INTRODUCTION:-

Alternative and Complementary therapies are increasingly popular with both consumer and

professional and are based on a philosophy of holism and an interaction between body, mind and
spirit in which it is believed that all components in combination contribute to the whole. Within
midwifery, use of alternative complementary therapies (CTs) has been driven by mothers
looking for ‘strategic to help them cope with pregnancy and labor discomforts and to aid
relaxation. It is thought that as many as 3quarters of women may self- administer substances
such as herbal, homeopathic, aromatherapy flower and it has previously been estimated that over
a 3rd of midwives use these therapies in their practices .

DEFINITIONS

  Complementary therapy : complementary therapies are those used in conjunction with

conventional therapies (for example meditation used as an adjunct to analgesic drugs)

  Alternative therapies : alternative therapies are used instead of conventional or

mainstream therapies( for example the use acupuncture/ acupressure rather than
analgesics to relieve pain)

The difference between complementary and alternative therapies

 The phrases complementary therapy and alternative therapy are often used as if they
mean the same thing. They may also be combined into one phrase – complementary and
alternative therapies (CAM). It is not always easy to decide whether something is a
complementary or an alternative therapy. But there is an important difference. 
 A Complementary Therapy means you can use it alongside conventional medical
treatment. It may help to feel better and cope better with disease and treatment. It is
important to discuss with doctor any complementary therapy that are of using. They are
used to enhance quality of life, to reduce pain, to reduce other symptoms, to make
patients generally feel better, stronger, and calmer. And most importantly they are used in
an adjunctive fashion along with, not instead of, mainstream therapy. For example, a
cancer patient receiving chemotherapy may also undergo acupuncture to help manage
chemo side effects like nausea and vomiting
 An Alternative Therapy:- It  is generally used instead of conventional medical
treatment. All conventional treatments have to go through rigorous testing by law in order
to prove that they work. Most alternative therapies have not been through such testing
and there is no scientific evidence that they work. Some types of alternative therapy may
not be completely safe and could cause harmful side effects. Alternative medicine differs
in that it is not used as a complement to, but rather as a substitute for traditional therapy.
An example would be a cancer patient who forgoes recommended chemotherapy and
instead chooses to treat the disease with specific dietary changes.

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CLASSIFICATION OF ALTERNATIVE AND COMPLEMENTARY THERAPIES

Experts divide complementary therapy into five categories

  Sensory
  Cognitive
  Expressive
  Physical
  Medical systems

I. SENSORY COMPLEMENTARY THERAPY

Sensory complementary therapies are that work in conjunction with five senses: smell, sight,
taste, sound & touch, as well as the body’s overall energy.
a. Aromatherapy
Aromatherapy is the therapeutic use of plant-derived essential oils to promote physical and
psychological well being. Essential oils are lipid-soluble and are rapidly absorbed when applied
externally or are inhaled . They are excreted through the kidneys or expired through the lungs.
The use of essential oils in low doses for massage or as an environmental fragrance is increasing
in healthcare settings. For labor, therapeutic-grade oils such as lavender or jasmine, mixed with a
carrier oil or lotion, can promote relaxation and perception of pain. Peppermint oil may be
effective in decreasing nausea and vomiting. Never ingest aromatherapy oils .

Contraindication :- during pregnancy, women should avoid many of the essential oils because
of toxicity of the fetus . Also pregnant women appear to have a particularly sensitive sense of
smell; therefore aromatherapy mixtures, if used should be well diluted.

Side effects :- some essential oils are contraindicated because of the a possible increased risk of
abortion, gestation hypertension or hemorrhage therefore oils should be administered by trained
aroma therapist in collaboration with the obstetrician .

b.Massage
Another complementary therapy that nurses can incorporate throughout labor is the promotion of
relaxation through the use of massage. Relaxation and massage have been shown to be factors in
promoting labor progress, decreasing pain perception, and increasing the woman’s ability to cope
with labor. The use of massage not only contributes to pain relief but also communicates caring
and concern for the woman.
Many massage techniques are practiced , but the most wide spread modern variation builds on
the basic strokes of Swedish massage. Effleurage is slow , rhythmic , gliding strokes, usually in
the direction of blood flow towards the heart .
Often the care provider uses the whole hand (palm and finger), gradually applying an increasing
amount of pressure (eg. During a labor contraction) . Variations of effleurage involve strokes
applied with the fingertips, heel of the hand , or knuckles. Effleurage is a procedure taught in
prenatal classes and is used when the women is having labor contractions .

