RAJKUMARI AMRIT KAUR, COLLEGE OF NURSING, LAJPAT NAGAR

Depth stuDy on AlternAtive AnD ComplementAry

therApies in lAbor AnD pregnAnCy

Submitted To: Dr. (Mrs.) Molly Babu HOD (Obstetrics & Gynecology Dept.)

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Submitted By: Savita Msc Nursing 1st Year

INDEX

S.No TOPIC PAGE No

1 Introduction and classification of alternative and complementary therapy

2-4

2 Mind Body Spirit Therapies: MeditationRelaxation TechniquesGuided ImageryMusic InterventionYoga

5-9

3 HypnotherapyBiofeedbackMedication: Definition, TechniquesPrayer: definition, TechniquesStorytelling

10-13

4 ReikiSelf treatment and practitioner benefitsAccupressureAccupuncture

14-15

5 Reflexology: Definition, UsesMassage: Definition, movements, Uses

16- 19

6 Aromatherapy: Definition, Indications, UsesHydrotherapy: Definition, Indications, Uses

20- 27

7 Nutraceutical: Definition, Indications, UsesHomeopathy

28- 30

8 Biologically Based Treatments:Herbal MedicineNutrition Therapy

30- 33

9 Manipulative and Body TechniquePhysical StructureBreathing TechniqueRelaxation TechniqueExercise

33- 36

10 Research Related to complementary and Alternative Therapy in Midewifery

37

3

11 Reference 38

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Complementary and Alternative Therapies in

Pregnancy, Labor and Pueperium

Complementary and alternative medicine includes various healing approaches and therapies that originate from around the world and that are not based on conventional western medicine .These therapies are called alternative medicine when they are used alone and complementary medicine when they are used with conventional medicine.

Alternative medicine included therapies and health care practices not widely taught in most medical schools; however many such practice are popular, and some are used in hospital.

Terminologies: Holism: The idea that the whole of the sick person, including their body, mind and way of

life, should be considered when treating them, and not just the symptom of the disease. Humanism: A system of thought that considers the solving of human problems with the help

of religious believe. It emphasizes the fact that the basic nature of human is good. Balance :A situation in which different things exist in equal ,correct or good amount. Energy: The ability to put effort and enthusiasm into an activity, work etc. Healing : The process of returning to normal function after a period of disease or injury.

Definition of Complementary & Alternative TherapyComplementary and alternative medicine is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.

Even though delivery is a natural phenomenon, it has been demonstrated that the accompanying pain is considered severe or extreme in more than half of cases. Besides conventional approaches, such as epidural analgesia, many complementary or alternative methods have been reported to reduce pain during labor and delivery. Complementary or Alternative Medicine (CAM) can be defined as theories or practices that are not part of the dominant or conventional medical system. Some of them have been reclassified as part of conventional medicine when supported by clinical experience or scientific data. These methods are popular because they emphasize the individual personality, and the interaction between mind, body and environment. They are attractive to people who want to be more involved in their own care and feel that such therapies are more in harmony with their personal philosophies. The conventional medical community usually offers traditional choices of analgesia, such as epidural and intravenous drugs. Patients may have access to alternative methods, but will generally be obliged to do the relevant research themselves beforehand. Those seeking alternatives are not necessarily dissatisfied with conventional medicine, but attempt to supplement rather than replace traditional care. Quite often, users of complementary medicine do not inform the practitioners in charge of their pregnancy and delivery. There are also different expectations for the management of pain during labor according to the category of professionals. Physicians are expected to provide pharmacological therapy, whereas midwives, nurses and other auxiliaries are required to assist patients with psychological methods, and in fact use alternative approaches more often. The theoretical bases for many alternative methods derive from Eastern tradition or philosophy.For the management of pain, conventional medicine focuses more on the physical side, while alternative methods deal mainly with emotional considerations. In the laboring patient, the two stages of labor correspond to different types of pain and routes of transmission. During dilatation (first stage), visceral pain predominates, due to mechanical distention of the cervix and of the lower part of the uterus. These stimuli are transmitted to the spinal cord at the level of the

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tenth thoracic to the first lumbar root. Uterine contractions may be felt as back pain because the nerves that supply the uterus also supply the skin on the lower back or lumbosacral area. During the descent phase (second stage), pain is also caused by distension and stretching of the pelvic floor and perineum. These stimuli are transmitted via the pudendal nerve to the second to fourth sacral nerves.Some factors are associated with increased pain: first delivery, history of dysmenorrhea (painful periods), fear of pain, a religious practice. Some factors diminish pain: childbirth preparation classes, complications during pregnancy, wish to breast feed, high socio-economic status, older age. An epidural involves the introduction of a local anesthetic agent to the sensitive nerves conducting the pain messages on their way to the spine. A catheter (fine flexible tube) is usually placed in the epidural space, allowing intermittent or continuous infusion throughout the delivery.Morphine-like drugs (opioids) can be given continuously or in intermittent doses at the patient's request or via patient-controlled administration. Recent reports suggest that the analgesic effect of these agents in labor is limited and that the primary mechanism of action is heavy sedation, which means that consciousness is reduced during delivery. Such drugs may also have some effect on the newborn, with rare but possible breathing difficulties that may require assistance. Nitrous oxide gas is given for inhalation at subanesthetic concentrations. Despite being used for more than 100 years, there is no clear quantitative evidence of the efficacy of nitrous oxide in relieving labor pain. The subjective feelings of mothers giving birth suggest, however, that nitrous oxide is beneficial in many cases. Many women report significant analgesia with it, and many would choose it again for another deliveryComplementary and alternative methods applicable to labor pain can be divided into mind-body interventions, alternative systems of medical practice, manual healing, bio electromagnetic and physical methods, and alternative medication. Mind-body interventions are based on the interconnectedness of mind and body and on the power of each to affect the other. Many mind-body interventions are applied to chronic illness, but this technique also appears to be applicable to the acute situation of delivery.

NCCAM Classification for Complementary Therapies and Examplesof Therapies

• Mind–Body TherapiesInterventions use a variety of techniques to enhance the mind’s ability to affect body functions and symptoms. Examples: imagery, meditation, yoga, music therapy, prayer, journaling, biofeedback, humor, art therapy.

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• Biologically Based TherapiesTherapies use substances found in nature. Examples: plant-derived preparations (herbs and essential oils), special diets, orthomolecular medicine (nutritional and food supplements), other products such as cartilage.

• Manipulative and Body-Based TherapiesTherapies are based on manipulation or movement of one or more parts of the body. Examples:, massage, body work such as rolfing.

• Energy TherapiesTherapies focus on the use of energy fields, such as magnetic and biofields that are believed to surround and permeate the body. Examples: healing touch, therapeutic touch, Reiki, magnets.

• Systems of CareWhole systems of care are built upon theory and practice and often evolved apart from and earlier than Western medicine. Therapies noted above may be from these systems of care.

IMPLICATIONS FOR NURSINGComplementary therapies (under a different name) and their basic philosophies have been a part of the nursing profession since its beginnings.In Notes on Nursing (1936/1992), Florence Nightingale stressed the importance of creating the environment in which healing could occur and the importance of therapies such as music in the healing process. Complementary therapies today simply provide yet another opportunity for nurses to demonstrate caring for patients. Although it is indeed gratifying to see that medicine and other healthprofessions are recognizing the importance of listening and presence in the healing process, nurses need to assert that many of these therapies have been taught in nursing programs and have been practiced by nurses for centuries. Therapies such as meditation, imagery, support groups, music therapy, humor, journaling, reminiscence, caring-based approaches, massage, touch, healing touch, active listening, and presence have been practiced by nurses throughout time.Complementary therapies are receiving increasing attention within nursing. Journals, such as the Journal of Holistic Nursing and Complementary Therapies in Nursing & Midwifery, are devoted almost exclusively to complementary therapies. Many journals have devoted entire issues to exploring the use of complementary therapies. Articles inform nurses about complementary therapies and how specific therapies can be used in providing care. Because of the increasing use of complementary therapies by patients to whom nurses provide care, it is critical that nurses possess knowledge about these therapies. Patients expect health professionals to know about complementary therapies; nurses need such knowledge so that they can:■ provide guidance in obtaining health histories and assessing patients;■ answer basic questions about use of complementary therapies and refer patients to reliable sources of information;■ refer patients to competent therapists; and■ administer a selected number of complementary therapies.

SELF-CAREBecoming a healer is a very individual process, one that grows from the inside. Each person is unique and must assess his or her individual strengths and talents so as to move toward wholeness. There are many ways to create a plan for self-care and intentional personal healing. Therapies that will help a person to increase self-knowledge, become more aware of transpersonal experiences, and accept the paradoxical mysteries in life need to be explored. Several concepts and techniques that are widely accepted as important in self-care are:■ A balanced diet appropriate to current health needs■ Exercise appropriate to the individual■ Adequate sleep and rest

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■ Social support systems■ Stress-management skills■ Meditation and prayer■ An active sense of humor

LISTENING :Listening is an active and dynamic process of interaction with a client, which requires intentional effort to attend to a client’s verbal and nonverbal cues. Listening is an integral part of nurse–client relationships. In fact, it is one of the most effective therapeutic techniques available to nursesTherapeutic listening is defined as “an interpersonal, confirmation process involving all the senses in which the therapist attends with empathy to the client’s verbal and nonverbal messages to facilitate the understanding, synthesis, and interpretation of the client’s situation”Therapeutic listening enables clients to better understand their feelings and to experience being understood by another caring person. Effective engagement in therapeutic listening requires nurses to be aware of verbal and nonverbal communication that conveys explicit and implicit messages. When verbalized words contradict nonverbal messages, communicators rely more often on nonverbal cues; facial expression, tone of voice, and silence become as important as words in determining themeaning of a message (Kacperek, 1997). Nonverbal communication is inextricably linked to verbal communication and can change, emphasize, or distract from the words that are spoken

Therapeutic Listening TechniquesActive Presence: Active presence involves focus on the client to interpret the message that he/she is trying to convey, recognition of themes, and hearing what is left unsaid. Short responses such as “yes” or “uh-huh” with appropriate timing and frequency may promote clients’ willingness to talk.

Accepting Attitude: Conveying an accepting attitude is assuring, and can help clients to feel more comfortable about expressing themselves. This can be demonstrated by short affirmative responses or gestures.

Clarifying Statements: Clarifying statements and summarizing can help the listener verify message interpretation and create clarity. Encourage specificity rather than vague statements to facilitate communication. Rephrasing and reflection can assist the client in self-understanding. Using phrases such as “tell me more about that” or “what was that like?” may be helpful, rather than asking “why,” which may elicit a defensive response from the client.

Use of Silence: Use of silence can encourage the client to talk, facilitate the nurse’s focus on listening rather than the formulation of responses, and reduce the use of leading questions. Sensitivity toward cultural and individual variations in the seconds of silence may be developed by paying detailed attention to the patterns of client communication.

Tone: Tone of voice can express more than the actual words through empathy, judgment, or acceptance. Match the intensity of the tone to the message received to avoid minimizing or overemphasizing.

