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A seminar on

Complementary therapies in
Obstetrics practice

Submitted To Submitted By

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Introduction
It is the happiest moment for the mother when she conceives, but it becomes worst
moment when labour pain starts & she suffers from anxiety & nervousness. There is recent
development in treatment modalities which is very helpful to the mother during labour. It
helps to reduce the pain, lowers her anxiety level & makes her ready for the process of
labour. These treatments are other than pharmacological modalities & known as alternative &
complementary therapies.

Alternative therapies
Alternative therapies are used instead of conventional or mainstream therapies for examples,
the use of acupuncture/acupressure rather than analgesics to relieve pain.

Complementary therapies
Complementary therapies are those used in conjunction with conventional therapies for
example meditation used as an adjunct to analgesics drugs.

Different alternative & complementary therapies

There are various modalities which can be used as a alternative or complementary therapy in
labour. They are as follows:

1. Hypnosis

The word hypnosis originates from the Greek “Hypnos” which means sleep. Hypnosis is
not sleep but a state of attentive and focused concentration in which the patient can be
relatively unaware, yet not completely blind to their surroundings.

Hypnotic focus on diminishing the awareness of pain as well as fear and anxiety.
Hypnosis advocates give several explanations of how the process works. One theory holds
that when a woman feels fear during childbirth, her body releases stress hormones that trigger
the body's "fight or flight" response. This causes muscles to tighten and interferes with the
birthing process. By training the subconscious mind to expect a safe, gentle birth, they say,
women can avoid going into the fight-or-flight state, allowing for a smoother birth.
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Self-hypnosis can be taught at various hypnosis training centers on special childbirth

classes that teach the technique of positive statements and concentrating on beautiful images
of child.

2. Biofeedback

Biofeedback is a treatment that uses monitoring instruments to provide visual or

acoustic feedback to patient’s physiological information of which they are normally unaware.
It is a therapeutic technique that teaches you how to control physical responses such as
breathing, muscle tension, hand temperature, heart rate, blood pressure and brain activity that
are not normally controlled voluntarily.

It puts the patient in control and gives them a sense of self-reliance that is an
important factor for laboring woman. For example childbirth classes or childbirth classes plus
video session about ping with labour pain etc.
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3. Yoga

Yoga, a method of Indian origin, proposes control of mind and body. Between the
different types of yoga, ‘energy yoga’ can be applied to pregnancy and delivery. Through
special training of breathing, it achieves changes in levels of consciousness, relaxation,
receptivity to the world and inner peace.

According to professionals who use this technique for delivery, yoga shortens the
duration of labor, decreases pain and reduces the need for analgesic medication.

There are different aasanas or positions which can be used during labour for the benefits.

a. Cat Pose

The cat pose makes you kneel on all fours and stretch. This helps to push the baby down once
your water breaks. You can also try lifting your leg up high to quicken the baby's movement.

b. Dog Tail Wagging

Kneel on all fours and move your hip as if you are a dog wagging its tail. You can vary the
pace of the tail wagging depending on the surge of pain you feel. It is a very soothing
position.

c. Child Pose

The child pose is named so because it is an extremely relaxing position. Your uterus
contractions will come in spell. The period in between the contractions is for resting. Try this
yoga position during the rest period.
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d. Squat

Squatting is the most traditional position in which women gave birth. It naturally opens
up the vaginal opening so that the baby can be born easily. Practice squatting beforehand so
that you can try this yoga position during labour.
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4. Sophrology

The word Sophrology derives from two Greek words, ‘sos’ harmony or serenity and
‘phren’ conscience or spirit. This technique derived from Indian yoga was introduced in
Europe during the 1960s.

Its purpose is to improve the control of body and spirit through three degrees of dynamic
relaxation: concentration, contemplation and meditation.

Applied to obstetrics, better control of the delivery process is expected. Patients

individually report a high degree of satisfaction with this experience of relaxation during
prenatal classes and delivery.

5. Music therapy

The use of music to relieve pain and decrease anxiety has been known to be helpful for
the relief of postoperative pain for same time. Research regarding the use of music to reduce
labour pain has also demonstrated that music may be used to promote relaxation during the
early stages of labour and as a stimulant to promote movement during later stages, when physical
exertion is required for bearing down process.