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Classic Swedish Massage :- Swedish massage is a classic form of massage that uses long
strokes and gentle techniques to help relax and energize you. Swedish massage targets the whole
body to help relax the body and mind, improve muscle tone, and enhance blood flow. Swedish
massage is an excellent technique for relieving muscle tension and releasing toxins from the
muscles.

Deep Tissue Massage :- Deep tissue massage uses more forceful pressure and slower strokes to
reach the deeper layers of the muscle. Deep tissue massage is an excellent choice for athletes
who suffer muscle cramping or have deep muscle tissue hyperextension. Deep tissue massage
can improve flexibility, loosen and spread connective tissue, and release toxins from the muscles.

Thai massage – is unique among massage therapies in combining both physical and energetic
aspects. It is a deep, full-body massage progressing from the feet up, and focusing on sun or
energy lines throughout the body, with the aim of clearing blockages in these lines, and thus
stimulating the flow of blood and lymph throughout the body. By the end, one feels both relaxed
and energized, in an almost dreamlike state, and typically without pain.
It combines many different techniques into one all-encompassing system, drawing particularly
on acupressure, reflexology, and assisted yoga postures. In short, it is a unique form of Buddhist
physiotherapy that blends yoga, acupressure and reflexology.
Stone massage :- A stone massage uses cold or water-heated stones to apply pressure and heat
to the body. Stones coated in oil can also be used by the therapist delivering various massaging
strokes. The hot stones used are commonly Basalt stones (or lava rocks) which over time have
become extremely polished and smooth. As the stones are placed along the recipient's back, they
help to retain heat which then deeply penetrates into the muscles, releasing tension.

Some of the benefits of massage  include:

 Stress relief
 Decreased anxiety
 Increased immunity
 Improved circulation
 Greater energy

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Contraindication :-
 Massage is not advised for anyone who has an infectious skin disease, a rash or an
unhealed wound. If the person is prone to blood clots,
 Circulatory problems such as vericose veins preclude the use of massage .
 It should be avoided over any known tumor .
 In an unstable pregnancy , abdominall massage should be avoided

Side effects :- massage can aggrevate existing swelling (edema). The pressure on the skin can be
painful for someone who has nerve injury . It is advisable to avoid massage immediately after
surgery, such as cesatean birth, because of the incresed risk of thrombophlebitis or blood clots

c. Hydrotherapy
The use of hydrotherapy during labor, whether in a shower or a tub, is a proven means of
relaxation and pain relief. The warm water stimulates the release of endorphins, relaxes muscles
to decrease tension, stimulates large-diameter nerve fibers to close the gate on pain, and
promotes better circulation and oxygenation. Hydrotherapy can promote increased diuresis,
decreased edema, decreased blood pressure , faster labor, less use of intramuscular and
intravenous medication, less use of epidural anesthesia, fewer instrumental births (vacuum
extractor or forceps), less perineal trauma, fewer episiotomies, and increased satisfaction with
birth experience.

Gate control theory: - According to this theory, pain is the result of interaction between several
specialized neural systems. . This theory postulate that a mechanism in the dorsal horn of the
spinal column serve as a valve or gate that increases or decreases the flow of impulses from the
periphery to the CNS. The gate mechanism is influenced by the impulses that descend from the
brain. Pain perception and response may activate the gate system and influence the psychological
process, attention or emotion. Therefore according to this theory the gate can be opened or
closed by the CNS activities such as anxiety, excitement etc.

How the therapy is performed :-

Water therapy can be done by bathing, showering or taking whirlpool baths. Jet hydrotherapy or
showering can stimulate the nipples and trigger more oxytocin production. If a tub bath is used, it
must be extremely clean to prevent infection. If Escherichia Coli gets in the water in the tub , the
risk for infection is increased.

