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COMPLEMENTARY AND ALTERNATIVE THERAPIES IN

OBSTETRICS

INTRODUCTION

Complementary therapy is increasingly popular with both consumers and

professionals, and are based on philosophy of holism and an interaction between
body, mind and spirit In which it is believed that all components in combination to
the whole.

Within midwifery, use of complimentary therapy has been driven by mothers

looking for strategies to help them cope with pregnancy symptoms and labor
discomforts and to aid relaxation.

DEFINITION
ALTERNATIVE THERAPIES

Alternative therapies are used instead of conventional therapy. For example ,the
use of acupuncture /acupressure rather than analgesic to relieve pain.
COMPLEMENTARY THERAPY

Complimentary therapy are those therapy used in conjunction with conventional

therapies. For example meditation used as an adjunct to analgesic drugs.

CLASSIFICATION OF ALTERNATIVE AND COMPLIMENTARY

THERAPY

1. Acupressure
2. Acupuncture
3. Herbal medicine
4. Aromatherapy
5. Biofeedback
6. Hypnosis/hypnotherapy
7. Visualization and guided imagery
8. Expressive therapy /sound therapy
9. Hydrotherapy
10.Homeopathy
11.Massage/touch therapy
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12.Reflexology
13.Yoga

ACUPRESSURE

It is form of alternative therapy in which manual pressure is used to stimulate

specific points on the body. Acupressure is done without needles but uses finger,
palm or knuckle pressure at points located along an invisible system of energy
channels called medians .The chines variation involves a more massage like
kneading motion. It may be performed on a floor mat or massage table, and the
person receiving the treatment usually wears comfortable, loose
clothing .practitioners may administer pressure to various points.

ADVANTAGES OF ACUPRESSURE

 Relieving stress ,tension and anxiety

 Improving sleep
 Relaxing muscles and joints
 Soothing the pain and discomfort of a sports or other injury
 Reducing digestive issues
 Minimizing headaches
 Alleviating chronic pain
DISADVANTAGES OF ACUPRESSURE
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 People having a fractured bone should avoid acupressure

 Patient with diarrhea and fever should not go for acupressure massage
therapy.
 Acupressure is less effective in soft pressure points such as stomach.
 Acupressure is not the right choice for patients having osteoporosis.

CONTRA INDICATIONS

The massage is administered in a slow and steady manner, although it can involve
forceful pressure .thus this may not be a choice for a person with brittle bones or a
history of spinal or other orthopedic injury or those who bruise easily.

POSSIBLE SIDE EFFECTS

After an acupressure treatment, some individuals report feeling light headed or

slightly groggy for a while .this feeling may be caused by buildup of endorphins.

ACUPUNCTURE

Acupuncture is well known Chinese practice. In this one uses needles inserted at
specific points to relieve pain, this therapy is found beneficial during pregnancy.

The puncture refers to insertion of tiny needles at very specific points on the
surface of the body . the insertion of the disposable needles has been described as
feeling like a place upto 20 to 30 minutes .in some cases a weak electrical current
is sent through the acupressure needles to enhance the effect .

It is used to relieve pain and also to reduce morning sickness.

The placement of needle will depend on which area and what kind of pain.

Advisable of take this treatment certificate practitioners.

ADVANTAGES OF ACUPUNCTURE

 Performed correctly, it is safe.

 There are very few side effects.

 It can be effectively combined with other treatments.

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 It can control some type of pain.

 It may help patient for whom pain medications are not suitable.

DISADVANTAGES OF ACUPUNCTURE

 It is dangerous if a patient has a bleeding disorder or takes blood thinners.

 Bleeding, bruising, and soreness may occur at the insertion sites.

 Unsterilized needles may infect the patient

 In rare cases, a needle may break and damage an internal organ.

 When needle inserted deeply into the chest or upper back, there is risk of
collapsed lung ,but this is very rare.

CONTRAINDICATIONS

People at risk of easy bruising or bleeding and those taking a blood thinning
medication should avoid acupuncture.

Pregnant women should avoid needle insertion or near the abdomen.

SIDE EFFECTS

Careless application or improperly sterilized needles can cause serious

complications ,if a blood vessel is punctured or injury to organs or nerves occurs.
therefore acupuncture should be done by a skilled and reputable practioner.

HERBAL MEDICINE

Herbal medicine involves the therapeutic use of plants in various forms, which
works pharmacologically. There is a common misconception that because herbal
remedies are natural they are automatically safe but there is now a growing body of
evidence about the risk of possible interaction between herbal and conventional
medicines.

Many herbal remedies should be avoided during preconception and antenatal

period and when breastfeeding because they may induce uterine bleeding.

ADVANTAGES OF HERBAL MEDICATIONS

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 More affordable than conventional medicine

 Promote natural healing

 Strength in immune system

 Stabilizes hormones and metabolism

 It is cost effective.