Nonverbal Behaviors: Clients relaying sensitive information may be very aware of the listener’s body language and will be viewed as either accepting of the message or closed to it, judgmental, and/or disinterested. Eye contact, or a nodding head, is essential to convey the listener’s true interest and attention. Maintaining a conversational distance and judicious use of touch may increase the client’s comfort. Cultural and social awareness is important to avoid undesired touch.

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Environment: Distractions should be eliminated to encourage the therapeutic interchange. Therapeutic listening may require careful planning to provide time for undivided attention or may occur spontaneously. Some clients may feel very comfortable having family present; others may feel inhibited when others are present.

MIND-BODY SPIRIT THERAPIES:NCCAM defines this category as encompassing therapies that promote the mind’s capacity to have an impact on the functioning of the body.Mind-body techniques are based on the theory that mental and emotional factors can influence physical health. Behavioral, psychologic, social, and spiritual methods are used to preserve health and prevent or cure disease.Because of the abundance of scientific evidence backing the benefits of mind-body techniques, many of the approaches are now considered mainstream methods include the following:

• Meditation• Hypnotherapy (hypnosis)• Biofeedback• Qigong & Tai Chi• Relaxation techniques• Guided imagery

Mind-body techniques can be used to treat anxiety and panic disorders, chronic pain, coronary artery disease, depression, headaches, difficulty sleeping (insomnia), and loss of urinary control (incontinence). Mind-body methods also are used as an aid in childbirth, in coping with the disease- related and treatment-related symptoms of cancer, and in preparing people before surgery.

1. MEDITATION In meditation, people regulate their attention or systematically focus on particular aspects of inner or outer experience. Meditation usually involves sitting or resting quietly, often with the eyes closed. Sometimes it involves the repetitive sounding of a phrase (a mantra) meant help the person focus.The most highly studied forms of meditation are transcendental meditation and mindfulness meditation. Meditation has been shown to have favorable effects on heart and blood vessel (cardiovascular) function, immunity, and brain activity, such as increasing activity in parts of the brain associated with mental clarity. Meditation often induces physical relaxation, mental calmness, and even-temperedness. Most meditation practices were developed within a religious or spiritual context and held as their ultimate goal some type of spiritual growth, personal transformation, or transcendental experience. As a health care intervention, however, meditation may be effective regardless of people’s cultural or religious background.

2. RELAXATION TECHNIQUES Relaxation techniques are practices specifically designed to relieve tension and strain. The specific technique may be aimed at reducing activity of the nerves that control the stress response (sympathetic nervous system), lowering blood pressure, easing muscle tension, slowing metabolic processes, or altering brain wave activity. Relaxation techniques may be used in combination with other techniques, such as meditation, guided imagery, or hypnotherapy.

3. GUIDED IMAGERY Guided imagery involves the use of mental images to promote relaxation and wellness, reduce pain, or facilitate healing of a particular ailment, such as cancer or psychological trauma. The images can involve any of the senses and may be self-directed or guided by a practitioner, sometimes in a group setting. For example, a person with cancer might be to imagine an army of white blood cells fighting against the cancer cells. Guided imagery has not been thoroughly scientifically studied, but many

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people claim to have had success with it.Imagery is the formation of a mental representation of an object, place, event, or situation that is perceived through the senses. It is a cognitive– behavioral strategy that uses the individual’s own imagination and mental processing and can be practiced as an independent activity or guided by a professional. Imagery employs all the senses—visual, aural, tactile, olfactory, proprioceptive, and kinesthetic. Although imagery is often referred to as “visualization,” it includes imagining through any sense and not just being able to “see something” in the mind’s eye. Van Kuiken (2004) describes four types of guided imagery: pleasant, physiologically focused, mental rehearsal or reframing, and receptive imagery. While inducing imagery, the individual often imagines seeing, hearing, smelling, tasting, and/or touching something in the image. The image used can be active or passive (playing volley ball versus lying on the beach). Although for many participants physical and mental relaxation tends to facilitate imagery, this is not necessary, particularly for children, who often do not need to be in a relaxed state. Imagery may be receptive, with the individual perceiving messages from thebody, or it may be active, with the individual evoking thoughts or ideas.Active imagery can be outcome- or end-state–oriented, in which the individual envisions a goal, such as being healthy and well; or it can be process-oriented, in which the mechanism of the desired effect is imagined, such as envisioning a strong immune system fighting a viral infection or tumor.

PAINPain is a uniquely subjective experience, and proper management depends on individualizing interventions that recognize determinants af fecting the pain response. Age, temperament, sex, ethnicity, and stage of development are all considerations when developing a pain management plan (Gerik, 2005; Young, 2005). Whether pain is from illness, side effects of treatment, injury, or physical stress on the body, emotional factors contribute to pain perception, and mind–body interventionssuch as imagery can help make pain more manageable (Reed, 2007). Stress, anxiety, and fatigue decrease the threshold for pain, making the perceived pain more intense. Imagery can break this cycle of pain– tension–anxiety–pain. Relaxation with imagery decreases pain directly by reducing muscle tension and related spasms and indirectly by lowering anxiety and improving sleep. Imagery also is a distraction strategy; vivid, detailed images using all senses tend to work best for pain control.In addition, cognitive reappraisal/restructuring used with imagery can increase a sense of control over the ability to reframe the meaning of pain.

MUSIC INTERVENTION:

The American Heritage Dictionaryof the English Language (2000) defines music as “the art of arranging sounds in time so as to provide a continuous, unified and evocative composition, as through melody, harmony, rhythm, and timbre.” Alvin (1975) delineated five main elements of music. The character of a piece of music and its effects depend on the qualities of these elements and their relationships to one another:

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■ Frequency or pitch is produced by the number of vibrations of a sound—the highness or lowness of a musical tone, noted by the letters A, B, C, D, E, F, G. Rapid vibrations tend to act as a stimulant, whereas slow vibrations bring about relaxation.

■ Intensity creates the volume of the sound, related to the amplitude of the vibrations. A person’s like or dislike of certain music partially depends on intensity, which can be used to produce intimacy(soft music) or power (loud music).

■ Tone color or timbre is a nonrhythmical, subjective property that results from harmony. Psychological significance results from the timbre of music because of associations with past events or feelings.

■ Interval is the distance between two notes related to pitch, which creates melody and harmony. Melody results from how musical pitches are sequenced and the interval between them. Harmonyresults from the way pitches are sounded together, described by the listener as consonant (conveying the feeling of restfulness) or dissonant (conveying the feeling of tension). Cultural norms determine what a listener deems enjoyable and pleasant.

■ Duration creates rhythm and tempo. Duration refers to the length of sounds, and rhythm is a time pattern fitted into a certain speed. Rhythm is what influences one to move with music in a certainmanner and can convey peace and security, whereas repetitive rhythms can elicit feelings of depression. Continuous sounds that are repeated at a slow pace and become gradually slower produce decreased levels of responsiveness. Strong rhythms can awaken feelings of power and control. Music is complex and affects the physiological, psychological, and spiritual dimensions of human beings. Individual responses to music can be influenced by personal preferences, the environment, education, and cultural factors.

TechniquesThe use of music can take many forms, such as (passively) listening to selected compact discs (CDs) or individual music downloads from the Internet, or actively singing or drumming. A number of factorsshould be kept in mind when considering the specific technique: the type of music and personal preferences, active versus passive and/or individual versus group involvement, length of time involved, and desired outcomes. Two of the more commonly used music intervention techniques will be discussed here: individual listening and group work.

GuidelinesMusic intervention for the purpose of relaxation uses music as a pleasant stimulus to block out sensations of anxiety, fear, and tension and to divert attention from unpleasant thoughts. A minimumof 20 minutes of music is necessary to induce relaxation, along with some form of relaxation exercise, such as deep breathing, prior to initiating music intervention.

YOGA:Yoga, an ancient art and science developed in India, and later in Tibet, means “integration” or “joining together” of body and mind with each other and the universe. Two millennia ago, the Indian sage Patanjali systematized yoga into the Yoga Sutra, a treatise consisting of 196 compact observations. This unique blend of theoretical knowledge and practical application is the primary text for all schools of yoga. In the Yoga Sutra, Patanjali analyzed how we know what we know and whywe suffer. In the Yoga Sutra, Patanjali described yoga as consisting of eight interconnected limbs, or aspects of the whole. Practicing these limbs simultaneously leads to progressively higher stages of ethics, spirituality, and healing. The first five limbs still the mind and body in preparation for the last

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three limbs. The eight limbs and their Sanskrit names are as follows (Hartranft, 2003):

1. Ethical behavior (yama)—nonharming, truthfulness, nonstealing, responsible sexuality, nonacquisitiveness.2. Personal behavior (niyama)—purity, commitment, contentment, self-study, and surrender to the whole.3. Posture (asana)—physical poses that stretch, condition, and massage the body.4. Breath regulation (pranayama)—regulation and refinement of breathing to expand prana (life-force) and get rid of toxins.5. Sensory inhibition (pratyahara)—temporary withdrawal of the senses from the external environment to the inner self, for example, by closing the eyes and looking inward.6. Concentration (dharana)—locking attention on an object or field, such as the breath, mantra, or image.7. Meditation (dhyana)—increasingly sustained attention, leading to a profound state of peace and awareness.8. Integration (samadhi)—a transcendent state of oneness, wisdom, and ecstasy.

Benefits of yoga therapy1. Yoga therapy show positive results in treating depression.2. Deep breathing associated with yoga is beneficial in controlling premature ventricular

complexes.3. Yoga therapy is beneficial in post-treating strategy, breast cancer and other survivors.4. Yoga therapy shows significant benefits that includes emotional functions, fitness

variations and psychological benefits. It also shows variations in tension, mood disturbances, cognitive function and gastrointestinal disturbances.

5. Practice of regular yoga exercise increases your body’s ability in using antioxidants. This is beneficial in the prevention of cancer.

6. If you are a diabetic patient then yoga therapy improves nerve function and lower blood sugar.

7. If you are a suffering from rheumatoid arthritis, the practice of yoga increases your hand grip strength.

8. Yoga helps in treating some problems like asthma, respiration problems, back pain, etc. it help in weight reduction.

4. HYPNOTHERAPY This alternative therapy is derived from western practice. In hypnotherapy (hypnosis), people are guided into an advanced state of relaxation and heightened attention. Hypnotized people become absorbed in the images suggested by the hypnotherapist and are able to suspend disbelief. Because

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their attention is more focused and they are more open to suggestion, hypnotherapy can be used to help people change their behavior and thus improve their health. Hypnotherapy can be used to treat or help treat purely psychological symptoms. Hypnotherapy also may be helpful in treating many conditions and symptoms in which psychological factors can influence physical symptoms:

• Phobias• Certain pain syndromes• Conversion disorders (in which apparent physical illness actually is caused mainly by

psychological stress and conflict)• Irritable bowel syndrome• Headaches• Asthma• Some skin disorders (such as warts and psoriasis)• High blood pressure• Nausea and vomiting caused by chemotherapy, particularly the nauea some people

get before chemotherapy (anticipatory nausea)• Anxiety and diminished quality of life in people who have cancer.• Hypnotherapy has been used with some success to help people stop smoking and

lose weight. Some people are able to learn to hypnotize themselves. The mechanism of hypnotherapy is poorly understood from a scientific standpoint.