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Contraindication :-
Hot and cold hydrotherapy is not advised for the patients with asthma, heart disease, or bleeding
disorder. Water baths are contraindicated in women who have high risk pregnancies and should
be in a hospital- based center where emergency facilities are available.

d.MusicTherapy
The use of music to relieve pain and decrease anxiety has been known to be helpful for the
relief of postoperative pain for some time. Research regarding the use of music to reduce labor
pain has also demonstrated some success: music may be used to promote relaxation during the
early stages of labor and as a stimulant to promote movement during later stages, when physical
exertion is required.

II. COGINITIVE COMPLEMENTARY THERAPY

Cognitive therapy promotes mind-body healing by using the power of positive thinking to
facilitate recovery.
a. Focusing & Guided Imaginary
Concentrating intentionally on a object is another method of distraction, or another method of
keeping sensory input from reaching the cortex of brain. For this, technique, a woman uses a
photograph of someone important to her or some images she finds appealing. she concentrates on
it during contractions ( focusing) other woman concentrate on a mental image , such as waves
rolling onto a beach (imagery). Focusing and guided imagery work in connection between the
brain and the involuntary nervous system. Visual images can influence both the voluntary and
involuntary nervous system.
How the therapy is performed :-
Instruments or monitors are not used . some times music is played in the background to aid
relaxation. Session begin with general relaxation exercises, and then move on to a specific
visualization. The individual is asked to build a detailed image in her mind using all five senses
and may repeat the exercise with a different image. If the person has a specific medical symptom
or discomfort, she will be asked to picture the affected organ working properly. Often guided
imagery asks the person to focus on a journey through several visualization which may be
described as a “focused daydream”.
Benefits :-
Numerous studies have confirmed the ability of meditation training to lower blood pressure and
control heart rate . Evidence shows that guided imagery can do so well. Therefore stimulating the
brain through imagery can have direct effect on both the nervous and endocrine systems,
ultimately producing changes in the immune and other body systems.
Contraindication :-
Guided imagery is generally considered safe for everyone.

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Possible side effect :-
There are no known side effects unless memory of an unpleasant event occurs.
b. Hypnotherapy
Hypnosis is an altered state of consciousness, somewhat like daydreaming. Hypnotherapy is the
therapeutic use of clinical hypnosis to suggest ideas, concepts and lifestyle adaptations to the
unconscious mind. The patient works with the therapist to enter an altered state of consciousness
or ‘trance’ state. Selected beneficial suggestions may then be made to the unconscious mind. The
therapist uses this state of heightened concentration to help the individual maximize their
potential, change limiting beliefs and behaviors, and gain new insights. Hypnosis has been found
effective for a variety of problems that hinge in emotions, habits and bodies involuntary
response. Hypnotherapy is not a new modality for labor, although it is not frequently used in
many areas.
It may take 15 minute a day to reproduce the feeling and concentrate on the images learned in the
sessions with the therapist.
How the therapy is performed :-
 Individual is usually asked to focused on a point and let their breathing become slow a d
regular .
 As the eyelids become heavy , the person is asked to close them and relax.
 When the person is in a daydream or focused attention state the therapist may make
suggestion how to make unwanted symptoms or habits disappear like pain relief etc.
Benefits :-
Hypnosis can allay stress by putting individuals into a relaxed state, offering positive suggestion,
and eliminating negative thoughts. It is associated with shorter labor and and less need for
analgesic medication.
Contraindication :-
Hypnosis is considered safe for everyone , although persons with a history of psychosis need
careful evaluation.
c. Breathing Techniques
Breathing patterns are also taught in most preparation for child breath classes. They are
advantageous because they help to relax a woman’s abdomen. They are largely distraction
techniques, because a woman concentrating on a slow-paced breathing cannot concentrate on
pain. Breathing strategies can be taught to woman in labour if she is not familiar with their
advantages before labor.

d. Biofeedback
A technique that teaches how to control body processes that is usually not under our control.
Generally, biofeedback works by feeding you information about some unconscious physiological
function (like heartbeat, blood pressure, or body temperature) as a therapist guides through

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various relaxation techniques. The therapist acts as a coach, helping to recognize body’s signals
and use these techniques to help change body’s reaction.
During pregnancy, biofeedback can help to stave off the headaches that plague so many women,
especially during the first trimester. It can also be a safe and effective partner to Kegel exercises
in preventing urinary incontinence. Other pregnancy symptoms that may be alleviated by
biofeedback include insomnia, morning sickness, depression, anxiety, and stress.

