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Massage and effleurage are two types of cutaneous stimulation used during labor for effective pain relief and comfort. Effleurage is a French word. When Dr. Fernand Lamaze's notes were translated from French into English, one of the few words kept was effleurage.
Practiced for over 5,000 years, touch is one of the oldest therapies. The whole person is treated using four basic techniques:
- Effleurage (stroking)
- Friction (pressure)
- Percussion (drumming)
- Petrissage (kneading)
All forms of massage use oil. Treatments restore relaxation and peace while reducing or ousting problems. Massage is now incorporated in other therapies such as Acupuncture, Rolfing (tissue massage), Aromatherapy, Reflexology and Shiatsu.
Effleurage is any light massage that glides over the skin but does not use pressure or movement of deep muscle masses (Tappan, 1978). Effleurage is performed by the laboring woman or by her partner/husband or her labor support (doula). Rhythmic slow circles are "drawn" with fingertips on the abdomen, thighs or arms. The sensation of pain is reduced by varying amounts, depending on the individual.
THE EFFLEURAGE MOVEMENT DESCRIPTION
Effleurage is the most basic massage movement and is often used as a linking movement by which the therapist maintains contact with the client while smoothly transferring from one movement or area of the body to the next. Effleurage is suitable for use any area of the body that would normally be massaged (that is, avoiding any areas in which massage is contra-indicated).
The word "effleurage" is derived from the French verb "effleurer" which means "to stroke", or "to skim over". These translations are basically correct, but incomplete, descriptions of the effleurage technique used in massage.
An effleurage movement is a relatively slow and smoothly continuous stroke using the flat of the hand. The fingers are generally held together and molded to the contour of the client's body in a relaxed way. Although the fingers precede the palm of the hand as it is moved along the body, and they do apply some pressure, most of the pressure during this movement is applied by the palm of the hand.
Even pressure is applied during effleurage. The amount of pressure may differ between the outward and return strokes - generally with more pressure applied in the direction towards the heart, then slightly less in the return movement back to repeat the sequence. However, the speed of the motion should remain steady throughout the whole sequence.
An effleurage movement is usually repeated several times over the same area on the body. This is to induce relaxation, and also the physical benefits of effleurage, which can include: Stimulating the nerves in the tissues worked; stimulating blood supply to the tissues worked; facilitating cleansing of the skin; relaxing muscle fibers, and reducing muscle tension.
Contact must be maintained throughout the whole sequence. A therapist would not take her hands off a client during a sequence of 3 effleurage strokes, as each stroke moves smoothly and continuously into the next.
THE GATE CONTROL THEORY
The use of effleurage and massage illustrates the Gate Control Theory (Melzack & Wall 1965) and is the same basic principle at work when you stub your toe and then rub it, reducing the pain. Pain fibers taking the pain stimulus to the brain are smaller and the sensation travels slower than the touch fibers, which are large. When touch and pain are stimulated simultaneously, the touch sensation travels to the brain and "closes the Gate" in the brain, limiting the amount of pain perceived by the brain. Touch may also include counter-pressure, backrubs, heat/cold therapies and even acupuncture.
When other non-pharmacologic pain relief methods such as a focal point and music therapy, the cerebral cortex of the brain focuses more on these comfort measures than on the pain stimulus. This adds to the limitation of pain sensations perceived by the brain. Finally, memory or the cognitive processes are stimulated by taking childbirth education classes/having been exposed to and practicing relaxation and breathing techniques. Again, these also add to the limitation of pain sensations perceived by the brain.
While no one can honestly promise that childbirth will be a pain-free process, the use of non-pharmacologic comfort measures such as the stimulation of touch is an effective pain management strategy.
REFERENCES:
- Melzack, R., & Wall, P.D. Pain Mechanisms: A New Theory. Science. Vol. 150. 1964.
- Nichols, F. & Humenick, S. Childbirth Education: Practice, Research & Theory. Saunders, 1988.
- Reeder, Martin, Koniak-Griffin. Maternity Nursing: Family, Newborn, & Women's Health Care. Lippincott, 1997.
- Simpson K.R. & Creehan, P.A. AWHONN Perinatal Nursing. Lippincott, 1996.
- Tappan, F. Healing Massage Techniques. Reston Publishing, 1993.
Copyright 1999-2004 by Perinatal Education Associates, Inc.
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