Phumdoung and Good 2003, in their study described music consistently provided
significant relief from severe pain across 3 hours of labour and delayed the increase of
affective pain for 1 hour, it also delayed increase in distress of pain for an hour and for some,
relief was fairly substantial.
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6. Acupuncture

Acupuncture is well known Chinese practice. In this one uses needles inserted at specific
points to relieve pain. This therapy is found beneficial and relaxing during pregnancy. During
labor, acupuncture can be used for pain relief, as a calming technique (which again will
lessen pain) and to keep labor contractions going. The placement of the needle will depend on
which stage of labor patient is and kind of pain. Advisable to take this treatment with
experienced certificate practitioners. The basic theory includes altering the body’s levels of

chemical neurotransmitters and influencing the natural electrical currents or electromagnetic

fields.
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7. Acupressure therapy

Acupressure is a descendant of Chinese manipulative therapy in which points are

stimulated by pressure, using hands, fingers and thumbs. Acupressure might increase blood
flow to the uterus, influence hormonal responses, and stimulate uterine contractions.

8. Homeopathy

There are homeopathic drugs that may help to lessen the pain of natural child birth.
These are pills with no side effects to be said that have to be taken at regular intervals
throught out the labour. Though homeopathy is not recognized as a way of curing an ailment
or pain quickly, it can start from the later months of pregnancy, with the aim of reducing the
eventual labour pain. These drugs only be taken by recognized homeopathy practitioner and
obstetrician. Homeopathy is a safe, natural alternative to pitocin/oxytocin. If the baby is
overdue,induce labour naturally by alternating the remedies caulophyllum 12C and
cimicifuga 12C, given once every hour. For example, hour 1: caulophyllum, hour 2:
cimicifuga, hour 3: caulophyllum, etc.

9. Ayurveda

Ayurveda, the ancient science of life focuses on protection of health based on life style
followed by curing the sick. Hence Ayurveda could play a significant role in prevention of
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obstetric complications, protecting the health of mother and baby as well as providing simple,
healthier, effective cures for common ailments.

PROMOTING NUTRITION

Ayurveda lays great emphasis on ensuring holistic nutrition. A combination of aahar (food),
vihar (action), vichar (emotions/thoughts) and aushadh (medications) is essential to improve
nutrition. A wholesome diet, based on locally available foods and herbs, compatible to ones'
own body constitution, body requirements and seasons is essential.

Pre conception care

Measures for a healthy pregnancy and childbirth begin even before conception.
Ayurveda lays emphasis on-physical and- emotional maturity at the time of conception.
Rituals and dietary modifications are suggested to ensure optimum quality of ova and sperm
as well as a balanced state of body processes and emotions. This understanding, that is, to
ensure health and maturity before conception needs to be included in all formal and non-
formal life skill education efforts of young people.

Care during pregnancy

Ayurveda, to ensure that the health of mother and child is maintained, suggests a
comprehensive, holistic regimen- garbhini paricharya. The regimen corresponds to the
growth

and development of the foetus and comprises of measures related to aahar (diet), vihar
(activity) and vichar (thoughts/emotions). Some of the specific measures as suggested in
garbhini paricharya include: a liquid and sweet diet in the first three months since the foetus
is in a fluid state, fulfillment of all the desires of the women, particularly during the fourth
month corresponding to the foetal heart, a sweet,

liquid and heavy diet focusing on intake of cereals in the next three months for optimal foetal
growth, measures like abdominal oleation and a liquid and solid diet rich in fats and proteins
(according to modern nutrition) during the last three months is suggested.

Care during childbirth

Childbirth is regarded as a natural process at the same time Ayurveda lays emphasis on
preparedness and readiness to deal with any complication. For a safe and easy childbirth
Ayurveda proposes that before the ninth month of pregnancy, a wooden hut must be prepared
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for delivery in the vicinity of the woman`s residence. This hut must be equipped with light,
fire, water and necessary medicines and equipments. Curtains must be put to ensure privacy
and to avoid direct light falling into the eyes of newborn (a direct contrast to the modern
room which is bright lit to the maximum). This hut must be neat and clean and with well
fitted doors and windows

10. Therapeutic touch

The purpose of therapeutic touch in labor is to communicate caring and reassurance.

