The WA department of health and ageing defines post-natal depression as Depression that
comes on within 12 months of having a baby, usually during the first few weeks or months.
It can start slowly or suddenly, and can range from very mild and transient, to severe and
lingering. Post-natal depression is most common after a mothers first pregnancy and
thought to affect one in 7 mothers, and one in 10 fathers.
PND rarely develops because of one direct cause. Emotional or mental health problems are
usually the result of many factors that interact in different ways for different people.
Some common risk factors include:
- Antenatal depression (depression during pregnancy)
- Personal or family history of mental illness
- Substance misuse
- Relationship difficulties or being single
- Lack of emotional or practical support
- Stressful life events
- Complications during pregnancy or delivery
- Adolescent, older or first-time mothers
- Recent cessation of medication
Postnatal depression affects a mother’s ability to cope with the care of her baby, and limits
her capacity to engage positively with the baby in social interactions (Murray & Cooper,
1996). Postnatal depression can be a long-lasting condition which affects both the mother
and her baby, that has adverse consequences for the mother–infant relationship, and the
infants cognitive and emotional development (Murray & Cooper, 1996; Poobalan et al,
2007). Given the transgenerational effects and high prevalence, it presents a significant
challenge and cost to the public health system.
Standard interventions usually include a combination of pharmacological, support groups,
psychotherapy and cognitive behavioural therapy. Improving a mother’s depression per se
has been found to have little impact on mother–infant interaction and most interventions
(with the exception of some forms of psychotherapy) tend to focus on the treatment and
outcomes for the mother only rather than outcomes for the child.
Some of the many benefits of infant massage include:
• Speeds the development, maturation and functioning of the digestive,
respiratory and circulatory systems
• Speeds myelination of the brain and nervous system
• Relaxation, reducing stress hormone levels and improving mood, improving
sleep, reduces crying
• Improved circulation and alertness, strengthening the immune system
• Special needs children, drug affected children, low birth weight/pre-term
babies
• Relief of discomfort
• Enhances cognitive and motor development
• Enhances attachment and bonding
Benefits for parents
• Reduced anxiety
• Fewer depressive symptoms
• Improved mood
• Decreased stress (measured by cortisol levels in saliva)
• Improved self esteem
• Improved interaction with their baby
(Bennet, Underdown and Barlow, 2013; IMIS training manual)
Massage should only be done by regular care givers and not by a stranger – IMIS
Certified Infant
Massage Instructors (CIMI) and
Paediatric Massage Consultants (PMC) provide massage education
and instruction to the parent/caregiver. The massage methodology is based on a combination of
Indian massage, Swedish massage and reflexology. Qualified instructors provide the parents with the
techniques and approaches and how to tailor these to best suit them and their baby, it is not a one
size fits all approach.
Massage tuition for parents can be provided in a group environment, (usually with 6-15 parents,
so the instructor is able to watch the parents and babies and provide assistance), or as a one-on-one
instruction with one or multiple caregivers. Baby massage tuition for parents should run for 4
hours in total to cover all the necessary education. Tuition is usually offered as an hour/week for 4
weeks. One off introductory sessions are also made available for parents who just want a little help,
getting started with the basics of infant massage.
Contraindications for massage (Source – IMIS)
• Circumstances under which you would not recommend massage
• Post surgery
• Inflammation
• Bleeding/open wounds
• Gain medical clearance
• Thrombosis or embolism
• Cardiovascular conditions
• Avoid during massage
• Local bruising/cuts/abrasions/infected skin irritations/burns
• Undiagnosed lumps
• Unhealed navel
Massage is completed with oil – cold pressed, organic fruit nut or seed oil, position is
important for safety - newborns can be massaged on parent’s knees while seated on the
floor, or with baby lying on the floor, when they are older massage can be completed in the
seated position between parent’s knees. Before massage there must be a
permission
sequence – a learned cue that massage is about to begin and gives infants the opportunity to
use body language or vocalisations to communicate whether they are happy to be massaged.
Massage should be conducted during the ‘quiet alert’ period, can be done up to
twice a day but otherwise frequency is up to the parents and infant. Infant does not have to
receive the full massage sequence at one time and the massage should only go for as long as
the infant is happy to receive it.