How it is performed :-
Biofeedback therapy applies noninvasive sensors to various points on the body. The location
depends on the problem that needs attention. For example, to treat heart problems , the sensor are
attached to monitor the heartbeat; to treat muscle tension, the sensor are placed on skin . Some
biofeedback machines signal changes on computer display. The therapist teaches the individual
mental and physical exercise that can address the function causing the problem.
Benefits :-
This therapy can reduce tension and anxiety and combat insomnia and fatigue.
It has proved useful for any disorder caused or aggravated by involuntary muscular tension or
tightening
It is a relaxation technique can be used for labor .Women must become aware of her body and its
responses and how to relax for biofeedback to be effective.
Side effect:-Although biofeedback is harmless, it is not a substitute for medical care if a person
has a serious medical problem (eg. Diabetes, heart disease, or hypertention).
e. Meditation
Meditation is self directed practice for relaxing the body and calming the mind. Mindfulness-
based stress reduction (MBSR), based on Vipassana meditation from India, is based on the
cultivation of intentional awareness of experiences in the present moment. Transcendental
meditation is a simple, natural, effortless effort while resting comfortably with the eyes closed.
Using this technique as individual experience a state of rest that can change physical and
emotional responses to stress.

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Physical Advantages of Meditation
·         Meditation improves brain functioning by strengthening communication between
different areas of the brain.  
·         It reduces cortisol (the body’s natural stress hormone) levels in the body and so
decreases stress. 
·         It reduces the heart rate and respiratory rate and so helps reduce blood pressure.
·         Improved breathing helps oxygenate the body more effectively. 
·         Reduces muscular tension and associated aches and pains.  
·         Meditating can even help strengthen the immune system .  
Psychological Advantages of Meditation
 
·      Mental stress and pressure is now often cited as the main cause of a high percentage of
physical diseases that are prevalent in the world today, such as cancer.
 The calming and relaxing effects created by meditating can greatly help combat stress
and its effects.
  Increased sense of wellbeing and happiness. 
·     Helps to develop a positive attitude and optimism.  
·     Helps to increase self-confidence and self- esteem. 
·     Helps to improve concentration and focus
Process of meditation :-In every day, as each of us lives in our "normal" state of consciousness,
our awareness is usually focused upon the particular thoughts, emotions or perceptions we
experience on the surface level of reality, whether they are the experiences and perceptions we
move through in our life in the outer world , or the thoughts and feelings that we have in our
inner world. As we move through life, we perceive, think, act and feel with the assistance of our
"thinking mind"—the active portion of our mind that deals with this surface level of reality,
through the use of thoughts, feelings, interpretations of perceptions, and actions. Our awareness
is usually identified with, preoccupied with and attached to, whichever of these particular
activities we engage in through the use of this "thinking mind." Although all these particular
components of our life are important, when we remain identified with, and therefore limited to,
these surface activities—these surface appearances of our deeper being—we are far less able to
perceive and act from a more fundamental level of greater awareness. The tendency of our
"thinking mind" to remain preoccupied with the particulars of life inhibits our ability to move to
the level of pure consciousness that is actually the source of all these particular states of mind.

f. Prayer

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For many woman , any time they are facing a stressful situations, prayer is the first measure that
they use to relieve stress. Woman may bring helpful worship objects such as Bible or cross into
hospitals with them to use prayer. These are sacred objects so be careful when changing sheets
during labor that they labor that they do not accidentally throw away such important objects.