Painful contractions of the uterus can be treated by the application of pressure with the hands
to the woman's back, abdomen, hips, thighs, sacrum.

Whether touch is perceived as positive or not is dependent on who is touching the

patient: in one study, touching was perceived positively by 94% of patients when they were
touched by a relative or friend, 86% by their husbands, 73% by a nurse and 21% by a
physician (32). Anxiety is reported to be reduced in patients who receive reassuring touch. In
a retrospective study of 30 patients, 77% experienced ‘less pain’ when they were touched
during labor, and 40% reported less need for pain medication.

11.Massage therapy

Touch and manipulation with the hands has been used in the practice of medicine since
its inception. The value of touch and massage and its positive effect is well documented.
Massage therapy can incorporate in nursing practice throughout labour to promote relaxation
and stress reduction.

Massage is thought to have a physiological basis, blocking pain impulses by increasing

A-fiber transmission or by stimulating the local releases of endorphins, stimulating large-
diameter nerve fibers to close a gate of pain, stimulating mechanoreceptors, stimulating
circulation with resultant increased oxygenation to tissues and facilitating the excretion of
toxins through the lymphatic system. Massage has been shown to be factors in promoting
labour progress, decreasing pain perception and increasing the woman’s ability to cope with
labour.

12.Transcutaneous Electrical Nerve Stimulation(TENS)

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This is a method of pain management in which electrodes fitted at the back, to pass
electric current into the body. This stimulates the natural secretion of endorphins, the body’s
painkillers. This usually used in the early stages and has no known side effect.

13.Sterile water injection

This is relatively new technique for curbing back pain during labour. Using this
technique allows the mother to remain fully conscious during labour. She can move and may
not need an epidural in the later stage. Counter-irritation is the process by which localized
pain felt in one part of the body may be relieved by irritating the skin in same dermatomal
distribution with either a hot, cold scratchy or electrical Stimulus.

A small amount of sterile water (0.1-0.2 ml) is injected in four places just under the skin
that covers the sacrum, the lower part of the back. It’s thought that the sterile water injections
stimulate the nerves which quickly send messages to the brain and interrupt the slower
messages from inside the body this has been called the ‘gate control’ theory of pain

management. Relief lasts for an hour, are more and procedure can be repeated any number of
times.

14.Hydro therapy
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The use of hydrotherapy during labour, whether in a shower or a tub, is a proven means
of relaxation and pain relief. The warm water stimulates the release of endorphins, relaxes
muscles to decrease tension, stimulates large diameters nerve fibers to close gate on pain, and
promotes better circulation and oxygenation.

Hydrotherapy can promote increased diueresis, decreased edema, decreased blood

pressure, enhanced fetal rotation due to increased buoyancy faster labour, less use of
intramuscular and intravenous medications, less use of epidural, episiotomies and increased
satisfaction with birth experience. Prior to implementing hydrotherapy, procedures and
protocols should be developed.

A common question asked by providers is whether hydrotherapy can or should be used

when membranes are ruptured. Several studies have looked at the risks of using hydrotherapy
after rupture of membranes. Finding gave shown no increase in choriomnionitis, postpartum
endometritis, neonatal infections etc., however precautions needed to reduce infection.

15.Birth ball

The Swiss Ball has been used in physical therapy and exercise programs for
decades.Birth balls were originally developed by physiotherapists and used for treating ortho-
neural disorders, but using them has been found equally beneficial for a pregnant woman.
Research on the use of ball demonstrates a significant improvement in core muscle stability,
including the muscles of the chest, abdomen and pelvis.These muscles are instrumental in the
labour process for deep breathing, pushing and general movement Rocking and movement
can be accomplished on a birthing ball during labour not only does the ball facilitate the
physiologic benefits of movements to help the fetus find its best fit through the pelvis but also
promotes comfort and can decrease pain by stimulating mechanoreceptors (sense organ or
cell that responds to mechanical stimuli such as touch or sound) and joint receptors.

The ball should be used with the following precautions:

 The woman should never use the balls unless her support person is with her
 The woman should always have a firm support in front of her to hold on to for
security
 A policy should be written outlining their use, cleaning and storage.
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16.Aromatherapy

Aromatherapy is the therapeutic use of plant derived essential oils to promote physical
and psychological wellbeing. Essential oils are lipid soluble and are rapidly absorbed when
applied externally or are inhaled.

