ALTERNATIVE AND

COMPLEMENTARY

THERAPIESIN LABOR

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 BALLThe 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.

THANK

YOU