5. BIOFEEDBACK Biofeedback is a method of bringing unconscious biologic processes under conscious control. Biofeedback involves the use of electronic devices to measure and report back to the conscious mind information such as heart rate, blood pressure, muscle tension, and brain surface electrical activity. With the help of a therapist or with training, people then can understand why these functions change and can learn how to regulate them. Biofeedback typically is used to treat pain including headache and chronic abdominal pain, stress, insomnia, fecal or urinary incontinence attention deficit disorder and mind cognitive impairment, and tinnitus.Biofeedback has been shown to be clinically effective in treating certain problems (for example, headaches, incontinence, and attention deficit disorder).Biofeedback is based on holistic self-care perspectives in which the mind and body are not separated and people can learn ways to improve their health and performance. Biofeedback therapists use instruments and teach self-regulation strategies to help people to increase voluntary control over their internal physiological and mental processes. Biofeedback instruments measure physiological activity such as muscle tension, skin temperature, cardiac activity, and brainwaves and then provide

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immediate and real-time feedback to the person in the form of visual and/ or auditory signals that increase his/her awareness of his/her internal processes. The biofeedback therapist then teaches the person to change these signals and take a more active role in maintaining the health of his/her mind and body. The holistic and self-care philosophies behind biofeedback and its focus on helping persons gain more control over his/her functioning make the intervention an appropriate one for nurses to use. Over time, the person can learn to maintain these changeswithout continued use of an instrument. The model for biofeedback is a skills-acquisition model in which persons determine the relationship between ANS functioning and their voluntary muscle or cognitive/affective activities. They learn skills to control these activities, which are then reinforced by avisual and/or auditory display on the biofeedback instrument. The display informs the person whether control has been achieved, reinforcing learning. Behavioral strategies, such as relaxation or muscle strengthening, are often part of biofeedback treatment to modify physiological activity.■ Biofeedback with relaxation strategies can be used to control autonomic responses that affect brain waves, peripheral vascular activity, heart rate, blood glucose, and skin conductance.■ Biofeedback combined with exercise can strengthen muscles weakened by conditions such as chronic pulmonary disease, knee surgery, or age. A biofeedback unit consists of a sensor that monitors the patient’s physiological activity and a transducer that converts what is measured into an electronic visual or auditory display to the patient. Frequently measured physiological parameters include muscle depolarization, which is monitored by electromyelogram (EMG), and peripheraltemperature.Biofeedback provides information about changes in a physiological parameter when behavioral treatments such as relaxation or strengthening exercises are used for a health problem. For example, a relaxation tape helps persons relax muscles, whereas the EMG biofeedback instrumentinforms the learner of progress (i.e., reduced tension in the muscle). Temperature feedback is also used with relaxation. As muscles relax, circulation improves and the fingers and toes become warmer.When exercises are used to strengthen perineal muscles in preventing urinary incontinence, success in contracting the correct muscles may be monitored by a pressure sensor inserted into the vagina. In health conditions exacerbated by stress, biofeedback is often combined with stress-management counseling. Feedback parameters that reflect mastery of the behavioral intervention are found in Exhibit 9.2. Frequently used mastery parameters include heart rate, muscle tension, peripheral temperature, blood pressure, heart rate variability, and EEG neurofeedback. It is important that the nurse be clear about mastery parameters that consist of ongoing feedback to the patient, for learning purposes, and outcome parameters that reflect the desired health improvement. For example, temperature feedback is used in peripheral vascular problems, but health care outcomes may be fewer episodes of painful vasoconstriction. Both EMG feedback and temperature feedback are learning modalities used in persons with diabetes mellitus, tension headache, and chronic pain. Outcomes may include decreased glycoslated hemoglobin, fewer and/or less severe headaches, cessation of urinary incontinence, or relief of pain.

MEDICATION:

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Borysenko (1988) defines meditation simply as any activity that keeps the attention pleasantly anchored in the present moment. It is the way we learn to access the relaxation response.In mental repetition, the person concentrates on a word or phrase, commonly called a mantra. Concentration on breathing is frequently the focus in physical repetition techniques; however, dance or other body movements can be the object of concentration. Jogging, for example, allows for concentrating on a physical activity, repetitive breathing, and the sound of one’s feet hitting the ground. In samatha Buddhist meditation, the person “watches” or concentrates on the breath entering and flowing from the tip of the nostrils. In problem-contemplation techniques, an attempt is made to solve a problem that contains paradoxical components, which Zen terms a koan. Finally, visual concentration techniques are akin to imagery. Mindfulness expands our capacity for awareness and for self-knowing. When a mindful state is cultivated, it frees people from routinized thought patterns, senses, and relationships and the destructive mind states and emotions that accompanythem. When people are able to escape from highly conditioned, reactive, and habitual thinking, they are able to respond in more effective and authentic ways.

INTERVENTIONA wide variety of meditation approaches is described in the literature; however, the following six techniques will be described: mindfulness meditation, transcendental meditation (TM), centering prayer, relaxation response, walking the labyrinth, and breath awareness.

TECHNIQUESMindfulness MeditationMindfulness, awareness, and insight meditation are Western terms used interchangeably to describe the Buddhist practice of vipassana meditation. The goal of this meditative practice is to increase insight by becoming a detached observer of the stream of changing thoughts, feelings, drives, and visions until their nature and origin are recognized. The process includes eliciting the relaxation response, centering on breath, and then focusing attention freely from one perception to the next.In this form of meditation, no thoughts or sensations are considered intrusions. When they drift into consciousness, they become the focus of attention

Transcendental MeditationA much-publicized technique, transcendental meditation was developed and introduced into the United States in the early 1960s by the Indian leader Maharishi Mahesh Yogi. It is estimated that there are now well over 2 million practitioners. The concept of TM is relatively simple. Students are given a mantra (a word or sound) to repeat silently over and over again while sitting in a comfortable position. The mantra is selected not for its meaning but strictly for its sound. It is the understandingthat this sound alone attracts the mind and leads it effortlessly and naturally to a slightly subtler level of the thinking process. If thoughts other than the mantra come to mind, the student is asked tonotice them and return to the mantra. It is suggested that practitioners meditate for 20 minutes in the morning and again in the evening. TM is easily learned and is practiced by people of every age,

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education, culture, and religion. It is not a philosophy and does not require specific beliefs or changes in behavior or lifestyle

Centering PrayerThough similar to TM in several respects, centering prayer is based in Christianity and is designed to reduce the obstacles to contemplative prayer and union with God. Thomas Keating (1995), the founder of the centering prayer movement, describes centering prayer as a discipline designed to withdraw our attention from the ordinary flow of thoughts. The understanding is that people tend to identify with their thoughts (the “debris” that floats along the surface of the “river”) rather than being in touch with the river itself (the source from which these mental objects are emerging). Keating suggests that, like boats or floating debris, our thoughts and feelings must be resting on something. They are resting, he asserts, on the inner stream of consciousness, which is our participation in God’s being. In centering prayer, as with TM, people are encouraged to find a comfortable position, to close their eyes, and to focus on a sacred word. Keating notes that 20 to 30 minutes is the minimum amount of time necessary for most people to establish interior silence and to get beyond their superficial thoughts.

Relaxation ResponseThe relaxation response incorporates four elements that are common in many of the other relaxation techniques: a quiet environment, a mental device, a passive attitude, and a comfortable position. A quiet environment, which is an element of Benson’s technique (1975), eliminates outside stimuli and allows the person to concentrate on the mental device. Some people prefer a church or chapel for meditating, but such a place may not be readily accessible. Playing music while meditating is not advocated because it may draw the person’s attention away from the internal processes. People should select the place they wish to use for meditation and continue to use that place. This eliminates adjusting to new surroundings and stimuli each time a person meditates.

Walking the LabyrinthA labyrinth is a single-path (unicursal) structure that has an unambiguous route to the center and back and is not designed to be difficult to navigate. As a spiritual tool or practice, it is thousands of years old. Labyrinths have been found in many ancient cultures, including Greece, Egypt, China, Peru, Ireland, and Scandinavia. As noted by Curry (2000), the labyrinth has roots that extend into prehistoric times and transcend geographic and cultural boundaries. Walking the labyrinth, for many, is a spiritual and even transformative process that can lead to self discovery and insight.

Breath AwarenessBreathing is common to all meditation techniques, but the use of the breath varies across meditation practices. Some meditation practices, such as Zen Buddhist meditation, direct that the practitioner control the breath. Other practices, such as vipassana, or awareness meditation, prescribe passive breathing that is carefully observed.

PRAYER:“Prayer” is from the Latin precarius, which means to obtain by begging, and from precari, which means to entreat. A simple definition of prayer is the lifting up of the heart and soul to a Supreme Being. According to Nouwen, Christensen, and Laird (2006), “prayer is an attitude of an open heart silently in tune with the Spirit of God, revealing itself in gratitude and contemplation” . Prayer, simply, is having a conversation with a loving God.

AssessmentSpiritual assessment should be part of a patient’s health history obtained by nurses or other health professionals. Many spiritual assessments include information about the beliefs people hold, how

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they address the Higher Being, and things that are important to them in order to pray.The Joint Commission (2008) notes the minimal spiritual assessment should obtain information about the faith community or denomination of the patient and what beliefs and spiritual practice, if any, are important to the patient. Examples of other questions that may provide information that is helpful to the health team in planning holistic care are:■ Does the patient use prayer in her/his life?■ How does the patient express his/her spirituality?■ What type of spiritual/religious support does the patient desire? (Joint Commission)Findings from the spiritual assessment will guide the nurse in deciding if, when, and how to use prayer as an intervention.

STORYTELLING:

Storytelling is defined as the art or act of telling stories (Story, 2009). A story is “a narrative, either true or fictitious, in prose or verse, designed to interest, amuse, or instruct the hearer or reader; [a] tale.”Sociolinguist William Labov (as cited in Sandelowski, 1994) states that a complete story typically is composed of:■ an abstract—what the story is about;■ an orientation—the “who, when, where, and what” of the story;■ the complicating action—the “then-what-happened” part of thestory;■ the evaluation—the “so-what” of the story;■ the resolution—the “what-finally-happened” portion of the story;■ the coda—the signal a story is over; and■ the return to the present.

USESThe use of storytelling in health care settings, health care research, and teaching is unlimited. This section will share some examples of the use of storytelling. Nurses can use storytelling in multiple situations across the life span for a variety of purposes. Stories can be used in family therapy and can assist members to tap into the flow of meaning of the past, present, and future, and help patients open up possibilities for making meaning and healing

Energy and Biofield TherapiesTherapies in this category use energy originating in or near the body as well as energy coming from other sources. The concept of energy and its use is universal. Most cultures have a word to describe energy: qi (pronounced chee) is a basic element of traditional Chinese medicine (TCM); ki is the Japanese word for it; in India it is prana; the Dakota Indian word is ton; and the Lakota Indians term it

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waken. Scientists and consumers tend to have the greatest skepticism about the efficacy of energy therapies, primarily because of the difficulty in measuring such “personal” energy.