They are excreted through kidneys or expired through the lungs. For labor therapeutic
grade oils in low doses for massage or as an environmental fragrance is increasing in health
care settings.For labour , therapeutic grade oils such as lavender or jasmine can promote
relaxation and perception of pain. Peppermint oil may be effective in decreasing nausea and
vomiting. To use aromatherapy effectively, nurses should have basic understanding of the
chemical.
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17.Breathing therapy

Controlled, rhythmic breathing has been found to be relaxing by women dealing with
labour pain. If women takes deep breathing it can help to calm and distract from the pain. It
can also help to diminish the natural instinct to hold the contractions.

18.Position

Different positions during labour have different ways of helping to relax and be more
comfortable. To avoid pain many nurses and doctors suggest mothers adopt semi-reclining
position or lie on their side.A walk, squatting position or fetal position can help case pain.
Whatever position in which woman find comfortable can be good for her.

19.Heat therapy

Sometimes a simple heating pad may work wonders to relieve the pain felt while giving
birth. Pads are available in different size and shapes suitable for almost all women and are
easy to use. If not available heat therapy can be done by using warm water bag or even a
warm pack or soak. Heat caused a small increase in uterine contraction and no any effect on
fetal heart rate. It seems that the heat stimulates heat receptors of skin and deeper tissues, and
it may reduce the pain as per the gate control theory

20.Reflexology

Another ancient practice is in which pressure is applied to specific body parts,

specifically the soles of the other parts of body. During labour, a reflexologist can help
woman cope with pain and speed the process of childbirth by pressure and stoking specific
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ankle points, which are said to stimulate the pituitary glands to release pain killing hormones.
Reflexology should only be performed by an experienced practitioner.

21.Distraction

In this a woman in pain can take her mind off of the contractions and labour by reading a
book, listening to music, walking, talking to a friend or watching TV. These activities are
simple to do and provide distraction from pain.

22.Nipple stimulation

Massaging nipples helps the body release oxytocin. Oxytocin plays a role in arousal,
initiating labor, and bonding between mother and child. This hormone also makes the uterus
contract after labor, helping it return to its pre pregnancy size. Stimulating the breasts may
also help bring on full labor by making contractions stronger and longer.
In a study published in Worldviews on Evidence-Based Nursing, a group of 390
Turkish pregnant women were randomly assigned to one of three groups during their labors:
nipple stimulation, uterine stimulation, and control. The results were compelling. The women
in the nipple stimulation group had the shortest durations of each phase of labor and delivery.
According to the study, the average duration was 3.8 hours for the first phase (dilation), 16
minutes for the second phase (pushing and delivery), and five minutes for the third phase
(delivery of the placenta). Even more interesting, none of the women in the nipple stimulation
or uterine stimulation groups needed to have a cesarean delivery. By comparison, many
women in the control group needed other induction methods like synthetic oxytocin to get
things going. Over 8 percent of women in the control group had a cesarean delivery.

Role of midwife in alternative & complementary therapy in labor

1. Be non-judgmental despite personal opinions.

2. Build rapport by showing client respect.
3. Understand that it can be beneficial, when used correctly.
4. Be aware that it can be dangerous if it interacts or interferes with conventional
treatment.
5. Be willing to teach the public about the positive and negative information regarding
that.
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6. Be aware that use of it is popular and increasing and must be included in the history &
physical examination.
7. Know that herbals, in particular, can have significant effect on prescription drugs and
body function.

Research Evidences

1. Complementary and Alternative Medicines Use during Pregnancy: A Systematic

Review of Pregnant Women and Healthcare Professional Views and Experiences

Aims. To undertake a systematic review of the recent (2008–2013) primary literature,

describing views and experiences of CAM use during pregnancy by women and healthcare
professionals. Method. Medline, Cumulative Index to Nursing and Allied Health Literature,
Cochrane Database of Systematic Review Library and Allied, and Complementary Medicine
Database were searched. Studies reporting systemic CAM products (homeopathic
preparations, herbal medicines, Vitamins and minerals, homeopathy, and special diets) alone
or in combination with other nonsystemic CAM modalities (e.g., acupuncture) were included.
Results. Database searches retrieved 2,549 citations. Removal of duplicates followed by
review of titles and abstracts yielded 32 relevant studies. Twenty-two reported the
perspectives of women and their CAM use during pregnancy, while 10 focused on healthcare
professionals. The majority of studies had significant flaws in study design and reporting,
including a lack of appropriate definitions of CAM and associated modalities, absence of
detailed checklists provided to participants, the use of convenience sampling, and a general
lack of scientific robustness in terms of data validity and reliability. Conclusion. To permit
generalisability of study findings, there is an urgent need to expand the evidence base
assessing CAMs use during pregnancy using appropriately designed studies.

