The Effectiveness of Reflexology on Fatigue, Constipation, Nausea and Vomiting During Pregnancy: A Narrative Review

3.1. Application of Reflexology on Nausea and Vomiting During Pregnancy

Nausea and vomiting during pregnancy is one of the most common gastrointestinal complaints among pregnant women, with its primary cause remaining unknown. It is a multifactorial disorder with causes including hormonal, mechanical, biochemical, immunological, psycho-emotional, vestibular, gastrointestinal, physiological, excessive smell, and developmental factors (e.g., number of births, young maternal age, and pathological disorders) (14). Since there is no definitive index to determine which type of NVDP may lead to hyperemesis gravidarum, this complication should not be left untreated, even in normal cases (15).

Due to the unknown factors affecting NVDP occurrence, treatment options are limited. Available treatments to control NAV include dietary and lifestyle changes, drug treatments, and complementary medicine (8). Drug treatments are recommended when symptoms worsen, recovery is delayed, quality of life is impaired, and malnutrition occurs. However, under normal conditions, safer methods for both mother and fetus are preferred (16). Consequently, the use of drugs has decreased in recent years, with non-drug methods and complementary medicine often being favored. Other adjunctive treatments for NVDP include herbal medicines, vitamin therapy, hypnotherapy, and acupressure (17).

Reflexology is a branch of complementary medicine that has shown positive effects on various pregnancy-related issues, including edema, constipation, insomnia, fatigue, and childbirth anxiety (16). Reflexology is part of traditional Chinese medicine, involving the application of pressure with fingers and toes on specific body points. It is based on the principle that reflex points correspond to internal organs and glands, mirroring the body's physical arrangement.

A significant point in REF is the solar plexus chakra (SPC), one of the body’s seven main chakras, located in the chest area of the upper abdomen, behind the stomach, and in front of the aorta. The SPC is the organic center for communication with the spleen, pancreas, and digestive system, significantly affecting the function of the stomach, intestines, spleen, pancreas, liver, peristaltic movements, and glandular secretions (18, 19). Physical conditions such as digestive system disorders, urinary system issues, skin sensitivities, and blood sugar disorders are sometimes linked to solar plexus disorders (11). The SPC reflex site in REF is located at the junction of the anterior one-third and posterior two-thirds of the foot in the midline, just below the plantar eminence (8, 12).

Various studies have explored the use of REF to control NAV in contexts other than pregnancy, but less research has focused on evaluating the effect of REF on NVDP. Asadollahi et al. conducted a study to evaluate the effect of foot reflexology (FREF) of the solar plexus on the severity of NAV in women during the first half of pregnancy. In this study, 73 pregnant women between 8 and 20 weeks of gestation were selected and divided into an intervention group receiving REF (36 participants) and a control group (37 participants). The results indicated that the average NAV scores after the intervention in the REF group were significantly reduced by 0.36 units (P = 0.04) and 0.77 units (P < 0.001) compared to the control group. The researchers concluded that FREF of the solar plexus has a positive and significant effect in reducing NVDP (19).

In another study by Wills and Forster, REF was found to have a positive and significant effect in controlling NVDP (20). Additionally, other studies have shown that REF is effective in controlling NAV in cancer patients, as reported in review studies by Prapti et al. (21) and Kim et al. (22). Yang (2005) also reported that FREF had a positive and significant effect in controlling NAV in breast cancer patients (23). Chainakin (2006) evaluated the effect of hand reflexology (HREF) on NAV in cancer patients undergoing chemotherapy, finding that NAV intensity significantly decreased in the intervention group compared to the control group after the intervention (P < 0.001) (24). Similarly, Ozdelikara and Tan (2017) demonstrated the positive impact of REF on controlling NAV symptoms in cancer patients undergoing chemotherapy (25).

Compared to other methods for reducing NAV, REF is a relatively easy, non-invasive method with no side effects and low cost (11). Moreover, REF can foster a positive relationship between the patient and caregiver. One of the advantages of REF is that it can be performed by the patient themselves (19). Based on past study results and the numerous advantages of REF, it is suggested that this method be used as a supportive and palliative approach alongside other existing methods by caregivers, especially midwives, to reduce NVDP symptoms in the first half of pregnancy.

