaar NM, Bijma HH, Hoogendijk WJG, Mulder CL, Luik AI, et al. Prevalence of benzodiazepines and benzodiazepine-related drugs exposure before, during and after pregnancy: A systematic review and meta-analysis. Journal of Affective Disorders. 2020; 269: 18-27.
10.  Levy I, Attias S, Lavee TS, Avneri O, Cohen G, Balachsan S, et al. The effectiveness of foot reflexology in reducing anxiety and duration of labor in primiparas: an open-label randomized controlled trial. Complementary Therapies in Clinical Practice. 2020; 38: 101085.
11.  Öztürk R, Sevil Ü, Sargin A, Yücebilgin MS. The effects of reflexology on anxiety and pain in patients after abdominal hysterectomy: a randomised controlled trial. Complementary Therapies in Medicine. 2018; 36: 107-112.
12.  Kapıkıran G, Özkan M. The effect of foot reflexology on pain, comfort and beta endorphin levels in patients with liver transplantation: A randomized control trial. European Journal of Integrative Medicine. 2021; 45: 101344.
13.  Yılar Erkek Z, Aktas S. The Effect of Foot Reflexology on the Anxiety Levels of Women in Labor. Journal of Alternative and Complementary Medicine. 2018; 24(4): 352-360.
14.  Shahsavari H, Abad MEE, Yekaninejad MS. The effects of foot reflexology on anxiety and physiological parameters among candidates for bronchoscopy: A randomized controlled trial. European Journal of Integrative Medicine. 2017; 12: 177-181.
15.  Asadollahi F, Babazadeh R, Abdi H, Esmaeily H. Effect of foot solar plexus reflexology on severity of nausea and vomiting at first half of pregnancy: A Randomized Clinical Trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2019; 22(6): 54-64. [Persian]
16.  Ghasemi S, Dehghanmehr S, Nezhad Jahantigh A, E A. The Effect of Foot Reflexology Massage on Anxiety of Hemodialysis Patients . Journal of Zabol Medical School. 2020; 3(1): 1-7. [In persian]
17.  Razmjoo N, Yousefi F, Esmaeeli H, Azizi H, Lotfalizadeh M. Effect of foot reflexology on pain and anxiety in women following elective cesarean section. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2012; 15(1): 8-16. [Persian]
18.  Hanprasertpong T, Kor-anantakul O, Leetanaporn R, Suwanrath C, Suntharasaj T, Pruksanusak N, et al. Reducing pain and anxiety during second trimester genetic amniocentesis using aromatic therapy: a randomized trial. Journal of the Medical Association of Thailand. 2015; 98(8): 734-738.
19.  Ventura T, Gomes MC, Carreira T. Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis. Psychoneuroendocrinology. 2012; 37(1): 148-156.
20.  Chen H-M, Chang F-Y, Hsu C-T. Effect of acupressure on nausea, vomiting, anxiety and pain among post-cesarean section women in Taiwan. The Kaohsiung Journal of Medical Sciences. 2005; 21(8): 341-350.
21.  Omara HM, Eman SE-F, Mohamed FAE-E, Ghada E. Effect of foot reflexology on stress and anxiety during pregnancy. The Medical Journal of Cairo University. 2018; 86(6): 1607-1611.
22.  Mahram B. [Validation of Spielberger anxiety test in Mashhad] [Thesis in Persian]. Tehran: University of Education; 1994.
23.  Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), McGill pain questionnaire (MPQ), short‐form McGill pain questionnaire (sf‐mpq), chronic pain grade scale (CPGS), short form‐36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care & Research. 2011; 63(11): S240-S52.
24.  Chang S-R, Chen K-H, Lin H-H, Chao Y-MY, Lai Y-H. Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study. International Journal of Nursing Studies. 2011; 48(4): 409-418.
25.  Adelmanesh F, Arvantaj A, Rashki H, Ketabchi S, Montazeri A, Raissi G. Results from the translation and adaptation of the Iranian Short-Form McGill Pain Questionnaire (I-SF-MPQ): preliminary evidence of its reliability, construct validity and sensitivity in an Iranian pain population. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology. 2011; 3(1): 27.
26.  Mahmoudirad G, Ghaedi MM, Bahrami H. Effect of foot reflexology on anxiety of patients undergoing coronary angiography. Iranian Journal of Critical Care Nursing. 2014; 6(4): 235-242.
27.  Moghimi-Hanjani S, Mehdizadeh-Tourzani Z, Shoghi M. The effect of foot reflexology on anxiety, pain, and outcomes of the labor in primigravida women. Acta Medica Iranica. 2015; 53(8): 507-511.
28.  Eman S.A. El-Fekey, Hala M.H. Omara, Ghada E. El-Refaye, El-Enin MFMA. Effect of Foot Reflexology on Stress and Anxiety during Pregnancy. The Medical Journal of Cairo University. 2018; 86: 1607-1611.
29.  Navaee M, Khayat S, Abed ZG. Effect of pre-cesarean foot reflexology massage on anxiety of primiparous women. Journal of Complementary & Integrative Medicine. 2020; 17(3).
30.  Abbaszadeh Z, Malakouti J, Maghalian M, Mirghafourvand M. The Effect of Reflexology on the Anxiety of Pregnant Women During Labor: A Systematic Review and Meta-Analysis. Current Women's Health Reviews. 2022; 19(3).
31.  Yang JM, Li ZQ, Ye H, Wu YL, Long Y, Zhong YB, et al. Effects of foot reflexology massage on pregnant women: a systematic review and meta-analysis of randomized controlled studies. Scientific Reports. 2024; 14(1): 1012.
32.  Liang X, Wu S, Li K, Zhang H, Yang F, Wang X, et al. The effects of reflexology on symptoms in pregnancy: A systematic review of randomized controlled trials. Heliyon. 2023; 9(8): e18442.
33.  Mc Vicar A, Greenwood C, Fewell F, D’arcy V, Chandrasekharan S, Alldridge L. Evaluation of anxiety, salivary cortisol and melatonin secretion following reflexology treatment: a pilot study in healthy individuals. Complementary Therapies in Clinical Practice. 2007; 13(3): 137-145.
34.  Mohamed NM, Mohamed NR, Mikheal IE. Effect of foot reflexology on low back pain intensity and functional abilities among pregnant women. Alexandria Scientific Nursing Journal. 2023; 25(1): 11-21.
35.  Mohan M, Varghese L. Effect of Foot Reflexology on Reduction of Labour Pain Among Primigravida Mothers. International Journal of Therapeutic Massage & Bodywork. 2021; 14(1): 21-29.
Journal of Midwifery and Reproductive Health
Volume 14, Issue 4
Autumn 2026
Pages 5730-5741