2. Complementary alternative medicine use among postpartum mothers in a primary

care setting: a cross-sectional study in Malaysia

Background

Complementary alternative medicine (CAM) is widely used among postpartum mothers to

maintain their well-being. This study aims to determine the prevalence and factors associated
with CAM use among postpartum mothers in a primary-care clinic in Malaysia.
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Methods

This is a cross-sectional study of 725 postpartum mothers, aged 18 and above, attending a
primary-care clinic. The systematic sampling method was used to recruit patients through a
structured, self-administered questionnaire. Data analysis was conducted using SPSS version
23. Multiple logistic regression was used to identify the predictors of CAM use among
postpartum mothers.

Results

The prevalence of CAM use among postpartum mothers was 85.5%. Manipulative body
therapies, including massage, reflexology, hot stone compression and body wrapping were
the most widely used methods of CAM (84.1%) among postpartum mothers, followed by
biological-based therapies (33.1%). More than half of the respondents (52.1%) opted to use
CAM, as they had observed good results from other CAM users. However, our study showed
that 57.1% of mothers who consumed herbal medicine reported neonatal jaundice in their
newborn. The median of the expenditure on CAM usage was 250 Malaysian Ringgits, or
USD 61.3 per month. According to multiple logistic regression analyses, being Muslim (OR
= 5.258, 95% CI: 2.952–9.368), being Malay (OR = 4.414, 95% CI: 1.18–16.56), having a
higher educational level (OR = 2.561, 95% CI: 1.587–4.133) and having delivered via
spontaneous vaginal delivery (OR: 5.660, 95% CI: 3.454–9.276) had a significantly positive
association with CAM use among postpartum mothers.

Conclusions

The prevalence of CAM use was high (8 out of 10) among postpartum mothers. Postpartum
mothers who are Malay, Muslim, have a higher educational level and who have had
spontaneous vaginal delivery tended to use CAM more. Manipulative body therapies,
including massage, reflexology, hot stone compression and body wrapping, were the most
widely used forms of CAM, followed by biological-based therapies. More than half of the
mothers who consumed herbal medicine reported neonatal jaundice in their newborn. Thus,
education to increase awareness regarding the consumption of herbs is urgently required in
this country.
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Conclusion
`Alternative & complementary therapies are the special treatment modalities which
can be used along with conventional therapies or mainstream therapies. It helps the mother in
reducing pain of labour, reducing the duration of labour & increasing the progress of labour.
It also helps in making the mother relaxed & reducing her anxiety or psychological affects &
making her string enough to cope with labour pain. Midwife should be enough
knowledgeable & skillful to apply all these therapies in her practice life as she is the
important person to help the mother to go through the labour pain.

References

1. Kamini Rao. “TEXTBOOK OF MIDWIFERY & OBSTETRICS FOR NURSES”;

1stedi;2011, Elsevier publication, New Delhi, Pp-171 & 172.
2. Myles,“TEXTBOOK FOR MIDWIVES”, 15th edi;2009, Elsevier publication, China, Pp477
& 478.
3. Web references:
 https://birthbliss.wordpress.com/2011/05/03/yoga-postures-for-labour -and-birth
 www.boldsky.com › Pregnancy Parenting › Prenatal
 www.healthline.com › Pregnancy › Home
 prenatalcoach.com/ homeopathy-natural-childbirth-guide
 https://www.bellybelly.com.au/birth/natural-pain-relief-for-labour
 https://www.researchgate.net/.../278309830_ Complementary and alternative therapies
 www.slideshare.net/.../alternative-and-complementary-methods-during-labor
 ssc.edu/.../COMPLEMENTARY%20AND%20ALTERNATIVE%20 THERAPIE.ppt