III. EXPRESSIVE CMPLEMENTARY THERAPY

Expressive therapies are treatments in which patients are encouraged to express their thoughts.
Expressive therapies are thought to alleviate anxiety by allowing the patient to release fear and
frustration in a positive, creative fashion.
a. Journal writing
Journal writing can allow a person to express difficult feelings in a safe & private way. Regular
journal writing also helps people to clarify their thoughts & make good choices.
b. Art therapy
Drawing, painting & sculpting, especially when carried out in a group environment, encourage
pleasure in creativity & enable people to find a way of expressing their feelings that cannot be
easily put into words.
IV. PHYSICAL COPMLEMENTARY THERAPY
a. Yoga
Yoga offers significant variety of proven health benefits, including increasing the efficiency of
heart, slowing the respiratory rate, improving fitness, lowering blood pressure, promoting
relaxation, reducing stress , & allaying anxiety. Exercises consist of deep breathing exercises,
body postures to stretch & strengthen muscles, & meditation to focus the mind & relax the body.
It may be helpful in reducing the pain of labor through its ability to relax the body & possibly
through the release of endorphins that may occur.

Benefits :-
 The exercises are performed to prepare the body by strengthening muscles and by
encouraging relaxation and concentration.
 Exercises are practiced in prenatal classes to prepare muscles for labor and birth

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  Regular yoga practice throughout pregnancy will help the pregnant women to get “in
tune” with her body.
 It can help to prevent headache, morning sickness, fatigue and back pain and help her be
in good physical condition for labor.
Contraindications :-
 Yoga should be avoided in patients who have had a back injury or recent surgery .
 Some postures are not recommended during pregnancy; thus special classes are often
available foe expectant mothers.
 Some suggest that pregnancy is not the ideal time to being yoga exercises.
Possible Side Effects :-
In the beginning, stiffness may occur while the body adapts. However, yoga should not be
stressful or tiring, and any stiffness should be temporary and minor.
b. Reflexology
Reflexology has been practiced for thousands of years in the China and Egypt. It was introduced
in the west at the beginning of the twentieth century. It suggest that reflexes, zones or pathways
run along the body and terminate in the palm of the hands , soles of the feet, ears, tongue and
head. All systems and organ are said to be reflected on the surface of the skin, in particular the
hands and the feet.
It may help to relieve a number of pregnancy complaints including backache and circulatory
problems, and reflexology has been used during labor to ease the pain of contractions. However,
deep pressure should be avoided near the ankles, which correspond to the uterus and ovaries, as
this may bring on premature labor. Some reflexologists also recommend it should be avoided
during the first trimester if the woman has a history of miscarriage.

How it is performed :-
Unlike massage, which involves a generalized rubbing action, reflexologist use their hands to
apply pressure to specific point on the feet and hands? The patient usually remains fully clothed,
sitting with leg raised or lying on a treatment table. After gentle massage the therapist begins
applying pressure to the reflex points. A rubber ball can be used by the therapist for applying
pressure.

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Contraindication:-
Reflexology has been considered safe. However , if the patient has a foot injury, ulcars , phlebitis
, or any other vascular problem in the lower legs, reflexology should be discussed with the
physician before undergoing the treatment. The reflex zone related to the uterus should not have
sustained pressure, and reflexology should not be used in unstable pregnancies.
c. Acupuncture
Definition :- Acupuncture is the insertion of slender needles into specific points of the body. It is
based on the principle that the body has complex meridians that are pathways to specific organs.
Acupuncture points are the areas of the body in which these meridians surface. Stimulation of
these points is thought to influence positive/negative energy that regulates body function .
How the therapy is performed :-
The puncture refers to insertion of tiny needles at specific points on the surface of the body. The
insertion of the disposable needles has been described as feeling like a mosquito bite. The needle
may be stimulated by twirling them or connecting them to a mild electrical current ,the needles
are left in place upto 20 to 30 minutes.

Benefits :-
Acupuncture may trigger the release of natural pain – killing substances within the body called
endorphins, thus blunting the perception of pain. This ancient Eastern practice is usually
perfectly safe during pregnancy as long as the treatment is carried out by a properly qualified
acupuncturist. It may be especially useful for alleviating morning sickness, or reducing lower
back pain during pregnancy. However, special precautions should be taken because certain
acupuncture points may stimulate uterine contractions.
d. Acupressure
Acupressure is a traditional Chinese therapy that has been used for centuries. Acupressure is
administered by a variety of practitioners, some of whom combine acupressure with other form
of Asian medicine, such as herbology.
According to traditional Chinese medicine, the body’s healing energy flows along 12 to 14
meridians that connect vital organs throughout the body. A blockage in the flow of some point
on a meridian can, they believe, cause disease and discomfort in the organ or tissue.