REIKI:Reiki is an energy healing method that can be used as an alternative or complementary therapy for a broad range of acute and chronic health problems. Increasingly, it is gaining acceptance as an adjunct to management of chronic conditions: pain management, hospice and palliative care, and stress reduction. The word Reiki is composed of two Japanese words—rei and ki. Rei is usually translated as “universal,” although some authors suggest that it also has a deeper connotation of all-knowing spiritual consciousness. Ki refers to life force energy that flows throughout all living things, known in certain other parts of the world as Ch’i, prana, or mana. When Ki energy is unrestricted, there is thought to be less susceptibility to illness or imbalances of mind, body, or spirit (Rand, 2000). In itscombined form, the word Reiki is taken to mean spiritually guided life force energy or universal life force energy. The mind–body component to Reiki healing is evidenced in the underlying belief that the deepest level of healing occurs through the spirit. The emphasis is on healing, not cure, which is believed to occur by Reiki energy connecting individuals to their own innate spiritual wisdom. Reiki flows through, but is not directed by, the practitioner, leaving the healing component to the individual receiving the treatment. Reiki is not only a healing technique, but a philosophy of living that acknowledges mind–body–spirit unity and human connectedness to all things.

USESThe range of potential practical applications with patients is broad and depends on the setting. Reiki has been used in hospice and palliative care, among cancer patients, in HIV/AIDS programs, for pre- and postoperative patients, and in stroke rehabilitation. The common theme described in many of these programs is the benefit of Reiki for pain relief, stress and anxiety reduction, and promoting relaxation. Reiki may have particular application for people suffering from chronic physical andmental health conditions, such as fibromyalgia and depression. A study by Shore (2004) provides evidence that Reiki may reduce symptoms of depression that last as long as one year following treatment. This author is currently serving as co investigator in a study testing feasibility, acceptability, and safety of Reiki touch for premature infants (Duckett, 2008), a new area of Reiki application.

SELF-TREATMENT AND PRACTITIONER BENEFITSOne of the more unique features of Reiki therapy is its capacity to self treat. A Reiki practitioner can self-treat by using hand positions on the head, abdomen, chest, or other areas of the body, reducing pain and/ or increasing a sense of relaxation. The concepts of empowerment and self-treatment have

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particular value when considering chronic health problems. For some Reiki practitioners, teaching their clients Level I Reiki provides the client with a greater sense of control over some of their health problems, including pain management and stress reduction (Miles & True, 2003; Mills, 2001). This author teaches Levels I and II to clients with a variety of health problems, including fibromyalgia,mood disorders, cancer, and neurological problems, such as advanced amyotrophic lateral sclerosis (ALS). Clients with physical limitations may gain particular benefits from learning Level II, or distance healing.

AcupressureAcupressure is defined by Gach (1990) as “an ancient healing art that uses the fingers to press certain points on the body to stimulate the body’s self-curative abilities” (p. 3). To assist the reader, the following definitions are also provided:

■ Acupuncture—“[a] procedure used in or adapted from Chinese medical practice in which specific body areas are pierced with fine needles for therapeutic purposes or to relieve pain or produceregional anesthesia” (Freedictionary, 2009).

Auriculotherapy—“also called ear acupuncture, applies the principles of acupuncture to specific points on the ear” (Firsthealth, 2009).■ Jin Shin Jyutsu—“a non-massage form of shiatsu—using pressure points to ‘harmonize’ the flow of ‘energy’ through the body” (Heall, 2006).■ Meridians—“specific interconnected channels through which Qi circulates” (Answers.com, 2006).

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■ Moxibustion—“[t]he burning of moxa or other substances on the skin, to treat diseases or to produce analgesia” (Freedictionary, 2009).■ Qi (pronounced chee)—“[t]he vital force believed in Taoism and other Chinese thought to be inherent in all things. The unimpeded circulation of chi and a balance of its negative and positive forms in the body are held to be essential to good health in traditional Chinese medicine” (Freedictionary, 2009).■ Shiatsu—“A form of therapeutic massage in which pressure is applied with the thumb and palms to those areas of the body used in acupuncture. Also called acupressure”

Pain of labor Ice massage at Waters & Ice massage assisted women the Large Intes- Raisler (2003) in reducing their pain perceptine 4 (LI 4) tion on a scale from dispoint tressing to uncomfortable.Pain of labor Acupressure us- Chung, Hung, Acupressure reduced the paining Large Intes- Kuo, & Huang of labor while not diminishing tine 4 (LI 4) (2003) the quality of contractions in and Bladder 67 first stage labor. (BL 67) points Pain and dura- Use of Spleen Lee, Change, & Pain and duration of labor tion of labor 6 with continu- Kange (2004) were reduced in the treatment ous pressure group.

Guidelines for UseNurses can incorporate acupressure into the care of patients by using some common points that have specific actions to relieve common symptoms. The nurse can treat the patient with acupressure or teach the patient or family members how to use acupressure as part of a care plan.Stimulating the PointThere are several different types of techniques to stimulate the points, according to Gach:■ Firm stationary pressure—using the thumbs, fingers, palms, the sides of hands, or knuckles■ Slow motion kneading—using the thumbs and fingers along with the heels of the hands to squeeze large muscle groups■ Brisk rubbing—using friction to stimulate the blood and lymph■ Quick tapping—with the fingertips, to stimulate muscles on unprotected areas of the body such as the face

REFLEXOLOGY:Reflexology is defined as a holistic healing technique aimed at treating the individual as an entity, incorporating the body, mind, and spirit. It is a specific pressure technique that works on precise reflex points of the feet that correspond to other body parts TCM posits that there are a number of invisible energy pathways, or meridians, within the body, that carry an energy called Qi, which is the vital energy behind all processes. All organs are interconnected with each other by a meridian network system and, to maintain health, energy needs to be flowing in balance. Factors impeding the free circulation of Qi are divided into categories of “excess” and “deficiency.” Excess refers to the presence of something that is “too much” for the individual to handle—too much food to digest, too much waste to eliminate, and so forth. Deficiency refers to the absence or relative insufficiency of one or more aspects of the life energies necessary for sustaining health and well-being. A deficiency or excess of life energy can allow outside factors to overwhelm the individual, thus inducing pathology, and leading to pain and illness.

USESResearch testing the effects of reflexology is limited and includes studies of many approaches to and practices of reflexology. Some conditions for which it has been used are listed. Reflexology has been found to significantly reduce the anxiety and pain of patients with lung and breast cancer after one session (Stephenson, Weinrich & Tavakoli, 2000). In another study, the duration of the effects of reflexology on pain was tested on patients with various types of cancer. The immediate effects on pain were supported, but the pain-relieving effects were not significant at 3 hours and 24 hours after

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the reflexology session (Stephenson, Dalton & Carlson, 2003). In a study by Ross and colleagues (2002), the effects of reflexology on anxiety and depression were compared with those of simple foot massage on two groups of cancer patients. These cancer patients received six sessions of intervention, and depression and anxiety were measured at baseline and within 24 hours after each session. No significant differences were found between the groups with respect to anxiety anddepression, but both groups indicated experiencing relaxing effects from the treatment.Massage, in the form of back rubs, is a basic skill that has been included in nursing curricula since the beginning of modern nursing. In recent years, back rubs have been largely abandoned by nurses, citing “too busy” as the reason for this decline in use. However, a number of nurses have pursued education to become massage therapists; the practice of massage therapy is often separate from their practice of nursing, although some nurses who are massage therapists use this modality in nursing homes and in independent practice as advanced practice nurses.

Figure 20.1 Relationship of body parts with reflexology points on the foot

MASSAGE:

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DEFINITIONThe term massage is derived from the Arabic word mass’h, meaning “to press gently” (Furlan, Brosseau, Imamura, & Irvin, 2004). Massage, as defined by the American Massage Therapy Association, is “the application of manual techniques and adjunctive therapies with the intentionof positively affecting the health and well-being of the client” (2004—http://www.amtamassage.org/about/definition/html). Various strokes are used to produce friction and pressure on cutaneous and subcutaneous tissues. The types of stroke and the amount of pressurechosen depend on the desired outcomes and the body part being massaged.There are a number of types of massage: Swedish (a massage using long, flowing strokes); Esalen (a meditative massage using light touch); deep tissue or neuromuscular (an intense kneading of the body); sports massage (a vigorous massage to loosen and ease sore muscles); Shiatsu(a Japanese pressure-point technique to relieve stress); and reflexology (a deep foot massage that relates to parts of the body). The different types of massage incorporate a variety of strokes, varying levels of pressure, and a multitude of procedures. Massage strokes can be administered to the entire body or to specific areas of the body, such as the back, feet, or hands.

SCIENTIFIC BASISThe use of massage is a natural healing process that helps to connect the body, mind, and spirit. Massage produces therapeutic effects on multiple body systems: integumentary, musculoskeletal, cardiovascular, lymph, and nervous. Manipulating the skin and underlying muscle makes the skin supple. Massage increases or enhances movement in the musculoskeletal system by reducing swelling, loosening and stretching contracted tendons, and aiding in the reduction of soft-tissue adhesions. Friction to the cutaneous and subcutaneous tissues releases histamines that in turn produce vasodilation of vessels and enhance venous return. Massage has been found to produce a relaxation response (Hattan, King, & Griffiths, 2002; Holland & Pokorny, 2001; McNamara, Burnham,Smith, & Carroll, 2003). Investigators report that massage has produced a decrease in certain physiological parameters (systolic and diastolic blood pressure, heart rate, and skin temperature), indicative of the relaxation response (Mok & Woo, 2004). Reduction of pain, a frequent desired outcome of massage, is closely related to the production of the relaxation response. Studies have validated that patients were more comfortable after the administration of massage (Frey Law et al., 2008; Simmons, Chabal, Griffith, Rausch, & Steele, 2004; Wang & Keck, 2004). The positive impact of massage on pain reduction is often posited on the gate control theory, with massage stimulating the large-diameter nerve fibers that have an inhibitory input on T-cells (Furlan et al., 2004). According to Wang and Keck, “massaging the hands and feet stimulates the mechanorecptors that activate thenonpainful nerve fibers, preventing pain transmission from reaching consciousness” The environment in which massage is administered is important. The room must be warm enough for the person to be comfortable, as shivering could negate the effects of the massage. In addition, privacy needs to be ensured. Adding music and aromatherapy to massage session has been thought to increase the effectiveness of massage.

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MASSAGE STROKESCommonly used strokes in administering massage include effluerage, friction, pressure, petrissage, vibration, and percussion.EffluerageEffluerage is a slow, rhythmic stroking, with light skin contact. Effleurage may be applied with varying degrees of pressure, depending on the part of the body being massaged and the outcome desired. The palmar surface of the hands is used for larger surfaces, the thumbs and fingers for smaller areas. On large surfaces, long, gliding strokes about 10 to 20 inches in length are applied.

