Investigating the Impact of Foot Reflexology on Postpartum Energy in Primiparous Women

* Corresponding Author: Shekoufeh Maleki, MSc. Address: Department of Reproductive Health, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Tel: +98 (21) 66927171 E-mail: malekishekoufeh@gmail.com 2. Department of Reproductive Health, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. 2. Department of Biostatistics, Nursing Care Research Center, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Maryam Moddares1 , *Shekoufeh Maleki1 , Shima Haghanni2


Introduction
he postpartum period initiates right after delivery and continues until the end of 6 weeks after delivery. During this time, the mother experiences numerous bio-T psychological changes [2]. Fatigue and decreased energy level are among the most frequent symptoms reported by women in postpartum. Studies investigating the energy level in the postpartum period are scarce [5]. Furthermore, there is a direct relationship between fatigue and energy levels in the 6 first weeks of postpartum with gestational age and labor duration [7]. The responsibility of caring for the baby could cause fatigue and decrease energy in the mothers during the postpartum period, i.e. a predictor of postpartum depression [10].
Reflexology is a branch of complementary medicine and a cheap and non-invasive method [15]. The mental effects of reflexology include increased energy, wellbeing, strengthening a positive attitude, and receiving electromagnetic energy from the ground by the foot [17]. In recent years, reflexology has been popular in the promotion of health, quality of life, as well as healthcare, especially in the field of maternal and child health. This is due to the increasing interest in complementary and alternative therapies [18]. The management role and the impact of midwives in employing complementary medicine provide a positive attitude and reduce medical interventions in maternity care services [20].

Materials and Methods
This quasi-experimental study was performed in two groups of reflexology and control. The inclusion criteria of the study included the following: primiparous; natural childbirth; delivering a full-term and healthy baby; breastfeeding exclusively; The lack of any diagnosed acute and chronic physical and mental illnesses (diabetes, hypertension, depression, etc.); achieving a score of ≥25 (medium, low energy level) from the energy items of the Visual Analogue Scale to Evaluate Fatigue Severity (VAS-F); referral between 10 and 15 days after delivery; the lack of using sedatives; as well as no varicose veins, pain, or injury in the lower leg. The study exclusion criteria included discontinuing participation in the study; failure to follow the massage program by the mothers for any reason for one session; as well as the occurrence of any adverse effects during the intervention, including sensitivity to the desired oil and sensitivity to touch.
The sample size was considered at a 95% confidence level and 80% test power, assuming that the effect of foot reflexology on fatigue in nulliparous women be reduced by 7 units as statistically significant. There were 32 individuals per group, i.e. estimated to be 35 subjects in each group (N=70), considering the sample dropout. A researchermade demographic-midwifery questionnaire and the VAS-F were implemented to collect the required information. The midwifery demographic questionnaire consisted of 11 items, i.e. completed through an interview before initiating the intervention.
The obtained data were analyzed in SPSS at P<0.05 by Independent Samples t-test, Chi-squared test, Fisher's Exact test, and repeated-measures Analysis of Variance (ANOVA).

Results
According to the present research results, the reflexology and control groups were homogeneous in terms of all demographic characteristics and revealed no statistically significant difference in this regard.
Furthermore, the pairwise comparison of Bonferroni test data indicated that the mean energy level of the study participants at one week after the intervention was significantly higher than immediately after (P<0.001) and before the intervention (P=0.02); thus, the effect of the group was not significant, but the effect of time was significant in this area.

Discussion
The current study explored the effects of foot reflexology on the energy level of primiparous mothers experiencing natural delivery. According to the collected findings, there was no significant difference in energy score between the intervention and control groups (P>0.05). Therefore, it seems that providing a massage or touching non-reflective areas could be as effective as the results of this study (even to a small extent), and indoctrination may be influential in this regard. Accordingly, the increase in energy levels in the control group may have been due to the inductive effect of mothers with cesarean section experience, who finally participated in an intervention to enhance their energy levels.
Touch plays an essential role in individuals and stimulating skin receptors could present a soothing and positive effect on the individuals [26]. However, in the explored intervention group, increasing energy levels could reflect the effectiveness of reflexology on the energy levels of mothers with a cesarean section experience. Despite the same number of massage sessions in both studies (3 consecutive sessions) and energy assessment with the VAS-F, the results of their study were inconsistent with our achieved data [1].

Conclusion
The provided massage intervention was not as effective as a non-invasive, low-cost method to improve the postpartum energy level in the study participants.