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How it is done :-
Acupressure is done without needles but uses finger, palm, or knuckle pressure at points located
along an invisible system of energy channels called meridians. It may be performed on a floor
mat or massage table, and the person receiving the treatment usually wears comfortable, loose
clothing. Practitioner may administer pressure to various points.
Benefits :- Acupressure as a massage , can be relaxing. It may work by triggering the body to
release natural pain killing compounds such as endorphins. It can be regarded as a way of toning
the body and promoting general health and well being.

f. Therapeutic Touch
Therapeutic touch is the use of touch to comfort. It is based on the concept that the body contains
energy fields that, when plentiful, lead to health and , when in lesser supply , result in ill health.
Therapeutic touch as the laying on of hands to redirect the energy fields that lead to pain.
Although the action is not well documented , touch and massage probably work to relieve pain
by increasing the release of endorphins this technique is serves as a forms of distraction.
Effleurage, the technique of gentle abdominal massage often taught with Lamaze preparation for
child birth classes, is a form of therapeutic touch.
g. Heat application:- Heat application is an effective ways to help relieve the pain of labor
contractions. Women who are having back pain may find application of heat to the lower back
by heating pad or moist compress comforting.
h. Cold Application:- Women who became warm from the exertion of labor find a cool wash
cloth to the forehead comforting. Ice chips to suck on to relieve mouth dryness are also
refreshing

i. Birth Ball

The Swiss Ball has been used in physical therapy and exercise programs for decades. Research
on the use of the ball demonstrates a significant improvement in core muscle stability, including:
the muscles of the chest, abdomen, and pelvis. These muscles are instrumental in the labor
process for deep breathing, pushing, and general movement. Rocking and movement can be
accomplished on a birthing ball during labor. Not only does the ball facilitate the physiologic
benefits of movement to help the baby find his best fit through the pelvis ,but it also promotes
comfort and can decrease pain by stimulating mechanoreceptors and joint receptors.

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The ball should be used with the following precautions:
1. The woman should never use the ball unless her support person is with her.
2. The woman should always have a firm support in front of her to hold on to for security. (This
can be accomplished by placing the ball at the side of the bed and raising the side rail for her to
hold for stability, or the ball can be placed at the foot of the bed where she can hold on to the
handles of the foot support or the squat bar).

j. Moxibustion
Moxibustion is a form of heat therapy in which dried plant materials called “moxa” are
burned on or very near the surface of the skin. The intention is to warm and invigorate the flow
of Qi in the body and dispel certain pathogenic influences.
Moxa is usually made from the dried leafy material of Chinese mugwort(Artemesia argyi or
A.vlugaris), but it can be made of other substances as well .The glowing end of the moxa stick is
held about an inch or two above the surface of the skin until the area reddens and becomes
suffused with warmth.
Moxibustion is used for:
Gynecological and obstetrical conditions, including breech presentation in late term
pregnancy Practitioners often do both acupuncture and moxibustion in the same clinic session
when appropriate to the diagnosis and treatment strategy. Practitioners believe that the therapies
increase each other’s effectiveness when used together. Unlike acupuncture, which is almost
always done by a trained practitioner in a clinic setting, moxibustion can be easily used at home.
It is not uncommon for Chinese medical practitioners to train their patients to use moxa on
themselves to strengthen the effect of the clinical sessions between appointments.

