The Continuum of Touch
Infancy
Adulthood and Old age
From prebirth
History of Touch
- perhaps the first form of medicine
- described in ancient texts in China,
India & Egypt
- described by Hippocrates in 400 BC
- touch is considered a form of therapy in
many parts of the world
Touch Therapy
Shiatsu
Reflexology
Massage Therapies
Infant
Massage
Thai Massage
Ayuverdic Massage
Kangaroo Care
Kangaroo Care
Infant
Co-sleeping
Doula
Mailman Center
Touch Research Institutes
• Established in 1992 by Dr. Tiffany Field
with a grant from Johnson & Johnson.
• The TRI was the first center in the world
devoted solely to the study of touch and its
application in science and medicine.
www.JJPI.com
Touch Research Institutes
To date, we have conducted over 100 scientific
studies on touch therapy effects and we have
established two other TRIs (Philippines, Paris).
www.miami.edu/touch-research
www.JJPI.com
Continuum of Touch
From Pregnancy …..
to Labor
….. to Infancy
Pregnancy Massage
Field, Hernandez-Reif, Hart, et al., (1999), J of Psychosomatic Obstetr Gyn
Field, Diego, Dieter, Hernandez-Reif, et al., (2004), Infant Behavior & Dev.
Field, Hernandez-Reif, Diego, et al,. (2004), J of Psychosomatic Obst Gyn
Progressive Muscle
Relaxation (PMR)
Study Design
• two 20-minute sessions per week
of Pregnancy Massage or PMR
for 5 weeks starting in 2nd
• focus on the head, neck, back,
arms, legs, and face
Pregnancy
Anxiety
50
40
*
*
Pre
Post
30
20
10
0
Massage
Relaxation
Pregnancy
Back Pain
5
4
3
*
2
1
Massage
Relaxation
Pregnancy
Disturbed Sleep
48
*
36
24
12
0
Massage
Relaxation
Pregnancy
Supplemental Sleep (Naps)
40
*
30
20
10
0
Massage
Relaxation
Birth Outcomes
150
120
*
*
90
Massage
Relaxation
60
30
0
OCS
PNF
Pregnancy
Depressed Mood
3
2
*
Pre
Post
1
0
Massage
Relaxation
Pregnancy and
Depressed Mood
10-30% of women are
depressed during pregnancy
Pregnancy Depression
on Maternal Cortisol
400
*
ng/mg
300
200
100
Depressed
Non-Depressed
Prenatal Cortisol
Prematurity and
Depressed Pregnancy
> 37
< 37
Percent of Group
100%
80%
60%
40%
*
20%
0%
Depressed
Non-Depressed
Prematurity
Low Birthweight and
Depressed Pregnancy
> 2500g
< 2500g
Percent of Group
100%
80%
60%
40%
*
20%
0%
Depressed
Non-Depressed
Low Birth Weight
Dieter, Field, Hernandez-Reif, et al., (2002).
Prenatal Depression
Effects on Neonate
400
*
300
ng/mg
600
*
200
500
ng/mg
100
400
Depressed
Non-Depressed
Prenatal Cortisol
300
200
100
Depressed
Non-Depressed
Neonatal Cortisol
Prenatal Depression
60
*
Percent Time
50
40
30
20
10
0
Depressed
Non-Depressed
Neonatal Indeterminate Sleep
Prenatal Depression
0.05
0
Depressed
F3
Non-Depressed
-0.05
-0.1
-0.15
-0.2
Frontal EE Asymmetry
Frontal EE Asymmetry
0.05
F4
0
Depressed
Non-Depressed
-0.05
-0.1
Mothers
Infants
Depressed Pregnancy
Effects Include:
For mothers:
-
Elevated cortisol (stress hormone)
Greater chance of having a preterm
baby
Greater chance of having a lowbirth
weight baby
Depressed Pregnancy
Effects Include:
For fetus:
- Greater fetal activity
For infants:
- Elevated cortisol & greater chance of
being born preterm or low birthweight
- Greater Indeterminate sleep
- Greater relative right frontal EEG
activation
Partners Massaging
Depressed Pregnant Women
Demographics
• N = 84 depressed pregnant women
• Mean age = 28.8 (SD = 5.7)
• Mean g.a.= 22.9 wks at recruitment
• 46% Caucasian, 39% Hispanic, 12% African
American and 3% Asian
Pre-Post Test Design
Recruited from Ob Gyn clinics in 2nd semester &
assigned to Massage, PMR group or control .
Massage Therapy (by partner)
• Two 20 min. massages per week for 16 weeks at
home.
PMR
• Two 20 min. relaxation exercise sessions per week
for 16 weeks.
Maternal
Cortisol Change (ng/ml)
Massage
PMR
10
0
*
-5
-10
-20
-16
-30
-40
-50
-60
-70
-80
-76
Control
6
Obstetric Complications
(higher score is optimal)
*
102
100
91
78
75
50
25
0
Massage
Relaxation
Control
Mothers’
Anxiety
50
40
30
Pre
Post
*
20
10
0
Massage
Relaxation
Control
Mothers’ depression
30
20
*
Pre
Post
10
0
Massage
Relaxation
Control
Infant Depressed Symptoms
On Brazelton Neonatal
Assessment Scale (BNBAS)
6
5
4
*
3
2
1
0
Massage
Relaxation
Control
Overall Conclusions
Pregnancy massage is a safe and effective intervention for
depressed and non-depressed mothers:
stress hormones (cortisol)
anxiety and depressed mood
disturbed sleep
Obstetric complications and postnatal complications,
hence improving neonatal outcomes, including reducing
the incidence of prematurity.
**These data also highlight the efficacy of using a
significant other to deliver the massage intervention.
Touch Therapies during Labor
Continuum of Touch
Touch therapies during Labor –
Doula - companion woman who stays in touch with