Other safety considerations are not to massage around bath time if under 5 months due to
overstimulation and after 5 months, massage should take place after a bath due to oil residue on
the skin posing a safety risk if massage is performed before bathing.
Evidence
Onozawa et al (2001) Infant massage improves mother-infant interaction for mothers with
postnatal depression.
This was a pilot study with 34 participants, and compared Edinburgh
postnatal depression scale (EPDS) and maternal/infant interaction before and after
participation in either an infant massage group or a support group. The study found a
statistically significant improvement in the maternal/infant interaction in the group that
participated in infant massage, EDPS fell in both groups. Limitations of this study are the low
sample size, high dropout rate. The same authors were published in Seminars of
Neonatology and reported the same results but presenting the mother–baby interaction
scores over time, showing that for mothers who attended the massage class a statistically
significant improvement was achieved (P<0.001) compared with the control group cited in this
study. The authors suggest that mechanisms by which this is achieved are not clear but may
include learning to understand their babies' cues and the release of oxytocin (Glover, V,
Onozawa, K and Hodgkinson, A. (2002). Benefits of infant massage for mothers with
postnatal depression.) Both of these studies have been referenced in critical/systematic
reviews of PND treatments. “Definite conclusions cannot be reached about the relative
effectiveness of most of the nonbiological treatment approaches due to the lack of well-
designed investigations.”
O’Higgins, St James Roberts and Glover published a study in 2008 with a similar design. 4
weeks postpartum, used the EPDS to identify mothers and again randomly assigned
participants to baby massage classes or a support group. Outcome measures were EPDS,
depression, anxiety and infant characteristics questionnaires and were filmed with their
infants before and after 6 interventions sessions and at one year. They also had 34 non-
depressed mothers who completed the study. More of the massage than support group
mothers showed a clinical reduction in EPDS scores between four weeks and outcome
(p < 0.05). At one year, massage-group mothers had non-depressed levels of sensitivity of
interaction with their babies, whereas the support group did not. There were no other
differences in either mother or child between the two intervention groups. Depressed
mothers did not achieve control depression or anxiety scores at one year. Limitations -
small sample size, no control group.
Lack of robust research – cochrane systematic review in 2013 titled Massage for promoting
mental and physical health in typically developing infants under the age of six months
found ’available evidence is of poor quality and many studies do not address the biological
plausibility of the outcomes being measured, or the mechanisms by which change might be
achieved’. Some future considerations – greater sample sizes, whether there are demonstrable
benefits for children, long term studies (and impact on children, parents and siblings).
In summary, infant massage is particularly suitable for mothers with PND as it focuses on
supporting early relationships and interactions between parents and babies, empowers the
parent and increases their confidence, teaches about communication and body language
and responding to baby appropriately and has many other health/wellness benefits for the
infant.
References
• Bennett C, Underdown A, Barlow J. (2013) Massage for promoting mental and
physical health in typically developing infants under the age of six months.
Cochrane Database of Systematic Reviews, Issue 4.
• Dennis, C. E. (2004). Treatment of Postpartum Depression, Part 2: A Critical Review
of Nonbiological Interventions. J Clin Psychiatry, 65, 1252-1265.
• Glover, V, Onozawa, K and Hodgkinson, A. (2002). Benefits of infant massage for
mothers with postnatal depression. Seminars of Neonatology, 7, 495-500
• McLoughlin, H. (2012). Infant Massage Training Manual and Student Handbook.
IMIS NSW Pty Ltd, Infant Massage Information Service.
• Murray, L. & Cooper, P. J. (1996) The impact of postpartum depression on child
development. International Review of Psychiatry, 8, 55 .
• O’Higgins, M., St James Roberts, I., Glover, V. (2008) Postnatal depression and
mother and infant outcomes after infant massage. Journal of Affective Disorders.
109, 189-92.
• Onozawa et al (2001). Infant massage improves mother-infant interaction for
mothers with postnatal depression. Journal of Affective Disorders, 63, 201-7.
• Poobalan et al. (2007). Effects of treating postnatal depression on mother–infant
interaction and child development: Systematic review. British Journal of Psychiatry,
191, 378-386
• WA Perinatal Mental Health Unit. (2012). Postnatal anxiety and depression.
Australian Government - Department of health and agein