Oxford Handbook of Midwifery (35 page)

1
Annual Evidence Update on Antenatal Care (2007).
Nausea and Vomiting in Early Pregnancy
. NHS Evidence. Women’s Health. Available at: M www.library.nhs.uk//womenshealth/
ViewResource.aspx?resID=269713 (accessed 20.3.10).

CHAPTER 6
Minor disorders of pregnancy

116‌‌

Varicose veins and haemorrhoids

Varicose veins are caused by weakening of the valves in the veins returning blood to the heart from the lower extremities, so they can occur in the legs, vulva, or rectum. Rectal varicosities are called haemorrhoids.

They can occur in any age group, but pregnant women are particularly prone if they have a family history of varicosities, are carrying twins, or have to sit or stand for long periods of time, for instance at work.

During pregnancy, the extra circulating blood volume increases pressure on the vessel walls and progesterone relaxes the blood vessel walls. The weight of the growing uterus creates back pressure in the pelvic and leg vessels. Constipation exacerbates haemorrhoids.

Signs and symptoms

• Legs ache and feel heavy.
  
• Throbbing sensation in the legs or vulva.
  
• Dilated surface veins in the vulva or legs.
  
• The vulva may be swollen and painful.
  
• Discomfort and itching round the anus and when opening the bowels.
  

  Advice
  

• Avoid constipation and straining on the toilet.
  

  •
  Ensure an adequate intake of fibre, e.g. fruit and also fluids.
  

• Avoid standing for prolonged periods of time.
  
• Wear graduated support tights to assist venous flow.
  
• Avoid constrictive clothing.
  
• Do not sit with the legs crossed.
  
• Take gentle exercise, such as walking, to help the circulation.
  
• Use vulval icepacks to reduce swelling.
  
• Proprietary haemorrhoid cream can be used safely during pregnancy.
  
• Be aware that iron supplements can cause constipation in some women and a liquid preparation may be preferable in this instance.
  

  Teach the woman to recognize the signs and symptoms of deep vein thrombosis.
  

  During delivery
  

• Promote a spontaneous normal delivery and use a non-directed pushing technique. Forceps or ventouse delivery may cause haemorrhoids to prolapse.
  
• Advise and encourage the woman to refrain from pushing during the second stage of labour until the vertex is visible, as this reduces straining efforts to a minimum.
  
• Avoid laceration to any vulval varicosities.
  

  Helping women cope with pregnancy: complementary therapies
  ‌‌
  

  Chapter 7
  

  117
  

  Introduction
  118
  

  Homoeopathy
  120
  

  Aromatherapy
  122
  

  Bach flower remedies
  128
  

  Reflexology
  131
  

  Oriental medicine
  132
  

  Yoga
  136
  

  

  Herbal medicine
  138
  

  CHAPTER 7
  Helping women cope with pregnancy
  

  118‌
  

  Introduction
  

  The use of complementary therapies (CTs) has escalated in recent years, with approximately two-thirds of the population accessing some kind of complementary therapy or treatment. This has been attributed to a change in people’s expectations and choice, resulting in a desire for less dependency on drugs and invasive treatments that often involve adverse side-effects. Almost one-third of this group are pregnant women, so there- fore many women choose to use CTs during pregnancy and childbirth.
  

  It is therefore pertinent that midwives familiarize themselves with knowledge and the safety issues of CTs with regard to pregnancy and childbirth. Some midwives may choose to specialize in the use of CTs, while others will have received in-house training to use CTs in their practice. It is important that midwives encourage women to access reputable therapists who are dedicated to working with the special needs of pregnant women.
  

  Although scientific evidence is sparse for many CTs, this is starting to change and mounting evidence from various sources worldwide is becoming established (b see Useful websites, p. 119). There is a plethora of anecdotal evidence that supports the safe use of CTs from European and Eastern cultures—such as Chinese medicine and herbal medicine. However, caution should always be exercised when using any form of treatment or therapy during pregnancy—expert advice is available and should be sought where there are any queries regarding the use of CTs for pregnant women (b see Recommended reading and Useful websites).
  

  Some of the traditional elements of medical research make it difficult
  

  to measure some CTs where individual remedies or treatments are used
  

  e.g. homoeopathy, reflexology, acupuncture, thus the randomized clinical controlled trial is not truly evaluative, making it difficult to compare effectiveness with orthodox medicine. Qualitative research methods, case studies, surveys and audit are all useful means to explore the efficacy of CTs.
  

  Recommended reading
  

  Ernst E, Pittler M, Wider B (eds) (2006).
  The Desktop Guide to Complementary and Alternative Medicine
  :
  An Evidence-based Approach
  , 2nd edn. Edinburgh: Mosby.
  

  Lewith G, Wayne JB, Walach H (eds) (2002).
  Clinical Research in Complementary Therapies— Principles, Problems and Solutions
  . London: Churchill Livingstone.
  

  Mantle F, Tiran D (2009).
  A-Z of Complementary and Alternative Medicine: A Guide for Health Professionals
  . Edinburgh: Churchill Livingstone.
  

  Miccozzi MS (2006).
  Fundamentals of Complementary and Integrated Approach to Care
  , 3rd edn. London: Elsevier.
  

  Tiran D (2003).
  Nausea and Vomiting in Pregnancy: An Integrated Approach to Care
  . London: Elsevier.
  

  Tiran D, Mack S (eds) (2000).
  Complementary Therapies for Pregnancy and Childbirth
  . Edinburgh: Churchill Livingstone.
  

  INTRODUCTION
  

  119
  

  Useful websites
  

  Bach flower education, advice and courses: M
  www.bachremedies.com or M www.
  bachflowertraining.com.
  

  Massage courses and educational site: M
  www.childbirth-massage.co.uk.
  

  Complementary Maternity Forum—a supportive network of midwives and complementary therapists who are dedicated to the safe use of CTs within maternity care: M www.the-cma.
  org.uk (accessed 22.2.11).
  

  Educational and research articles: M
  www.essentialorc.com.
  

  Educational Resource for Midwives and Complementary Therapists Providing Courses in CTs, Resource Materials, and Consultancy: M
  www.expectancy.co.uk.
  

  Books and journals on CTs: M
  www.harcourt-international.com/journals.
  

  International Federation of Professional Aromatherapists—the main professional organization for aromatherapy within the UK: M
  www.ifparoma.org.
  

  Aromatherapy Global Online Research Archives (AGORA) Index: M www.users.erols.com/
  sisakson/pages/agoindex.htm.
  

  Shiatsu Site—courses and consultancy for midwives and therapists: M
  www.wellmother.org. Natural Health website: M
  www.winaturalhealth.com.
  

  

  An excellent resource for papers and studies on complementary medicine is at: M www.nccam.
  nih.gov/camonpubmed.
  

  CHAPTER 7
  Helping women cope with pregnancy
  

  120‌‌
  

  Homoeopathy
  

  Homoeopathic remedies offer a gentle and safe alternative means of relieving some of the common ailments of pregnancy. Pregnancy is con- sidered to be an acute state and therefore knowledgeable women may feel that they would want to self-medicate. However it is generally recom- mended that these women seek homoeopathic advice during pregnancy. Any pre-disposing, complex, or chronic conditions need to be treated by a qualified practitioner/midwife homeopath.
  

  Morning sickness may well be treated with remedies that match the symptom picture of nauseous feelings in the morning, with minimal sickness or vomiting. However, women with long-term nausea and vomiting resulting in hyperemesis gravidarum would require input from a homoeopathic practitioner alongside conventional medical care.
  

  General principles and administration