the laboring mother (stroking, holding, speaking to
her).
Studies from the 1980s by Klaus & Kennell revealed
that 127 of 128 non-industrial societies included a
woman present with the mother-to-be during labor.
Doula vs No Doula
80
20
70
15
60
50
Doula
No Doula
40
30
Doula
Non Doula
10
5
20
10
0
0
Complications
Medication
Klaus et al, 1986 (Study on 417 laboring women in Guatemala)
Doula vs No Doula
20
18
16
14
12
10
8
6
4
2
0
14
12
10
Doula
No Doula
8
Doula
Non Doula
6
4
2
0
C-Section
Labor Hrs.
Klaus et al, 1986 (Study on 417 laboring women in Guatemala)
Benefits of a Doula Present at the
Birth of a Child (Stein, Kennell &
Fulcher, 2004)
• 50% reduction in C-sections
30
• 40% reduction in use of forceps
• 60% reduction in epidural
analgesia
23%
14%
20
10
0
C-Section
• 25% decrease in labor length
Father
Fa + Doula
Labor Massage by Partner
Field, Hernandez-Reif. et al., (1997). J of Psychosom Ob Gyn.
Labor Massage
Conducted by partner every hour for 5 hours.
20-min sequence consisting of stroking for 5min each of the following regions:
1) head, 2) neck, shoulders and back,
3) hands and arms and 4) legs and feet.
Control group who did other activities
(breathing exercises), but no massage.
Labor Massage
(MOOD 1st session)
16
14
12
10
*
8
Pre
Post
6
4
2
0
Massage
Control
Labor Massage
(Pain 1st session)
5
*
4
3
Pre
Post
2
1
0
Massage
Control
No. of Hours in Labor
12
*
8
4
8.5
11.3
Massage
Control
0
Post Labor
Depression
20
*
16
12
8
15.4
19.8
Massage
Control
4
0
Skin-to-Skin (Kangaroo care)
• KC - consists of holding the infant (in diaper) against the bare
chest with an over-covering.
• This practice started in Bogota Colombia by Drs. Rey and
Martinez in the 1970s, because of overcrowding in their
NICU, few resources and high mortality and infection rate.
• KC was introduced to the mother (benefit of access to
breastfeeding) who did KC for 24/7 and later to the fathers
• Can begin in the delivery or recovery room between 30-40 min
postbirth to help stabilize the infant or can begin earlier.
Research Benefits
of KC
• Thermal synchrony – maternal temperature
regulates infant’s temperature
• Regulate heart rate and respiration
• More deep sleep
• Fewer days in incubators
• Greater weight gain and earlier discharge.
Preterm Infant
Massage Therapy
•Can be started as soon as
preterm infant is stable
•Can be taught to parents
or performed by nurse
•Takes 15 minutes and
involves rubbing & flexion
and extension of limbs
(kinesthetics)
Introduction
Premature infants receiving massage therapy:
– Have shorter hospital stays
– Show a 21-47% greater increase in weight gain
Proposed mechanism for the effects of massage therapy
in stimulating preterm infant weight gain
Massage Therapy
Pressure/ Bar
Receptor
Stimulation
 Vagal Activity
Food Absorption
Hormone Release
 GI Activity
 Weight Gain
Method (Participants)
48 Medically stable premature infants assigned to
•
•
•
Massage therapy (n=16)
SHAM massage therapy (n=16)
Standard care control group (n=16)
Group assignment based on a random stratification
procedure designed to ensure equivalence across
groups on the following variables:
(a)
(b)
(c)
(d)
(e)
Gestational age (± 2 wks)
Birthweight (± 150 g)
Gender
Days in the NICU
Study entry weight
Method (Procedure)
Massage Therapy:
Baby on stomach: 1st & last 5-min.
Rubbing the head, shoulders, back,
legs and arms
Baby on back: 5 min of flexion and
extension of the arms and legs and
SHAM massage:
• Identical to the massage therapy
procedure exception that the light
pressure rubbing was used.
Weight Gain (gms p/day)
20
15
Control
Massage
Sham
Linear (Control)
10
5
0
Groups
Vagal Activity
Control
Massage
SHAM
Vagal Activity (RSA)
4 .5

4 .0




3 .5




3 .0
Pre
D u rin g
Pos t
Pre
D u rin g
Pos t
Pre
D u rin g
Pos t
Gastric Motility
Control
8.0
Massage
SHAM


7.0







6.0
Pre
During
Post
Pre
During
Post
Pre
During
Post
Preterm Infant Massage Effects
• Has been replicated in Taiwan, Philippines,
Israel, and China
• Nurses and parents can be trained to
conduct the therapy and has been shown to
reduce mothers’ depression.
• Simple to do, safe and reduces hospital
costs because of earlier discharge.
Fathers’ Massaging Babies
• 32 fathers (M age = 33) and their
infants (R: 3-14 mo) were studied.
• Predominantly middle class
• ½ were taught to do infant massage
and the other half were on a wait-list
Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & Care
Fathers’ Massaging Babies
4
3.8
3.6
3.4
3.2
3
Massage
Express
Control
Warmth
Accept
Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & Care
Fathers’ Massaging Babies
Caregiving Score (feeding, cleaning, playing, etc)
50
40
30
1st day
Last day
20
10
0
Massage
Control
Touch can Span Across the Ages