Friction MovementsIn friction movements, moderate, constant pressure to one area is made with the thumbs or fingers. The fingers may be held in one place or moved in a small circumscribed area.

Pressure StrokeThe pressure stroke is similar to the friction stroke, except pressure strokes are made with the whole hand.

PetrissagePetrissage, or kneading, involves lifting a large fold of skin and the underlying muscle and holding the tissue between the thumb and fingers. The tissues are pushed against the bone, then raised and squeezed in circular movements. The grasp on the tissues is alternately loosened and tightened. Tissues are supported by one hand while being kneaded with the other. Variations include pinching, rolling, wringing, and kneading with fists or fingers. Petrissage is limited to tissues having a significant muscle mass.

Vibration StrokesVibration strokes can be administered with either the entire hand or with the fingers. Rapid, continuous strokes are used. Because administering vibration strokes requires much energy, mechanical vibrators are sometimes used.

Percussion StrokesFor percussion strokes, the wrist acts as a fulcrum for the hand, with the hand hitting the tissue. Strokes are made with a rapid tempo over a large body area. Tapping and clapping are variants of percussion strokes.

USES:RelaxationMany people use a massage therapist to ameliorate their stress. Mok and Woo (2004) reported a positive response to a slow-stroke back massage in elders who had had a stroke. In a review of 22 studies in which massage had been used, Richards, Gibson, and Overton-McCoy (2000) found that the most commonly reported outcome was a reduction in anxiety. Using foot massage with cardiac patients, Hattan et al. (2002) found that subjects receiving this therapy reported feeling much calmer.In addition to using massage with patients, massage can also be used with a patient’s family members who are experiencing high levels of stress. A short hand massage may help to relax a family member so they can rest or sleep.

PAINReduction of pain is another condition for which massage is often used. Numerous studies have found that massage resulted in a reduction of pain. Ernst (2004), in a meta-analysis of seven studies,

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found that use of Swedish massage may be effective in lessening pain. However, the author also noted that many methodological concerns about the studies existed. In a review of research on the use of massage and aromatherapy in persons with cancer, Fellowes et al. (2004) found a reduction inpain in 3 of the 10 studies reviewed in which massage and aromatherapy had been used with cancer patients. Wang and Keck (2004) reported a lessening of pain in postoperative patients, and Mok and Woo (2004) found that massage lessened pain in patients with strokes.

AROMATHERAPY

Aromatherapy originates in herbal or botanical medicine. There is evidence of plant distillation dating back 5,000 years. In ancient times, essential oils and other aromatic plant products were used throughout much of the world. In ancient Egypt and the Middle East, they were used in embalming, incense, perfumery, and healing. The therapeutic applications of essential oils were recorded as part of Greek and Roman medicine, and essential oils have been used in Ayurvedic medicine inthe Indian subcontinent and in traditional Chinese medicine for over a thousand years. With the expansion of trade and improvements in distillation methods, essential oils became common elements of herbal medicine and perfumery in Europe during the Middle Ages

Aromatherapy uses plant materials and aromatic plant oils, including essential oils, and other aroma compounds for the purpose of altering one's mood, cognitive, psychological or physical well-being.[1]

It can be offered as a complementary therapy or, more controversially, as form of alternative medicine. Complementary therapy can be offered alongside standard treatment, with alternative medicine offered instead of conventional, evidence-based treatments. Aromatherapists, who specialize in the practice of aromatherapy, utilize blends of therapeutic essential oils that can be issued through topical application, massage, inhalation or water immersion to stimulate a desired response.There is no good medical evidence that aromatherapy can either prevent or cure any disease, but it might help improve general well-being

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Essential oils are obtained from a variety of plants throughout the world, but not all plants produce essential oils. Depending on the plant, the essential oil may be found in flowers, leaves, bark, wood, roots, seeds, or peels. Most essential oils are obtained by steam distillation of a specific plant material. Steam-distilled essential oils are concentrated substances made up of the oil-soluble, lower-molecular-weight chemical constituents found in the source plant material. Essential oils fromcitrus fruit peels are usually obtained by expression (similar to grating or grinding). Carbon dioxide extraction is increasingly accepted by scientists and practitioners as a legitimate method for obtaining essential oils; however, other types of solvent extraction generally are not accepted for clinical use. Expressed and CO2 extracted essential oils contain a broader range of the chemicals present in the plant material. Essential oils do not necessarily have the same medicinal properties as the plants from which they are derived.

TYPES OF OILS USEDThere are two types of oils used essential oils and career oil

Essential oilsThese are called the ‘living source’ or ‘energy source’ of the plant Kingdom. They are reputed to influence mood, being either enlivening or Sedating. Essential oils have been found to have various properties experimentally and clinically for example antiviral ,antibacterial ,antifungal, antiseptic, anti inflammatory, sedative, analgesic and stimulating to the movement of body fluids. Essential oils are highly flammable and volatile evaporating rapidly to form vapours. When exposed to air some oil will oxidized. Essential oil should be used to externally only and never undiluted. It is the policy of Auburn Hospital that essential oils are the only ingredient that should be added to a carrier oil. It is wise never to use synthetic oil mixers because they will not be effective in achieving the therapeutic outcome desired.Some of the Essential oil that have been found useful in our midwifery practice in a burn are listed below:1. Eucalyptus is antibacterial, decongestant and energizing though used for its decongestant

properties it is often chosen for its Aroma alone.2. Jasmine contains many of the properties of Rose but it is expensive and it over balance some

people Jasmine is not recommended for used during pregnancy but it is suitable to use during labour

3. Lavender is antidepressant soothing, calming, balancing. This oil has proven to be the most popular and is used for relaxation by either massage or inhalation

4. Lemon and grapefruit are uplifting and refreshing a few drops in water may be sprayed as an air freshener

5. Papper mint is analgesic, decongestant, antispasmodic .it has been found to be useful for nausea associated with labour

6. Rose is antidepressant uplifting and a hormone Balancer. Although reputed to be useful for postnatal depression it can also be used as an alternative to Rose or lavender according to a woman’s preference

7. Sandalwood is a relaxing, sedating and warming. It is beneficial in preserving the aroma in essential oil blends.

CARRIER OILSThese are oils into which the essential oils are blended. They inhibit evaporation of the essential oil and encourage it’s absorption into the skin. They are also known as base oils.Carrier oils have emollient value and contain vitamins that are beneficial for the skin of the mother and baby. The carrier oils also assist the masseur hands to slide smoothly and avoid damage to the skin of the person being massaged.There are many different types of carrier oils. Good carrier oils are sweet almond, apricot kernel,

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peach kernel, grape seed, olive oil or corn oil. Peanut oil or blended oils should not be used. It is important to remember that carrier oils should always be cold pressed, which means there is no change in the composition of the oil during extraction, because no heat is involved in the process. They should be stored in glass and in a cool environment, out of direct sunlight.Aromatherapy is administered in the birth unit by inhalation or in combination with massage or hydrotherapy.

MASSAGEThe multiple benefits of massage are fully discussed below:A. Physical: through its mechanical physiological and reflex effectB. Emotional: through its effects wire the sense of touchC. Mental by promoting a feeling of well beingD. Spiritual energy :through the interchange of energies between the patient and the practitioner

INDICATIONS FOR THE METHOD OF MASSAGEAromatherapy massage is used for the general effects described above but more specifically for emotional support easing of muscle tension and natural pain relief through the release of endorphins. It lends itself especially to Midwifery by1. Deepening the bond between advice and women 2. Providing natural pain relief 3. Easing muscle tension4. Encouraging relaxation 5. Complimenting a normal process 6. Relieving stress and tension related to childbirth and Motherhood 7. lessening common discomfort of pregnancy 8. relieving – discomforts for babies examples gas and constipation.

Massage oils should not be used where there is a history of skin allergies or skin disease. Oil is applied with a movement of effleurage. Message is used commonly both for mother and baby.

MOTHERHelps relieve mothers of tension, backache, breast engorgement and the baby blues:

a) Tension. Although any message seems to help tension, messaging the neck and shoulders is the most effective. Commence effleurage using the palms of the hands and start from the base of

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the shoulders. Petrissage is best used on shoulders to release tension and toxins from the muscles. Use the hand and fingers to gently squeeze the shoulders working from the neck towards the arms. Circular movement over the trapezium muscle helps to relieve upper back tension.

b) Backache in the laboring women it is often caused by a posterior position of the fetus. A back message while the woman is on all fours is beneficial. Placing cushions and bean bags on the floor or bed for the woman to lean over may make the position more comfortable and easier to maintain. Apply the oil over the back area while gentle deep circular movements of the thumbs, working from the coccygeal area of the hip.

c) Breast engorgement : breast engorgement is rarely seen these days gentle massage of lumps and massage towards the nipple is effective in encouraging lymphatic drainage Normally breast massage is not encouraged .Any Essential oil used on the breasts should be washed off before feeding.

d) baby blues: Hormone changes may leave the women feeling depressed. A full body massage can help her to relax and give her an increased sense of well being. Some midwives say they themselves feel more relaxed after giving a woman a massage.

Baby The benefits of massage for the baby :1. improvement in quality of sleep2. assistance in relaxation 3. aid to positive nonverbal communication4. strengthening of respiratory and circulatory function 5. Encouraging weight gain in premature babies

Newborn babies are massage with carrier oils only an essential oils are too concentrated when massaging a baby it is important to use light pressure on the hands, legs and feet. All others areas are massaged with very light stroking movements. Premature babies improve when they are gently stroked showing weight gain and maturation It is important to note, however, that some babies such as those who are medically unstable, can be adversely affected by touch stimulation. Massage is frequently promoted for mother- child interaction and also keeps mother calmer, and makes her feel involved.Session in baby massage for parents or just been established and will be conducted by a midwife with a certificate in infant massage from the international Association of Infant massage.

INHALATIONThe sense of smell is the most evocative of all the senses as the olfactory system, the special sensory nerves of smell, quickly affects the limbic system where emotions are processed. Bad smelling substances are said to Warn of danger, while great Joy may come soon from a scented garden. Inhalation of the Essential oil is the quickest, most direct route into the body due to the vapourization and then the gaseous exchange in the lungs.Experience has shown that ‘ less is better’ when using Essential oil and 2 to 5 drops is all that is required. The Aroma of the oil is effectively dispersed using an oil vaporizer, but a dish of hot water on a piece of cotton wool can also be used. The most common oils used for this purpose are peppermint for nausea, lavender for relaxation, Rose force grieving, eucalyptus for congestion and Floral and citrus oil for freshness.

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HYDROTHERAPY As with inhalation compresses and baths required only a few drops of Essential oil in the water. Water temperature should be tested on the inside of the wrist. compresses are usually in the form of a well wrung out towel, nappy or sponge. Most women choose heat for comfort during labour although some prefer cool compresses to the perineum.

