to identify the effectiveness of sacral massage on labor pain, depression, stress, and anxiety: A randomized clinical trial

Labor is regarded as one of the physiological behaviors in humans that has existed since the beginning of humanity, the formation cycle of which has remained unchanged. Labor is a health state that most women aspire to, at some point in their lives. The first thought that comes to the mind of an expecting woman regarding her delivery is the pain of labor. The pain of labor is the central and universal part of a woman's experience of childbirth. Labor is a normal physiological process, which while it should be an occasion for rejoicing, it also accompanies with it, lots of pain, agony, and discomfort and certain risks. Thus although being a joyful and empowering experience, it can end with negative and tragic results, leaving the woman filled with fear and anxiety for future birth (Labrecque, Nouwen, Bergeron, & Rancourt, 1999). The causes of labor pain can be either physical or psychological. Physical factors include uterine contractions, cervical dilatations, cervical effacements and so on. Psychological factors include fear and anxiety, previous experiences, inadequate support, inadequate knowledge. Pain perceived during labor may be different for each woman (Sethi & Barnabas, 2017). The fear and anxiety that pregnant women experience during the labor process leads to the stretching of pelvic muscles and creates resistance against the repulsive force of the uterus and the repulsive force exerted by women during labor. The extension of the anxiety-related tension in the pelvic muscles causes general fatigue in pregnant women, increased pain and decreased power to cope with the pain. Anxiety also reduces the selfconfidence of an individual. As a result of this situation, pregnant women perceive themselves as incompetent and unskilled. The anxiety experienced during labor directs women to caesarean section by their own will (Fenwick, Staff, Gamble, Creedy, & Bayes, 2010). The essence of midwifery can be with woman providing comfort in labor. Touch communicates caring and reassurance. Manual healing methods used today during delivery include touch and massage therapy. Painful uterine contractions can be treated by applications of pressure with the hands to a woman's back, hips, thighs and sacrum. By massage therapy, pharmacological management during the first stage of labor can be reduced, so fewer negative effects will be there on the fetus and mother (Smith, Levett, Collins, & Jones, 2012). Non-pharmacological and supportive methods that are used to decrease pain are a part of midwifery/nursing practices. Massage is the oldest tactile stimulation method that is used to relieve labor pain. Massage is a manual process performed on the soft tissues of the body for systemic purposes to improve health and well-being. Massage decreases the severity of pain, loosens the spasms and provides general relief during labor (Field, 2010).

Inclusion Criteria:

• 15-45-year-old primiparous pregnant women
• singleton pregnancies between 38-42 weeks
• pregnant women whose labor began spontaneously
• pregnant women with a healthy fetus
• pregnant women without any complications that may cause dystocia during labor
• pregnant women for whom analgesia and anesthesia were not used during the first phase of labor
• pregnant women who volunteered to participate in the research and who could establish verbal communication.

Exclusion Criteria:

• pregnant women with high-risk pregnancies
• caesarean section indication
• pregnant women with a chronic illnesses