Effect of partner-administered endorphin massage before cesarean birth on preoperative anxiety and pain: a quasi-randomised controlled trial

Abstract Introduction Preoperative anxiety before cesarean birth may negatively affect maternal well-being and fetal outcomes. As pharmacological agents can cross the placenta and influence neonatal adaptation, non-pharmacological interventions are recommended. This study evaluated the effect of partner-administered endorphin massage accompanied by relaxation music on pain, anxiety, and serum cortisol levels before elective cesarean birth. Methods This quasi-randomised controlled trial was conducted between October 2023 and February 2025 at Manisa Celal Bayar University Hafsa Sultan Hospital. A total of 80 women were allocated to the intervention ( n = 40) and control ( n = 40) groups. Of these, 64 participants were included in the final analysis (intervention group, n = 33; control group, n = 31). The intervention group received 20 min of partner-administered endorphin massage accompanied by relaxation music on the morning of surgery, while the control group received routine nursing care. Pain was measured using the Visual Analog Scale (VAS), anxiety using the State-Trait Anxiety Inventory (STAI), and stress response through serum cortisol levels. Post-test outcomes were analyzed using analysis of covariance, adjusting for baseline values. Results The intervention group demonstrated significantly lower post-test VAS pain scores (− 0.84; 95% CI,−1.50 to − 0.19; p = 0.013; ηp²=0.097). The STAI-State subscale score was also significantly lower in the intervention group, with a large effect size (adjusted mean difference :-10.53; 95% CI,−14.49 to − 6.58; p < 0.001; ηp²=0.317). Serum cortisol levels were significantly lower in the intervention group (adjusted mean difference :−3.52; 95% CI,−4.96 to − 2.07; p < 0.001; ηp²=0.280). No significant difference was observed in the STAI-Trait subscale score ( p = 0.889). Conclusion Partner-administered endorphin massage accompanied by relaxation music was associated with lower immediate preoperative state anxiety and serum cortisol levels, as well as a modest reduction in pain, in this single-centre sample. Larger, prospectively registered trials with concealed allocation and appropriate attention-control conditions are needed before routine implementation can be recommended. Trial registration The ClinicalTrials.gov identifier for this study is: NCT06342154. The study was retrospectively registered on 22 March 2024.