ALTERNATIVE AND

COMPLEMENTARYTHERAPIESIN LABOR

ANCY ABRAHAM

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.

ALTERNATIVE APPROACHES

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.

Self hypnosis can be taught at various

hypnosis training centres 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 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

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.

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, but there is no controlled

evaluation in the literature.

6. 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.

In another study done decades ago by Hanser,

Larson, O’ Connell 1983 indicated that mothers

recorded fewer pain responses in the music versus

no music groups and that music aided

concentration, relaxation, cued breathing and

diverted attention from pain. It indicated that music

made from a positive contribution to the child

bearing experience for mothers.

7. 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.

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

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 include altering the body’s

levels of chemical neurotransmitters and

influencing the natural electrical currents or

electromagnetic fields

8. ACUPRESSURE SYSTEMS

• Acupressure is a descendant of Chinese manipulative therapy in which points are stimulated by pressure, using hands, fingers and thumbs .

9. 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.

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 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.

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

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 of pregnancy 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 dematomal distribution with either a hot, cold scratchy or electrical Stimulus.

Pure sterile water is injected into 4

specific locations on the lower back of

the back of the mother. This may cause

a stringing pain 20-30 seconds, but relief

lasts for an hour, are more and

procedure can be repeated any

number of times.

14. HYDROTHERAPY

• 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 ffit through the pelvis but also

promotes comfort and can decrease pain by

stimulating mechanoreceptors 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.

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

• For labor therapeutic grade oils in low doses for massage

or as an environmental fragrance is increasing in health

care settings.

17. BREATHING

• 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. What ever position in

which woman find

comfortable can be good for

her.

19. HEAT THEORY• 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

20. REFLEXOLOGY• Another ancient practice is which pressure in

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.

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.

THANKYOU