V. MEDICAL SYSTEMS COMPLEMENTARY THERAPY

a. Herbal remedies

Many people use herbal medicine as a treatment of choice. An increasing number of individual
are expressing an interest in herbal medicine to relieve discomfort during pregnancy and for
menopause. Herbs are gentle and healing, but they can also be irritating to the skin and GI tract
as well as toxic to the mother or the fetus.so it is important for the nurse to be extremely careful
with herbal remedies. Only take them during pregnancy and birth on the advice of a qualified
medical herbalist or a midwife who is trained to use herbal medicines.
Ginger :-
 Remedy employed for nausea in traditional cultures
 Efficacy due to aromatic, carminative, and absorbent properties

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Raspberry leaf tea is one of the best-known herbal remedies for pregnancy and birth.It’sthought
to tone the muscles of the uterus (womb) and make contractions more effective, reducing labour
pain. Because of its effect on the uterus, it’s not recommended if:
•Caesarean section in the past
•having a planned caesarean
•problems with bleeding
•premature labour in the past
Blue cohosh is used by some nurse-midwives in the US to stimulate contractions, but has been
linked to serious side-effects, including heart and blood pressure problems. Herbalists in the UK
discourage its use.

Soy :- Soy rich foods have demonstrated lipid-lowring properties, its long-term effectiveness in
postmenopausal women remains under study. Soy may also be helpful in preventing bone
resorption that occurs in estrogen deficiency.
Fish Oil :- Omega three fatty acids and N-3 polyunsaturated fatty acids have shown positive
results in decreasing sudden cardiac death among high-risk patient. However, the mercury levels
of the fish selected should be monitored.
Other herbal remedies sometimes used in labour include :
• Black Cohosh
• Ginseng
• Evening Primrose Oil
• Castor Oil

b.Homeopathy
Homeopathy uses minute, highly diluted doses of substances which if taken as a full dose would
cause the same symptoms that the diluted doses attempt to treat. We don’t fully understand how
homeopathy works. Remedies are very gentle and do not interfere with any prescribed
medicines.
It is best if treated by an experienced homeopath or a midwife who is trained in homeopathy.
Some homeopaths prescribe a “birthing set” of remedies which are designed to suit labour.
Homeopaths recommend arnica for treating any shock, trauma or bruising may experience after
giving birth. Start taking arnica within an hour of baby’s birth, and take it three to four times a
day for up to five days.

VI. OTHER COMPLEMENTARY THERAPY

a. Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is therapy promoted as energy medicine. It is used for all type of localized pain, such as
chronic back pain, can be used in combination with analgesic medication. It is advocated for
conditions such as labor, contractions, menstrual pain, jaw muscle pain, cancer pain and nerve
damage.

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How The Therapy Is Performed
TENS is performed with a small electronic unit that send the pulsed currents to a set of
electrodes applied to the skin. When used for labour uterine contractions. It involves the place-
ment of two pairs of electrodes from a battery –operated devices on either side of the thoracic
and sacral spine. During the contraction the women increases the stimulation by turning control
knobs on the device. Women describe the sensation as a tingling or buzzing that provide pain
relief.
What This Therapy Hopes To Accomplish: - TENS units also believed to stimulate the
production of endorphins, the body’s natural pain killer ; thus the women’s discomfort is
alleviated. TENS is credited with reducing the need for analgesia while increasing the women’s
perception of comfort over the experience. Studies shown that TENS is effective.
Contraindication :- TENS should only be used by the women after full medical consultation. It
should be discontinued if there is skin irritation from electrode patches. It is not used before 37
weeks of gestation.
Side Effects:- No harmful side effects have been reported in healthy women in labor ; however
approval should be given by the physician. Benzodiazepine drug and corticosteroids may
produce effectiveness of TENS. Application of electrodes at appropriate site must be done by a
competent, trained professional.
Guidelines to be followed in Alternative and complementary therapies

1. Therapists will be responsible for observing all the guidelines in line with normal volunteering
policy, including equal opportunities, safe handling, health and safety, and hygiene.

2. All practitioners will agree with and sign a declaration of patient confidentiality.

3. Therapists must hold an appropriate professional insurance policy for their approved therapy.

4. Permission for a session must come from the patient themselves; although staff may suggest a
session or help a patient select one which is appropriate to their needs.

5. Sessions will only be given after the therapist has met with, and discussed the therapy with the
patient. Patient’s medical and nursing notes should be made available to the therapist.

6. Details of each treatment will be documented by the therapist within the patient’s notes and
will then be dated and signed by the therapist.