DISADVANTAGES OF HERBAL MEDICATIONS

 Herbal medicines take a longer time to work compared to pharmaceutical

drugs. If an individual take the herbal alternative to pharmaceuticals , he or
she must be very patience.

 Herbal medicines are often self administered .as a result , there is no dosage
or warnings specified. when herbal medicines are consumed with
pharmaceutical drugs, the two can interact with each other resulting injuries
to health.

AROMATHERAPY

The therapy relies on the use of concentrated essential oils extracted from various
plants .many oils are used as a form of a home remedy. The use f herbal teas and
vapors is reported to have good effects on labor and pregnancy for some women.

CONTRAINDICATIONS

During pregnancy, women should avoid many of the essential oils because of
toxicity to their fetus.

SIDE EFFECTS

Possible increase of an abortion, pregnancy induced hypertension or hemorrhage

BIOFEED BACK

Biofeedback is techniques that allows individuals to gain control over physiologic

reactions that are ordinarily subconscious malfunctions in these automatic
responses contribute to several medical problems. Bio feedback has shown the
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ability to help bring counterproductive reactions back into line, providing

significant relief.

CONTRAINDICATIONS

If a pregnant women has an implanted pacemaker, the biofeedback technique that

requires an electrical device, should not be used to gain control over physiologic
reactions.

SIDE EFFECTS Like other mind body forms of therapy, bio feedback is notably
free of side effects. Although biofeedback is harmless, it is not a substitute for
medical care if a person has a serious medical problem, e.g diabetes, heart disease
or hypertension.

HYPNOSIS/HYPNOTHERAPY

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

Hypnosis focus on diminishing the awareness of pain as well as fear and anxiety.

ADVANTAGES OF HYPNOSIS IN OBSTETRICS

 Reduction or eradication of fear, tension, and pain before and during labor
with a consequent rise in the pain threshold.

 Complete control of painful uterine contractions; the mother can choose to

experience the sensations of childbirth or not, as she sees fit.

 Decreased shock and speedier recovery.

 Lessened incidence of operative delivery since the responsive patient

cooperates more fully, particularly during the expulsive stage. Relaxation
and anesthesia of the perineum are produced by autohypnosis or by direct
suggestion from the hypnotherapist; this eases delivery, episiotomy, and
suturing of the perineum.

 Lack of undesirable postoperative effects such as may be encountered with

drug anesthesia; hypnoanesthesia is also more readily controlled.
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 Hypnosis shortens the first stage of labor by approximately 3 hours in

primiparae and by more than 2 hours in multiparae.

 Hypnosis raises the resistance to fatigue, thus minimizing maternal

exhaustion.

 Hypnosis can be used in debilitated individuals, in those who have ingested

food shortly before delivery, and in those who are allergic to drugs. Also, it
is indicated in premature delivery.

DISADVANTAGES OF HYPNOTHERAPY

 Dizziness

 Headache

 Feelings of anxiety

 Stomach upset

VISUALIZATION AND GUIDED IMAGERY

Visualization and guided imagery refer to concentration on images held in the

mind’s eye. visualization is the form of mind to body technique that has been
tested is used extensively in labour.

HOW THE THERAPY IS DONE

Instruments or monitors are not used. sometimes music is played in the background
to aid relaxation .sessions begin with general relaxation exercises ,then move on to
a specific visualization. The individual is asked to build a detailed image in her
mind, using all five senses and may repeat the exercise with a different image. if
the person has a specific medical complaint ,she will be asked to picture the
affected organ working properly.

CONTRAINDICATIONS

Guided imagery is generally considered safe for everyone.

POSSIBLE SIDE EFFECTS

There are no known side effects unless memory of an unpleasant event occurs.
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EXPRESSIVE THERAPY /SOUND THERAPY

DEFINITION

Expressive therapy is a nonthreatening outlet for people to express their feelings

that are difficult to put in words and is used as a coping strategy. Expressive
therapy includes many forms of expression, such as music, puppetry, and personal
diaries. Only music is discussed at this time.

Sound therapy has had an impact on many people.classiical music is soothing to

some, soft ballads soothe others ,heavy metal music can be both enjoyable or
anxiety provoking ,and an anthem sung at the beginning of a ball game can stir
people.

CONTRAINDICATIONS

Sound therapy is considered safe to use. If possible, the selection of the type of
music should be made by the patient.

POSSIBLE SIDE EFFECTS

The volume should be kept low when using a sound therapy device.with loud
music the client may suffer hearing loss. No other side effects are known.