3.2. Application of Reflexology on Fatigue During Pregnancy

Fatigue is a common issue among pregnant women, though its mechanism is not fully understood. According to physiological principles and theories, fatigue results from disturbances in the body's energy balance due to hormonal, metabolic, mental, and physical adaptation, as well as contracting certain diseases during pregnancy (3-7). Increased fatigue can lead to complications during pregnancy, childbirth, and postpartum, including a higher prevalence of premature birth, decreased birth weight, prolonged labor, increased need for auxiliary equipment such as forceps, cesarean section, and postpartum depression (4, 6).

Luke et al. (2005) reported that fatigue during pregnancy (FDP) is a factor affecting premature birth (26). Magann et al. (2002) found that birth weight is a crucial indicator of societal health status, and noted that FDP has received less attention among factors affecting low birth weight (27). Chien and Ko (2004) identified FDP as a significant problem in pregnant women, potentially increasing cesarean delivery rates. They reported that FDP is often overlooked by healthcare workers, necessitating measures to reduce FDP to decrease cesarean sections (28).

Reflexology can be employed as a nursing intervention to reduce FDP (16). Ghaffari and Pour Ghaznein (2010) conducted a clinical trial to evaluate the effect of FREF on FDP severity. In this study, 74 pregnant women were divided into a test group (36 participants) and a control group (38 participants), matched by age and occupation. The intervention group received FREF twice a week, with each session lasting 30 minutes over 5 weeks. Fatigue intensity was measured before and after the intervention for both groups. The study found that FREF significantly reduced fatigue intensity in pregnant women. Additionally, the authors noted that social support and iron supplementation also reduced FDP (29).

In a similar study by Shobeiri et al. (2017), the effects of counseling and FREF on FDP were evaluated. Three groups were studied: A counseling group (42 participants), a FREF group (42 participants), and a control group (42 participants). Fatigue intensity was measured before and after the interventions for all groups. The study concluded that both counseling and FREF interventions significantly reduced FDP (30).

Overall, based on these studies, FREF can effectively reduce FDP, while other measures, including counseling, iron supplementation, and social support, can also mitigate this pregnancy complication.

3.3. Application of Reflexology on Constipation During Pregnancy

The CDP is a common digestive issue affecting 11% to 40% of pregnancies, particularly in the first and third trimesters (31). Constipation is associated with factors such as hemorrhoids, headache, depression, and appetite disorders (10, 32). The use of laxatives to treat this problem can lead to side effects, including sodium retention, impaired absorption of fat-soluble vitamins, hypoprothrombinemia, maternal bleeding, and infant diarrhea (33, 34).

Reflexology is a complementary and alternative treatment for reducing constipation, with its positive effects reported in various studies. Bishop et al. (2003) conducted a study on 50 children aged 3 to 14 years with chronic constipation, finding that REF significantly improved constipation (35). Tovey (2002) evaluated REF's impact on 34 patients with irritable bowel syndrome, showing significant differences in abdominal pain control, constipation severity, and diarrhea between the test and control groups (36). Ponce et al. (2008) also reported significant differences in constipation severity before and after FREF (37).

Yang et al. (1994) investigated FREF's effect on constipation severity in 40 elderly center residents (20 with constipation and 20 without). All participants received REF treatment. The study found that the time interval between bowel movements decreased from 45 hours to 24 hours in the constipated group and from 57.5 hours to 46 hours in the non-constipated group (38).

Sehhatti et al. (2020) conducted a randomized controlled trial to determine FREF's effect on idiopathic constipation symptoms in pregnant women, showing that FREF significantly reduced CDP symptoms in the intervention group compared to the control group (39). In another study, Ghaffari et al. (2007) reported that FREF had a positive and significant effect on reducing CDP symptoms in pregnant women in the intervention group (40).

Overall, these studies demonstrate the positive effect of FREF on reducing CDP symptoms in pregnant women.