SDM INSTITUTE OF NURSING

SCIENCES SATTUR, DHARWAD

CLINICAL SPECIALITY-1
OBSTETRIC AND GYNAECOLOGICAL
NURSING
UNIT-4
NORMAL LABOUR AND NURSING MANAGEMENT

SUBMITTED TO
Mrs. MRS. BIJLEE MUNDINMANI
ASST. PROFESSOR
HOD DEPT. OF OBSTETRIC &
GYNECOLOGICAL NURSING
SDM UNIVERSITY OF NURSING
SCIENCES, SATTUR, DHARWAD.

SUBMITTED BY:
MISS. SAVITA S. HANAMSAGAR
1ST YESR MSc. STUDENT

SDM UNIVERSITY OF NURSING

SCIENCES, SATTUR, DHARWAD.

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 TOPIC:
ROLE OF NURSE MIDWIFERY PRACTIONER IN
ALTERNATIVE / COMPLIMENTARY THERAPIES IN LABOUR

TOPIC CONTENT:

1. Introduction
2. Alternative therapies
3. Complementary therapies
4. Different alternative & complementary therapies
 Hypnosis:
 Biofeedback
 Yoga
 Sophrology
 Music therapy
 Acupuncture
 Homeopathy
 Therapeutic touch
 Massage therapy
 Transcutaneous Electrical Nerve Stimulation(TENS)
 Sterile water injection
 Hydro therapy
 Birth ball
 Aromatherapy
 Breathing therapy
 Heat therapy
 Reflexology
 Distraction
 Nipple stimulation
5. Role of Nurse midwife in alternative & complementary therapy in labor
6. Summery
7. Conclusion
8. Bibliography

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ALTERNATIVE & COMPLEMENTARY THERAPY IN LABOUR

 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.

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 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.
 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 coping with labour pain etc.

3. Yoga:
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  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 asanas or positions which can be used during labour for the
benefits.
I. 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.

II. 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.

III. Child Pose

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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.

IV. 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.

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.

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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.
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
throughout 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

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 12C, given once every hour. For example, hour 1: caulophyllum, hour 2: cimicifuga,
hour 3: caulophyllum, etc.

9. 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 or perineum.
 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.

10. 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.

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11. Transcutaneous Electrical Nerve Stimulation(TENS):

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.

12. 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.

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  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.
 Its 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.

13. Hydro therapy:

 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 diuresis, 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
chorioamnionitis, postpartum endometritis, neonatal infections etc., however
precautions needed to reduce infection.

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14. 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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15. 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.

16. 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.

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17. 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. What ever position in
which woman find comfortable can be good for her.

18. Heat therapy:

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  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.

19. 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 ankle points, which are said to stimulate
the pituitary glands to release pain killing hormones. Reflexology should only be
performed by an experienced practitioner.

20. 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.

21. Nipple stimulation:

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  Rubbing or rolling your 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.
 If you want to try it, gently rub or roll your nipples. Massage the darker area around
your nipple (areola), not just the tip of your nipple. You can do this by placing your palm
over the areola and moving it in a circular motion, firmly and gently. Stimulate your
breasts for an hour, three times a day.

 Role of Nurse 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.

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

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 body function.

 Summary:

Today we have discussed about alternative & complementary therapies used in labour to
reduce the labour pain & to help the mother. There are various therapies which we have
discussed like- hypnosis, Sophrology, Acupuncture, Acupressure, Hydrotherapy, Breathing
therapy, Music therapy, Bio feedback, Yoga, Massage therapy, sterile water injection,
Therapeutic touch, Transcutaneous electrical nerve stimulation, Homeopathy, Birth ball,
Aroma therapy, Heat therapy, reflexology, different positions & distraction therapy.

 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.

 Bibliography:

Books:

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

edi;2011, Elsevier publication, New Delhi, Pp-171 & 172.

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 2. Myles, “TEXTBOOK FOR MIDWIVES”, 15th edi;2009, Elsevier publication, China,
Pp477 & 478.

Web references:

1. https://birthbliss.wordpress.com/2011/05/03/yoga-postures-for-labour-and-birth/
2. www.boldsky.com › Pregnancy Parenting › Prenatal
3. www.healthline.com › Pregnancy › Home
4. prenatalcoach.com/homeopathy-natural-childbirth-guide/
5. https://www.bellybelly.com.au/birth/natural-pain-relief-for-labour
6. https://www.researchgate.net/.../278309830_Complementary_and_alternative_therapies_
7. www.slideshare.net/.../alternative-and-complementary-methods-during-labor
8. ssc.edu/.../COMPLEMENTARY%20AND%20ALTERNATIVE%20THERAPIES.ppt
9. www.babycentre.co.uk › Pregnancy › Labour and birth › Pain relief in labour

Journals:

1. ww.ncbi.nlm.nih.gov/pubmed/25118632
2. https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)

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