There are several uses for hydrotherapy 1. Some women prefer a warm Essential oil compress for the lower back or abdomen instead of a

massage.2. lavender compresses can be used to relieve the stinging sensation when the perineum is

stretching to accommodate the baby’s head during the second stage of labor.3. Sitz bath is still popular with some people two drops of Lavender oil in a bowl of water will help to

sooth damaged tissue and encourage healing. Sitz baths also helps to alleviate the discomfort of hemorrhoids

4. Essential oil mixed with water and sprayed on a face cloth and placed on the forehead is greatly appreciated by women specially during summer months. During the second stage of labour some women prefer to have a face cloth soaked in lavender water over the forehead to relieve tension and keep them cool.

5. Compresses can also be useful in easing the pain of breast engorgement.6. An Essential oil bath is an effective alternative to body massage 7. Most women like their feet massage or soaked in a bowl of water with a few drops of peppermint

oil to Soothe aches and pains.

SCIENTIFIC BASISEssential oils processed by any of the above methods are highly volatile, complex mixtures of organic chemicals consisting of terpenes and terpenic compounds. The chemistry of an essential oil largely determines its therapeutic properties. There are 60 to 300 separate chemicals in each

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essential oil, with the proportions of the constituents within plant species varying naturally, depending on a host of genetic and environmental factors. Knowing the plant species, the chemotype, the part of the plant used, the country of origin, and the method of essential oil extraction can provide an indication of the essential oil’s chemical constituents using readily accessible aromatherapy reference books. The pharmacologic activity of essential oils begins upon entry to the body through the olfactory, respiratory, gastrointestinal, or integumentary systems. All body systems can be affected once the chemical molecules making up essential oils reach the circulatory and nervous systems. The compounds within an essential oil find their way into the bloodstream however they are applied (Tisserand & Balacs, 1995). Inhaled aromas have the fastest effect, although compounds absorbedthrough massage can be detected in the blood within 20 minutes When inhaled, the many different molecules in each essential oil act as olfactory stimulants that travel via the nose to the olfactory bulb, and from there impulses travel to the limbic system of the brain. Ofthe limbic system regions, the amygdala and the hippocampus are of particular importance in the processing of aromas. The amygdala governs emotional responses. The hippocampus is involved in the formation and retrieval of explicit memories. The limbic system interacts with the cerebral cortex, contributing to the relationship between thoughts and feelings; it is directly connected to those parts of the brain that control heart rate, blood pressure, breathing, stress levels, and hormone levels. Although inhalation of essential oils is largely thought to be associated with olfaction, some molecules from any vapor inhaled will travel to the lungs, where they can have an immediate effect on breathing and can be absorbed into the circulatory system. Tisserand and Balacs (1995) gave the example of the effect of Lavandula angustifolia (true lavender), thought to reduce the effect of external emotional stimuli by increasing gamma-aminobutyric acid (GABA), which in turn inhibits neurons in the amygdala, producing a sedative effect similar to that of diazepam Essential oils are absorbed through the skin by diffusion, with the epidermis and fat layer acting as a reservoir before the components of the essential oils reach the dermis and the bloodstream. Topically applied essential oil preparations are absorbed rapidly through the skin; some have been used to enhance the dermal penetration of pharmaceuticals (Williams & Barry, 1989). The rate and extent of penetration and absorption can vary depending on multiple factors, such as the part of the body treated, the condition of the skin, the age of the patient, and the carrier or vehicle for the essential oil. Massage can enhance dermal penetration through heat and friction. Essential oils are excreted fromthe body through respiration, kidneys, and insensate loss.

INTERVENTIONThe choice of application method—inhalation, topical application, ingestion— depends on the condition being treated or the desired effect, the nurse’s knowledge and practice parameters, the available or desired time for the action to occur, the targeted outcome, the chemical componentsof the essential oil, and the preferences and psychological needsof the patient. Although essential oils are not always pleasant smelling, inhalation is one of the simplest and most direct application methods. With this method, one to five drops of an essential oil can be placed on a tissue or floated on hot water in a bowl and then inhaled for 5 to 10 minutes.Other inhalation techniques include the use of burners, nebulizers, and vaporizers that can be operated by heat, battery, or electricity and may or may not include the use of water. Larger, portable aroma-inhalation systems are available commercially to provide controlled release ofessential oils into rooms of any size. Inhalation effects as well as skin effects are also experienced when essential oils are used in a bath. Four to six drops of the essential oil are dissolved first in a teaspoon of whole milk, rubbing alcohol, or carrier oil (cold-pressed) and then placed in the bath water. Because essential oils are not soluble in water, they would float on the top of the water if used without such a dispersant and this could result in an uneven and possibly too concentrated treatment. The essential oil bath should last about 10 to 15 minutes. Essential oils can also be dissolved

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in salts (e.g., Epsom salts); this can be soothing to muscles and joints. One such recipe for bath salts consists of 1 tablespoon of baking soda, 2 tablespoons of Epsom salts, and 3 tablespoons of sea salt with 4 to 6 drops of essential oils mixed throughout. Salts should be added to the bath water just before immersion and after agitating the water to disperse them. Compresses can be a useful method for applying essential oils to treat skin conditions or minor injuries. To prepare a compress, add 4to 6 drops of essential oil to warm water. Soak a soft cotton cloth in the mixture, wring it out, and apply the cloth to the affected area, contusion, or abrasion. Cover the compress with plastic wrap to retainmoisture, place a towel over the plastic wrap, and keep it in place for as long as desired (up to 4 hours). The use of very warm water can enhance the absorption of some of the components of essential oilsMassage also can facilitate absorption of essential oils through the skin and can reduce the patient’s perceived stress, thus enhancing the healing process and possibly communication as well. To create a mixture for massage, dilute one to two drops of an essential oil in a teaspoon (5 mL) of cold-pressed vegetable oil, organic and scent-free cream, or gel. Mixtures for massage are generally 1 to 5% essential oil concentration Essential oils should not be used undiluted on mucous membranes; even on intact skin they are generally used in concentrations seldom exceeding 10%. When used to treat conditions such as vaginal infections, essential oils preparations can be created or purchased as pessaries or suppositories. Only essential oils high in alcohols, such as tea tree, are appropriate in pessaries; alcohols are less likely to cause skin irritation. If essential oils are applied via tampons, they should be changed regularly (Buckle, 2003). Oral thrush (candidiasis) in adults also can be treated with diluted essential oils by the swish-and-spit method, taking care not to swallow

General Guidelines for Use of Essential OilsThere are general safety guidelines for essential oils that nurses should be aware of for patient education and in practice. These include:1. Store essential oils away from open flames; they are volatile and highly flammable.2. Store essential oils in a cool place away from sunlight; use amber or blue-colored glass

containers. Close the container immediately after use. Essential oils can oxidize in the presence of heat, light, and oxygen, changing their chemistry, and thus their actions, in unpredictable ways.

3. Be aware that essential oils can stain clothing and textiles and that undiluted essential oils can degrade some plastics. Take appropriate precautions.

4. Keep essential oils away from children and pets unless you are well-versed in clinical aromatherapy. The literature is full of case studies of adverse reactions or deaths related to improper applications or accidental ingestion in small children and pets.

5. Use essential oils from reputable suppliers. Seek the advice of a trained aromatherapist or the recommendation of a knowledgeable clinical provider. If using essential oils in clinical or research settings, test results verifying the chemical constituency should be obtained.

6. Special care is needed when using essential oils with or around persons who have a history of severe asthma or multiple allergies. Be sure to ask.

7. Despite the relative safety of essential oils when used properly, sensitization and skin irritation can occur with topical application. In these cases, any residual essential oil solution should be removed and its use should be discontinued. Most such reactions resolve without treatment; however a health care provider should be consulted if discomfort/itching is severe or persists.

8. If an essential oil gets into the eyes, rinse it out with milk or carrier oil first and then with water.

Some of the materials employed include:a. Essential oils: Fragrant oils extracted from plants chiefly through

steam distillation (e.g., eucalyptus oil) or expression (grapefruit oil). However, the term is also

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occasionally used to describe fragrant oils extracted from plant material by any solvent extraction. This material includes incense reed diffusers.

b. Absolutes: Fragrant oils extracted primarily from flowers or delicate plant tissues through solvent or supercritical fluid extraction (e.g., rose absolute). The term is also used to describe oils extracted from fragrant butters, concretes, and enfleurage pommades using ethanol.

c. Carrier oils: Typically oily plant base triacyl glycerides that dilute essential oils for use on the skin (e.g., sweet almond oil).

d. Herbal distillates or hydrosols: The aqueous by-products of the distillation process (e.g., rosewater). There are many herbs that make herbal distillates and they have culinary uses, medicinal uses and skin care usesCommon herbal distillates are chamomile, rose, and lemon balm.

e. Infusions: Aqueous extracts of various plant material (e.g., infusion of chamomile).f. Phytoncides: Various volatile organic compounds from plants that kill microbes.[ Many terpene-

based fragrant oils and sulfuric compounds from plants in the genus "Allium" are phytoncides] though the latter are likely less commonly used in aromatherapy due to their disagreeable odors.

g. Vaporizer (Volatized) raw herbs: Typically higher oil content plant based materials dried, crushed, and heated to extract and inhale the aromatic oil vapors in a direct inhalation modality.

Functional Foods and NutraceuticalsThe FDA defines foods as “articles used primarily for taste, aroma, or nutritive value” (Federal Food, Drug and Cosmetic Act, 1938, § 210). Historically, the FDA has made several attempts to regulate these products and remove some of them from the market (Kottke, 1998). Functional foods are defined as manufactured foods for which scientifically valid claims can be made. They maybe produced by food-processing technologies, traditional breeding, or genetic engineering. Functional foods should safely deliver a longterm health benefit. Accordingly, a functional food may be one ofthe following:■ A known food to which a functional ingredient from another food is added■ A known food to which a functional ingredient new to the food supply is added■ An entirely new food that contains one or more functional ingredients

NUTRACEUTICAL

Nutraceutical has been defined as “a blend word of nutrition and pharmaceutical, for a substance that

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may be considered a food or part of a food and that provides medical or health benefits, including the prevention or treatment of disease” (Marshall, 1994, p. 243). These substances pose problems for official medicine regulators. The Japanese, who were among the first to use functional foods, have highlighted three conditions that define a functional food:■ It is a food (not a capsule, tablet, or powder) derived from naturally occurring ingredients.■ It can and should be consumed as part of a daily diet.■ It has a particular function when ingested, serving to regulate a particular body process, such as enhancement of the biological defense mechanism, prevention of a specific disease, recoveryfrom a specific disease, control of physical and mental conditions, and slowing of the aging process.

USESNutraceuticals have been used to promote health and to prevent and treat illness. Nutraceuticals can be used to target deficiencies, establish optimal nutritional balance, or treat diseases. Because heart disease, cancer, and stroke are leading causes of death in the United States, greater access to nutraceuticals that have been shown to improve riskfactor profiles is desirable. Furthermore, people in the United States and worldwide could benefit from nutraceuticals when there are deficienciesof specific nutrients.

