Table 1.

Steps of the intervention

Steps	Process
1.	Prepare the equipment.
2.	Explain the procedure to the primigravida and advise her to lay on her left side* with a pillow on the side of her stomach.
Breathing exercise intervention for 5 min
3.	Ask the primigravida to perform deep breathing by inhaling slowly through the nose for 2 s and then consciously release the air by breathing out for another 2 s during contractions.
4.	Rest for 1–3 s, then repeat the same technique for a total of 5 min. Then, proceed to the reflexology as described below.
Reflexology intervention technique for 10 min on each foot
5.	Put a towel under the right foot and cover the left leg.
6.	Apply warm oil over the right foot and roll it left to right five times.
7.	Press palms on the Achilles heel and knead the ankle five times.
8.	Knead the thumb pads on the central and bottom parts of the heel five times.
9.	Knead the foot following the CIUW† shape on the lateral and intermediate aspects of the foot followed by the MST‡ shape five times.
10.	Press the wooden reflexology stick on the toes, forefoot, mid-foot and hind-foot five times.
11.	Repeat steps 5–11 on the opposite side. Then, proceed to the next lower limbs massage.
Lower limbs massage for 2 min 30 s on each leg
12.	Effleurage massage on the whole, lower flexed leg by using two hands three times.
13.	Half effleurage massage from the heel to the popliteal area three times.
14.	Palm and thumb kneading on the gastrocnemius muscle over the lateral and medial sides, followed by scooping on the gastrocnemius, each step three times.
15.	Thumb kneading on the hamstring muscle over the medial, intermediate and lateral sides three times.
16.	Repeat steps 12–17 on the right leg. Then, proceed to lower back massage.
Lower back massage for 15 min
17.	Effleurage massage from the sacrum to the shoulders and deltoids three times.
18.	Thumb kneading and pressure over the lateral sides of the lumbar area of the spine three times.
19.	Apply fist knuckling motion and thumb kneading on the lower back, side by side, three times. Then, proceed to upper back massage.
Upper back massage for 15 min
20.	Effleurage massage followed by palm kneading from the lumbar region to trapezius laterally three times.
21.	Thumb kneading over both sides of erector spinae, then draining between the ribs towards the armpit areas three times.
22.	Apply squeeze on the deltoid muscle with draining towards the armpit three times.
23.	Apply finger kneading on trapezius muscle, followed by fist scooping three times.
24.	Finally, press on the neck and shoulder area on both sides three times.

*The left-side position allows maximum blood flow to the placenta, because it applies less pressure from the fetus on the vena cava.⁷⁰

†CIUW shape: C-shape; I-shape, U-shape and W-shape. These shapes indicate the orientation and placement of the palms and knuckles of the therapist.

‡MST shape: M-shape, S-shape and T-shape. These shapes indicate the orientation and placement of the palms and knuckles of the therapist.