7. All therapists will uphold the dignity of the patient at all times and strictly observe the ethical
code of their professional body.

8. Before offering complementary therapies to patients the complementary therapist must inform
the person in charge of the ward/ outpatient area that therapies are to be offered / given to ensure
that complementary therapies are not offered / provided to patients for which these are not
suitable.

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9. Regular communication between the therapist and nursing staff and other healthcare
professionals is encouraged. Therapist’s concerns regarding changes in the patient’s condition
should be discussed immediately with the nurse in charge, and documented in the patient’s
record.

10. All therapists are expected to be committed to continuing personal development and will be
spported and encouraged to develop their knowledge and skills in specialist areas.

11. All patients will be offered an evaluation form to record their comments regarding the
therapies they receive which includes asking how good the therapist is about giving appropriate
information, how the patient has felt about the session, and any

12. The location of the sessions will vary according to the patient’s needs and environment, but
the wishes of the patient regarding privacy should be respected at all times.

Nurses’ Responsibilities in Providing alternative and Complementary Therapy

The following describes nurses’ responsibilities in providing a complementary therapy. Nurses

are expected to be competent in the care they provide :
1. Nurses should know that ,What is the client’s health status? What are the available
interventions? What is the anticipated effect of this therapy? What are the potential
benefits of this therapy?
2. What are the potential risks of this therapy? What is the expected outcome of this
therapy? Is the client informed about this therapy?
3. The nurses should inform the client about the risks, benefits and effects of the treatment,
and other available options, to make an informed choice.
4. Consent from the client is required regardless if the therapy is requested by the client or
proposed by a health care practitioner.
5. Is the therapy incorporated into the client’s plan of care?
6. Nursing and administrative authorities would make this decision. If the complementary
therapy is not a recognized intervention, nurses may wish to advocate for it to be
recognized.
7. Nurses need the necessary assessment skills to carry out the ongoing assessment and
evaluation of the effects of the therapy. The entire nursing process must be used as a
basis for incorporating the complementary therapy into a plan of care.
8. Some therapies require technical skill. Nurses who provide such therapies must be
competent in the technical aspects.
9. Nurses must be able to evaluate the effect of the complementary therapy on the overall
health status of the client, and to recognize when additional skill, knowledge and
expertise are required.

CONCLUSION:-Complementary therapies for women in labor are evidence-based and an ideal

addition to the nursing care for the laboring woman. The journey to change the culture has been
ongoing and dynamic; they dared to dream and gave nurses the tools necessary to be successful
in offering evidence-based, nonpharmacologic labor-support choices to patients. The hope is that
each woman, each nurse, and each physician will become empowered to use the
nonpharmacologic complementary therapies to improve birth experiences.

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 GOVT . COLLEGE OF NURSING
CRP LINE, INDORE

SUBJECT: NURSING EDUCATION

PRACTICE TEACHING CLASS ON: ALTERNATIVE AND

COMPLEMENTRY THERAPIES USED IN OBSTETRICS

SUBMITTED TO SUBMITTED BY
RESP.A. RAM MADAM MS. BHAWANA MALVIYA
GOVT. COLLEGE OF NSG M.Sc. NSG PREVIOUS YR.
INDORE GOVT. COLLEGE OF NSG
INDORE

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 BIBLIOGRAPHY

1) Dutta, D.C. (2004), Textbook Of Obstetrics ,(6th ed.), Calcutta: New Central Agency,114-118

2) Jacob, A. (2008), A Comprehensive Textbook of Midwifery, (2nd ed.), New Delhi: Jaypee
Brothers Medical Publishers (P) Ltd, 151-174.

3) Lifer . (2005). Maternal Nursing Introductory Text (9th ed.), USA : Elsevier , Saunders
publishers ,49-97 .

4) Myles, (2003), Textbook of Midwives, (14th ed.), London: Elsevier Science Limited, 499-570.

5) Sharma, J.B. (2012), Textbook Of Obstetrics, 1st ed. Sirmour: Avichal Publishing
Company.42-56 .

6) www.google.com/http;alternative & complimentary therapy.

7)http://en.wikipedia.org/wiki/Alternative therapy

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