Women’s Health and Nutritional NeedsThroughout their life span, women have unique nutritional needs that place them at risk for nutrition-related diseases and conditions. Nutrition has been shown to have a significant influence on the risk of chronic disease and on the maintenance of optimal health status. Although food should be the first choice in meeting such needs, nutritional supplementation may be necessary (American Dietetic Association, 2001). Following are some examples of increased nutritional needs across the life span:■ An increase in calcium during pregnancy and menopause is necessary.■ Folic acid requirements increase during pregnancy to prevent neural tube defects.■ Iron needs increase during menstruation and pregnancy.Although acquiring these nutrients through food sources would be ideal, supplementation is often necessary. It is also important to remember that intake of certain nutrients above a certain level can be teratogenic (e.g., too much Vitamin A in the first trimester of pregnancy) and, becausemany foods are often enriched with vitamins and minerals, it is possible to consume too much.

ACCUPUNCTURE

Acupuncture has been used in China for more than 2000 years. Specific anatomic parts of the body are stimulated for therapeutic purposes. This can be done in the usual way with needles, but practitioners may also use heat, pressure, impulse of magnetic energy, burning by a preparation of the herb Artemia vulgaris, electrical stimulation or surface electrodes at acupuncture loci.

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Acupuncture is based on the balance between Yin and Yang. Treatment is aimed at reconstituting the normal movement between these two opposites. The meridians are considered as energy channels. Most treatments of obstetrical and gynecological problems involve the use of points on different meridians: spleen-pancreas located on the inside of the ankle bone, conception, governing or penetrating vessel.Acupuncture may produce effects through several different mechanisms. One hypothesis is that acupuncture points have electrical properties that, when stimulated, may alter the level of chemical neurotransmitters in the body. Another hypothesis is that endorphins are released due to activation of the hypothalamus. The effects of acupuncture have also been attributed to alterations in the natural electrical currents or electromagnetic fields in the body.The use of acupuncture for pain relief has given equivocal results. Wallis et al.in San Francisco in 1974 found that 19 of 21 patients had inadequate pain relief based on pain scores and none of the 21 subjects was judged by investigators to have adequate analgesia. Abouleish and Depp in the USA in 1970 used electroacupuncture and described relief of pre-existing pain in 7 of 12 participants. The investigators, who found the technique time-consuming, cited some disadvantages: inconsistency, unpredictability and lack of completeness. Hyodo and Gega in Japan in 1977 in a study of subjective and objective relief of labor pain in 32 women described an improvement in ~60% of 16 primiparous women and 90% of 16 multiparous women. However, all patients received systemic sedation. The authors concluded that acupuncture is useful for delivery because of its safety, despite erratic and less potent results than conventional analgesic techniques. In Nigeria in 1986, 19 of 30 women (63.3%) given sacral acupuncture by Umeh indicated that they had adequate pain relief by responses on a visual scale and did not request another form of analgesia. Yanai et al. in Israel in 1987 evaluated electroacupuncture during the labor of 16 parturients. Fifty-six percent of the women reported mild to good pain relief and 81% described increased relaxation. The perceived positive effects led the authors to believe that acupuncture should be pursued as an additional method of pain control. In 1999, Lyrenas et al.in Sweden studied 31 primiparous women who had received repeated acupuncture compared with untreated women. Pain assessed on a VAS was not reduced in women treated with acupuncture, and the acupuncture did not reduce the need for analgesics during labor. In 2002 Ramnero et al. in Sweden reported a randomized, controlled study in 90 parturients, 46 of whom received acupuncture during labor as a complement or alternative to conventional analgesia. Acupuncture significantly reduced the need for epidural analgesia (12% vs. 22%). Patients in the acupuncture group reported a significantly greater degree of relaxation compared with the control group. The authors considered these results to suggest that acupuncture could be a good alternative or complement for women who seek an alternative to pharmacological analgesia in childbirth, but further trials are required to clarify whether the main effect of acupuncture during labor is analgesic or relaxing. In the trial by Skilnand et al.,210 parturients were randomly assigned to receive either real acupuncture or false acupuncture. Real acupuncture consisted of a treatment protocol from the Norwegian School of Acupuncture. The same type and number of needles were used not on the classic meridians. Pain was assessed using a linear VAS (rated 0-10) recorded at 30, 60 and 120 min after treatment. There were significantly lower pain scores at 30, 60, 120 min after treatment (P < 0.001), and significantly less need for epidural analgesia and intramuscular pethidine (P = 0.01 et P <0.001, respectively). Qu and Zhou compared in a prospective randomized study 20 primipara with electro-acupuncture and 19 as controls. The electro-acupuncture group was found to exhibit a lower pain intensity and a better degree of relaxation than the control group (P = 0.018 and 0.031).Acupressure is a descendant of Chinese manipulative therapy in which points are stimulated by pressure, using hands, fingers and thumbs. Acupressure supposedly promotes the circulation of blood, the harmony of yin and yang and the secretion of neurotransmitters, thus maintaining the normal functions of the human body and enhancing well being. Some midwives use acupressure to release the pain of labor. Pressure is applied simultaneously to both sides of the spine in the lower back. Pressure against spots that are sensitive can be particularly efficacious. Force is initially applied during contractions and then continuously.

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HOMEOPATHY

Homeopathy involves the use of diluted substances that cause symptoms in their undiluted form. According to homeopathic theory, remedies stimulate the self-healing mechanism. The amount of medicine prescribed is so small that it often cannot be measured in molecular amounts.We found no studies evaluating the effect of homeopathic treatment on labor pain. Smith[31] has reviewed cervical ripening and labor induction by "caulophyllum". There were no differences between the homeopathy and control groups in a randomized, controlled trial involving 40 women.Manual healing methods used today during delivery include therapeutic touch and massage therapy.

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

Massage Therapy. The practice of massage varies from the tickling massage of 'kung fu' to a firm massage. The effect of a gentle massage of the periumbilical area by their partner was studied in nine women compared with six who received no massage. There was no significant difference between the two groups in pain evaluated by means of visual scale, and no difference in the time of use of epidural analgesia for labor.

Transcutaneous Electrical Nerve Stimulation. TENS involves administration of low voltage electrical stimuli through flat electrodes applied to the skin. TENS units consist of a stimulator and two pairs of electrodes. The upper electrodes are taped at the level of the tenth thoracic to the first lumbar root and the lower pair at the level of the second to fourth sacral nerves. The stimulator has two channels for the two pairs of electrodes. Initial reports were encouraging. Augustinson et al. (1977) found that among 147 women, 44% rated pain relief as good or very good and 44% as moderate. Bundsen et al. found TENS to be especially beneficial for labor pain localized in the back. However, a meta-analysis by Carroll et al.of 10 randomized, controlled trials in 877 women, 436 receiving TENS and 441 as controls, revealed no significant difference in pain and the use of additional analgesic interventions was not different between the two groups.Sterile Water Blocks. Counter-irritation is the process by which localized pain may be relieved by irritating the skin in the same dermatomal distribution. For example, the uterus is supplied by the

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lower thoracic spinal cord segments. Some of these receive stimuli from the skin of the lower back and the sacrum. Labor analgesia may be produced by counter-irritation of this area. Irritation can be achieved by intracutaneous injection of sterile water papules over the sacrum with a fine needle. Lytzen et al.in Sweden noted instant and complete relief of lower back pain in the first stage of labor in 83 women. Pain relief lasted as long as 3 h. In some women, the block was repeated. Half of the women required no other form of analgesia. Martensson and Wallin compared in a randomized study pregnant women with severe labor pain treated by injections of water intracutaneously and isotonic saline subcutaneously injections (placebo). Labor pain was significantly lower in the first group compared with the placebo group (P = 0.002 and 0.006). Labrecque et al.compared water blocks with TENS for the treatment of lower back pain during labor. Women who received the sterile water injections rated the intensity of pain lower than did women in the TENS group. Intracutaneous water injections are associated with a sharp injection pain that lasts between 20 and 30 sec, which some women find less acceptable than lower back pain. This method may be an alternative for women who have lower back pain during labor but wish to avoid epidural analgesia. (ll) Biologically Based Treatments

1. Herbal MedicineHerbal medicine has always attracted some scientific interest and many well known drugs are plant-derived, for example digoxin from foxgloves and morphine from poppies. The following are some of the herbs commonly thought to be effective: St Johns’s Wort (Hypericumperforatum) is a safe and effective treatment (if taken as the only

treatment) for mild to moderate depression. It may also help fatigue- possibly because fatigue is a common aspect of depression.

Ginkgo Biloba may be effective in relieving the symptoms of dementia and it may also support memory in all older people.

Horse chestnut seed extract can alleviate the symptoms of varicose veins. Tea tree oil may be effective against fungal infections such as athlete’s foot. Vegetable from the allium family (onions and garlic) may protect against certain cancers if eaten

regularly especially cancers of the digestive tract, though further studies need to be done. Remember, some herbal medicines and prescribed drugs do not mix, consult your doctor if you

are taking conventional drug.

HERBAL MEDICINE is described as the use of plant materials in medicine and food for therapeutic purposes. Various herbal remedies are used during the prenatal period to 'prepare' the uterus and cervix for childbirth and ease pain during labor and delivery.In a study of the practice of a group of independent midwives in Utah, specific herbs were used because of their perceived actions and properties, in particular a '5-week formula' which is a combination of 10 herbs used during the last 5 or 6 weeks of pregnancy. This is said to facilitate birth. Some herbal remedies are used as the principal method of managing pain and enhancing endurance during delivery. Practitioners observed that these herbal formulas had a calming and relaxing effect. Labor pain can also be treated specifically with motherwort. The effect of raspberry leaf in facilitating labor in 192 multi parous women was studied by Simpson et al. in a double-blind, randomized, placebo-controlled trial in Australia. Raspberry leaf was consumed in tablet form from 32 weeks of gestation until labor. Contrary to popular belief, it did not shorten the first stage of labor but rather the second (mean difference 9.59 min), and also lowered the rate of forceps deliveries (19.3% vs. 30.4%). The difficulty with herbal remedies is that few have undergone scientific scrutiny, chemical isolation, or extraction to identify the pharmacologically active agent or to enable toxicity testing.a. Nutrition and DieteticThis includes the prescription of a balanced wholesome, natural diet, based on the principles

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advocated by naturopathic practitioners.Nutritional therapy is a system of healing based on the belief that food, as nature intended, provides the medicine we need to obtain and maintain a state of health: out food is our medicine and our medicine is our food. Although some health problems require specific medication, many conditions can be relieved effectively with nutritional therapy. These include disorders raging from chronic fatigue, energy loss, insomnia and depression, to backache, skin complaints, asthma, and headaches.Nutritional therapy will also benefit you if you have no specific illness, but want to maintain a state of optimum health. It is safe for babies and children as well as adults, and the change of eating patterns that is typically prescribed usually has far fewer side effects than synthetic medicines.Nutritional therapy is a holistic discipline; nutrition as the key to good health is the all-embracing fundamental principle used since the time of the famous Greek doctor and founder of western medicine, Hippocrates, to help people of all ages to stay at their personal peak of energy and vitality. Today, new insights of food scientists play a significant role in the practice of nutritional therapy as preventative medicine.During the last fifty years, many wonderful breakthroughs have improved our understanding of the role of food in our lives. Many of us are realizing that food is the cornerstone on which, our modern lifestyle, has been built.Antioxidants are the nutritional supplements which can remove the free radicals from human boy so as to prevent serve disease conditions like cancer.