HYDROTHERAPY

Hydrotherapy or water therapy, by bathing showering, or jet hydrotherapy .warm

water may be used to promote comfort and relaxation. water therapy can also
reduce anxiety, which triggers a decrease in adrenaline production. This in turn can
trigger an increase in endorphins, which reduce the pain such as labour. Pain relief
associated with bahing, showering, or jet hydrotherapy has been proposed to be
that of a distraction device or stimulation of large diameter nerve fibers, as
mentioned in the gate control theory. The warm water allows local vasodilatation
and muscle relaxation. The water should be kept at a controlled temperature to
prevent hyperthermia or hypothermia.
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BENEFITS OF HYDROTHERAPY

 Hydrotherapy helps loosen weight, tense muscles tone and encourages

relaxation. hydrotherapy increases the digestion activity and metabolic rate.
 Hydrotherapy helps in boosting the immune system allowing it to function
more efficiently.
 Hydrotherapy stimulates the blood supply improving the function of the
internal organs.

DISADVANTAGES OF HYDROTHERAPY

Hydrotherapy can also put on a risk of allergic reaction known as contact

dermatitis for some patients using essential herbs and oils in their bath water.

HOW THE THERAPY IS DONE

Water therapy can be done by bathing, showering or jet hydrotherapy or showering

can stimulate the nipples and trigger more oxytocin production. If a tub bath is
used, it must be extremely clean to prevent infection.

CONTRAINDICATIONS

Hot/cold therapy is ill advised for patients with asthma ,kidney disease and a
bleeding disorder .water births are contraindicated in women who have high risk
pregnancies and should be in a hospital based centre where facilities are available
for emergencies.

HOMEOPATHY

Homeopathic drugs that may help to lessen the pain of natural child birth. Through
homeopathy is not recognized as a way of curing an ailment of pain quickly,it can
start from the later months of pregnancy, with the aim of reducing the eventual
labor pain.

These drugs only be taken by recognized homeopathy practitioner and obstetrician.

ADVANTAGES OF HOMEOPATHY

 Pregnant woman are very sensitive to any eating products .but the medicines
of homeopathy can protect pregnant woman as it proves safe for them.
 If a person has already been taking medicines. Then he can also continue
with the treatment of homeopathy.
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 It also controls the reactions caused by the medicines.

 It does not encounter any side effect.
 The homeopathy treatment is not very expensive ,and it is affordable by the
common man.

DISADVANTAGES OF HOMEOPATHY

 The treatment of homeopathy does not work at the time of emergency.

 It takes a long time to cure the disease.
 Its treatment is restricted to eat so many things like the pickle, non-veg, oily
food, etc.

CONTRAINDICATIONS

Coffee, menthol and strong flavors such as peppermint should be avoided as they
may reduce the effect of the homeopathic product.

MASSAGE OR TOUCH THERAPY

Massage Is the applied use of touch. Massage has been shown to be very relaxing,
reducing blood pressure and increasing excretory processes. In labor it assists in
reducing pain and easing fear and tension.

Pregnancy or prenatal massage is used to reduce stress, reduce swelling in the arms

and legs and relieve muscle and joint pain in pregnant women.

Massage in pregnancy can involve many different massage techniques. It is usually

a gentle massage.

ADVANTAGES OF MASSAGE

 Benefits of massage demonstrate that it is an effective treatment for reducing

stress , pain and muscle tension.
 Helpful for anxiety, digestive disorders.

CONTRAINDICATIONS
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Massage is not advised for anyone who has an infectious skin disease ,a rash or an
unhealed wound. if the person is prone to blood clots, it is unwise to have the
therapy immediately after surgery.

SIDE EFFECTS

Massage can aggravate existing swelling .the pressure on the skin can be painful
for someone who has nerve injury.

REFLEXOLOGY
Reflexology is a specialist massage whereby controlled pressure is applied to
specific points, known as reflexes, mainly on the feet, but also on the ears, face,
hands and back. Each reflex is believed to correspond to particular structures or
organs of the body. By applying pressure to these points the reflexologies aims to
promote homeostasis and, as a result, restore and maintain physiological and
psychological health and wellbeing.
Pregnant women might use reflexology — where a therapist uses hands, fingers
and thumbs to stimulate certain areas of the feet — to reduce low back or pelvic
pain. It is reported to be safe.

YOGA

Yoga is a set of exercises that offers a variety of proven health benefits . It

increases the efficiency of the heart and slows the respiratory rate , improves
fitness ,lowers blood pressure , promotes relaxation ,and reduces stress and
anxiety.

CONTRA INDICATIONS

Yoga should be avoided in patients who have had a recent back injury or surgery.
Some postures are not recommended during pregnancy.

SIDE EFFECTS

One may have some stiffness while the body adopts.

5 YOGASANAS DURING PREGNANCY

1. Bhadrasana (Butterfly pose):

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Sit on the mat with legs fully stretched. Keeping the legs in contact with
the mat, form 'Namaste' with your feet, touching each other. -Sit straight,
without leaning forward. Place your hands on knees or ankle. Hold the
posture for some time until you feel comfortable. Straighten your legs,
relax for a minute and repeat again.
Benefits:
It strengthens the pelvic region, improves flexibility in the groin and hip
region, stretches the thighs and knees and reduces pain.