b. FastingThe controlled abstinence from food has been therapeutically for over 2000 years. It was advocated by Hippocrates as a treatment for many diseases, because it allowed the body to concentrate its resources on dealing with disease rather than the processes of digestion. Although largely ridiculed by orthodoxy for many years, fasting has recently begun to gain a reputation as an excellent and safe treatment for conditions such as obesity, high blood pressure, arthritis and rheumatism, various allergies and some psychiatric disorders.

c. Structural adjustmentBy such methods as osteopathy, chiropractic, neuromuscular technique, postural re-education and remedial exercises, the naturopathic practitioner seeks to balance and integrate the spine, muscles, ligaments and joints of the whole body.

d. HydrotherapyThis is the use of water, both internally and externally in the form of baths, packs, compresses, sprays and douches. Hydrotherapy is of value in most conditions and rightly applied can give remarkable results in the treatment of both acute and long-standing conditions.The popularity of undergoing part of labor in water has increased dramatically around the world. The expected benefits include pain relief and decreased use of analgesia and anesthesia. Several studies have reported use of analgesia for women undergoing labor in water, but others have found no difference from control groups. In a 1987 non-randomized, prospective, controlled study, Lenstrup et al evaluated the effect of a warm bathtub on 88 parturients, and found that cervical dilatation rate and pain relief could be improved in patients who had a bath during the first stage of labor. In 1988, independent midwives used hydrotherapy in which a clean bathtub was filled with warm water. The clinical impression of practitioners who use hydrotherapy is that their patients experience shorter and less painful labor. Burn and Greenish Studied 302 women who used a labor pool. Fifty percent of the primigravidas in the pool group used pain medication, compared with 76% in the control group. Rush et al. found in a randomized study in 785 women that the tub group required fewer pharmacological agents than the control group (66% vs. 59%, P = 0.06). Cammu et al. in a prospective randomized trial using a VAS showed that absolute values of labor pain were not

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significantly different between hydrotherapy and control groups.In the Cochrane Pregnancy and Childbirth register, eight randomized controlled trials (2939 women) comparing bath tub/pool with no immersion during pregnancy, labor or birth were selected. Women who used water immersion during the first stage of labor reported statistically significant less pain than those not laboring in water. There was a statistically significant reduction in the use of epidural/spinal/paracervical/analgesia/anaesthesi among women allocated to water immersion during the first stage of labor compared with those not allocated to water immersion. There were no significant differences incidence of an Apgar score less than 7 at 5 min, neonatal unit admissions or neonatal infection rates.Maternal satisfaction with this birth experience has been measured and women report increased levels of satisfaction, self-esteem, pain relief and relaxation with immersion. Ruptured membranes have been discussed as a potential problem in the use of hydrotherapy

e. Healthy LifestyleThis includes the general care of one’s body, the use of moderate physical exercise, the cultivation of a positive approach to life and health, relaxation techniques, etc.

f. EducationIn naturopathic philosophy it is just as important, if not more so, to explain to the patient why disease occurs and what the patient can do for him or herself to maintain the new, improved level of health given to them by naturopathic treatment. In this way the patient is given responsibility for his or her health.Naturopathy is based on the belief that the body is self-healing. The body will repair itself and recover from illness spontaneously if it is in a healthy environment. Naturopaths have many remedies and recommendations for creating a healthy environment so the body can spontaneously heal itself.

(IV) Manipulative And Body

1. YogaThe fundamental idea behind the practice of Yoga is to unite the individual self (Jiva) with supreme or pure consciousness (Brahma). The factual connotation of Yoga is unification. Merging in this static realism liberates the spirit from all sense of separation. It liberates the mind from the ignorance of time, space and causation. However, as Yogic philosophy says, the human body and mind are parts of the deceptive world of matter, with a limited period, whereas the spirit is endless and passes onto a new world when this body dies. Therefore, fundamental to Yogic philosophy are the concepts of Karma- cause and effect relationship.In the present view, Yoga is one of the most helpful and healthy forms of experience to manage the influence of thinking by turning psychological and physical force into spiritual energy. Yoga therapy eases oneself from the cramped tension. Concentration is enhanced by Yoga. Yoga therapy cures all diseases and controls the aging process. Its daily practice is often seen as a way of gaining control over your health.Most of the practices of yoga therapy are used as complementary practices to conventional medicine. Some of these practices are exercise, meditation and massage limitations into account.The main aim of yoga therapy is the mind/body integration, which strike into the normal healing properties of the body and helps to restore functions of your body and health.Yoga therapy consists of three basic parts of your body which work together.

Physical PostureIt helps to stretch and strengthen your muscles. It also improves your mobility, flexibility and balance. The proper posture enhances your body’s natural functions of circulation, elimination, respiration, and

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digestion.

Breathing techniqueIt mainly focuses on awareness of breath and helps promote calm, focus the mnd and relieve stress and fatigue.

Relaxation techniqueIt mainly helps you to recharge and ease tension.

Self careSleep is one of the most important activities that mom can do to care for herself and her baby. Sleep will allow mom’s body to heal and to make the major adjustments to caring for a dependent little baby. Whenever baby is sleeping, mom should be sleeping in the first 2 – 6 weeks. Housework, cooking, visitors, phone calls, helping others, working outside the home and computer time all are of very little importance compared to mom getting sufficient sleep.

Breastfeeding may be one protective factor against postpartum illness. Some research indicates that when a mother breastfeeds her infant, the hormones oxytocin and prolactin provide a decreased neuro-endocrine response to stressors (Nutritional Review, July 2004, 261-268). In other words, little things don't produce as much stress reaction. Furthermore, the higher levels of prolactin produced by breastfeeding also serve to enhance a mother's sense of well-being. Therefore, in addition to the many other benefits of breastfeeding, nursing mothers may also have a decreased incidence of severe postpartum depression.

Nutrition - Deeply nourishing foods, sufficient water, herbal teas and select supplements help to form the most basic and essential substances for postnatal recovery, renewal and long-term well-being. Breastfeeding mothers actually need slightly higher levels of many vitamins and minerals than pregnant women. Ideal foods will be iron-rich, sustaining, slow releasing and organic. Berries, high-protein whole grains, leafy greens, legumes, nuts, seeds, fresh organic fruits and vegetables, organic meats, and fish that are low in mercury are all excellent choices.

What is good for the mother is usually good for the baby as well, so commitment to the healthiest dietary choices is a gift to yourself and your growing family. Eating low-allergenic foods is also important for women who have a family history of allergies, in order to avoid reactions in their babies. In addition, these specific herbal teas and supplements are healthful choices:

• Continue to take prenatal vitamins and minerals.

• Enjoy raspberry leaf and nettles tea. This mixture is iron- and nutrient-rich, and raspberry leaf is a uterine tonic, supporting the return of the uterus to a healthy post-pregnancy condition and preventing after-pains.

• Take fish oils containing a high amount of DHA. DHA is the main essential fatty acid in breastmilk, supports brain development in the baby, and helps to prevent postpartum depression for mom as well.

• Probiotics, in particular Lactobacillus GG, help to support a healthy gut flora in the mother and, when taken six weeks before and after birth, have been shown to reduce the incidence of allergies and allergic-related conditions (e.g. eczema) for the baby.

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Exercise: Research has shown that 30 minutes of exercise a day is as effective as any anti-depressants, without the side effects of the drugs. Many movement activities are beneficial, including:

Walking and runningBiking or roller bladingSwimmingBelly dance Tai chi and qi gongAikidoBallroom and swing dancingSkiing or skatingYour favorite activities!

Meditation practices offer abundant methods of calming oneself, developing awareness, working with difficult mind-states, and undoing unhelpful habits of the mind. Everyday mindfulness practices are a resource for postpartum women to foster compassion, joy and spaciousness for herself as she goes through the intense changes of motherhood and tending baby. A postpartum woman may find she has beliefs, expectations or emotional reactions that are not helpful to her, her baby or her situation. Mindfulness practices are a gentle process of self-care, love and acceptance of things just as they are. Meditation can complement any faith. RESEARCH :

Complementary and Alternative Medicine in Pregnancy: A Survey of North Carolina Certified

Nurse ‐ Midwives

Allaire, alexander d. Md, msph; moos, merry-k fnp, mph; wells, steven r. Md conducted a study in January 2000 - Volume 95 - Issue 1 - p 19–23, To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina.

Methods: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients.

Results: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation.

Conclusion: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.

Complementary and alternative medicine is composed of medical systems, practices, interventions, applications, theories, or claims that are not currently part of the dominant or conventional medical

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system. The public and conventional medical care providers have shown increasing interest in complementary and alternative medicine. Two recent national surveys found that the use of alternative medicine by adults in the United States increased from 34% in 1990 to 42% in 1997.1,2 Unconventional therapy was common among those of reproductive age,1,2 and more common among women of reproductive age.2 Almost half of all women (48.9%) reported use.2 Therefore, it is possible that a significant number of pregnant women are currently using complementary and alternative medicine to treat disorders of pregnancy, although the percentage is unknown.

Pilot research, including review of nurse-midwifery professional publications, a pilot survey of nurse-midwives outside North Carolina, and discussions with local nurse-midwives, found that many nurse-midwives have incorporated complementary and alternative medicine into their practices. It is unknown how prevalent complementary and alternative medicine is among nurse-midwives. Almost no literature exists concerning the use of complementary and alternative medicine in pregnancy by physicians (obstetricians and family practitioners). Recent reviews of the literature showed that quality scientific research evaluating efficacy and safety of those agents is limited.3–5

The goal of this study was to investigate the use of complementary and alternative medicine by certified nurse-midwives in North Carolina. The primary objective was to determine the percentage of nurse-midwives offering those treatments, the conditions during pregnancy for which they are used, and the most common types being used. Pilot research suggested that herbal therapy was commonly used, so patterns of use of herbal therapies were studied in depth.

REFERENCE:

1. www.parentingoasis.com2. www.childbirthcollective.org/3. Permissions to reprint excerpts of Deborah Savran’s article, ‘Postpartum Care for the

New Mother’ from their newsletter Mix, May/June 20084. Elsevier ‘complementary/ alternative therapies in nursing, Mariah Synder and Ruth

Lindquist. Edition-6, page no 119-2765. Ausmed ‘ Complementary Therapies in Nursing and Midewifery from vision to practice’ by

Pauline Mc Cabe.page no-283-2976. http://journals.lww.com/greenjournal/Abstract/2000/01000/Complementary_and_Alternati

ve_Medicine_in.4.aspx