2.   Trikonasana (Triangle Pose):

Stand straight while keeping your feet joined. Rest your hands on either
side of the body. Slowly spread your legs apart. Lift your right hand up.
Take a deep breath and bend towards your left and balance by keeping the
left palm on the floor. Tilt your head upwards and fix your gaze on the
right-hand fingertips and count up to 20. Repeat the posture while
bending towards right. Take 1 minute of rest and continue the entire
posture for two more times.
Benefits:
It reduces back pain and stress, improves digestive function during
pregnancy and enhances hip flexibility.
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3.    Marjariasana (Cat Pose/Cow Pose):

Bend on your knees and keep your head straight. Inhale deeply and lift
your chin while pushing back your head a bit. Keep your buttocks firm and
hold the posture for 30 seconds or as long as comfortable, while breathing
deeply. Breathe out and bring your chin close to your chest. Relax your
buttocks and arch the back as much as comfortably possible. Hold for
some time and repeat the posture for 3 more times.

Benefit:
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This is beneficial in the third trimester. It improves blood circulation,

stretches the back and shoulders, making the spine flexible.

4.    Parvatasana (Mountain Pose):

Sit erect and while you inhale. Raise your arms and join your palms in the
'Namaste' position. Keep your elbows straight. Place your hands near to
your ears. Hold the posture for a few seconds and come back to the
normal position again. Repeat for 3 to 5 times.
Benefit:
It improves body posture, relieves from back and neck pain and increases
the flexibility of the hip.
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5.    Shavasana (Corpse Pose):

Lie down on your back and close your eyes. Relax your body and mind. and
think happy peaceful thoughts. Take your time while you do this. Breathe
normally and do not hold your breath. After some time, stand up.
Benefit:
This yogasana cools the body, calms the mind and marks the end of the
yoga session. Practice this after every asana to allow the body to relax in
between the asanas.

CHIROPRACTIC AND OSTEOPATHY

Osteopathy has been regulated since 1993 by the general osteopathic council and it is based n
the principle that misalignment of the neuro- musculo skeletal system. Treatment aims to re-
align and rebalance the whole person.

Osteopathy is a form of manual medicine characterized by a whole-body

intervention and the presence of a specific placatory aspect to drive the treatment ,
the so-called somatic dysfunction . The latter is defined as an “impaired or altered
function of related components of the somatic (body framework) system: skeletal,
arthrodial and myofascial structures, and their related vascular, lymphatic, and
neural elements’’. Osteopathy is a wide-spread complementary medicine whose
use has steadily increased over the past decade.
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CONCLUSION:

Alternative therapies are used instead of conventional therapy .for example, the
use of acupuncture/acupressure rather than analgesic to relieve
pain.complementary therapy are those therapy used in conjunction with
conventional therapies . for example meditation used as an adjunct to analgesics
drugs. It can be seen that there are many complimentary therapies during intra
natal period which can be applied to the care of pregnant women , although they
are not always without risk and must be used accurately and appropriately.

JOURNAL STUDY

An observational, population-based, cohort study of parents and children of 14,541

pregnant women residing within the former county of Avon in south-west England.
To report the frequency of Complementary and Alternative Medicine (CAM) use
by a population of pregnant women in the UK. Four postal self-completion
questionnaires completed at 8, 12, 18 and 32 weeks’ gestation provided the source
of CAMs used. Questions asked for written descriptions about the use of any
treatments, pills, medicines, ointments, homeopathic medicines, herbal medicines,
supplements, drinks and herbal teas. The study was concluded as CAM use in
pregnancy, where a wide range of CAMs has been assessed, has not been widely
reported. Studies that have been conducted report varying results to this study
(26.7%) by between 13.3% and 87% of pregnant women. Survey results will be
affected by a number of factors namely the inclusion/exclusion of vitamins and
minerals, the timing of data collection, the country of source, the number of
women surveyed, and the different selection criteria of either recruiting women to
the study or of categorising and identifying a CAM treatment or product.
Complementary Therapies in Medicine
Volume 19, Issue 6, December 2011, Pages 303-310
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REFERENCES

1. A text book of midwifery and gynecological nursing.

Neelam kumari, shivani Sharma, Dr.preethi gupta.page no.48-62
s.vikas and company medical publishers P.V.books
2. Midwifery and obstetrical nursing,as per INC syllabus ,third edition ,
nima baskar,page no.51-64,emess medical publishers
3. myles textbook for midwives
jayne marshall,Maureen raynor,sixteenth edition,international edition
page no. 55-80
Churchill living stone,Elsevier
4. http://www.slideshare .net