Oxford Handbook of Midwifery (61 page)

Pregnant women can access courses and classes to learn self-hypnosis and visualization. The techniques do not involve deep, trance-like states, rather a state more like redirected focus is involved, similar to daydreaming or being absorbed in a book. The mind and body are relaxed while also being in control and conversant with the surrounding environment.

Benefits

In addition to the above indications, hypnosis purports to have many benefits:

1. Melh Madrona LE (2004). Hypnosis to facilitate uncomplicated birth.
   American Journal of Clinical Hypnosis
   46
   (4), 299–312.
   
2. Cyna AM, Andrew MI, McAucliffe GL (2006). Antenatal self-hypnosis for labour and childbirth: A pilot study.
   Anaesthesia and Intensive Care
   34
   (4), 464–9.
   

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   Aromatherapy during labour
   

   The use of essential oils in labour can enhance the woman’s coping strat- egies when used alone or in conjunction with other complementary therapies, other coping mechanisms, such as breathing and relaxation techniques or conventional methods of pain relief.
   

   The main contributions of essential oils during labour and childbirth are to:
   

   • Assist with pain relief
     
   • Relieve stress and anxiety
     
   • Assist with efficient functioning of the uterus
     
   • Prevent fatigue.
     

     For details of the safe administration and therapeutic properties of essential oils, b see Aromatherapy, pp. 122–126.
     

     The following oils are some of the most commonly used essential oils for labour and delivery. Some aromatherapy practitioners/midwives may wish to use other oils not listed here.
     

   • Lavender
     : is a very versatile oil, with relaxing, antispasmodic and
     

     pain-relieving properties. It is therefore useful to help ease the pain of contractions, and as a general, all-round, helpful oil throughout labour. It is best avoided by people with hay fever and asthma. Take care with vaporizing the oil, as some women find the aroma unpleasant and overpowering; it may also cause headaches in some people.
     

     0
     Do not
     use lavender in conjunction with epidurals because it has hypotensive properties. It may also possibly interact with narcotics, so care should be taken in conjunction with pethidine or diamorphine.
     

   • Chamomile
     : is calming and relaxing during labour. It has significant anti- inflammatory and antispasmodic properties. Chamomile should not
     

     be used until late pregnancy because it has emmenagogic properties, which theoretically may induce menstruation, and therefore bleeding.
     

   • Clary sage
     : a uterine tonic and euphoric oil, it is useful for stimulating contractions and pain relief. Clary sage has emmenagogic properties, so should not be used in pregnancy until near term and if overused may cause drowsiness and headaches.
     

     0 Driving is not recommended if exposed to Clary sage for lengthy periods, and it should not be combined with alcoholic drinks.
     

   • Frankincense
     : is a very useful oil for calming anxiety and panic, especially where this is associated with hyperventilation. May not be suitable for asthmatic people due to its strong aroma and conflicting
     

     reports regarding its benefits for asthma.
     

   • Jasmine
     : is a uterine tonic that has been used traditionally as an aid to
     

     childbirth. It helps to strengthen contractions, while also having pain- relieving and antispasmodic properties. It is reputed to be useful as
     

     a compress, placed on the lower abdomen, to help expel a retained placenta. Emotionally it has energizing and antidepressant qualities. 0
     Do not
     use jasmine until the onset of labour.
     

   • Lemon
     : is an antiseptic and astringent, also reputed to be a circulatory tonic. A gentle, uplifting oil with a pleasant, fresh aroma. Often mixed with other oils to minimize pungent aromas, this makes it a versatile oil to use at any time during labour and birth. Lemon has phototoxic properties, therefore after use care should be taken to reduce exposure to sunlight, as with most citrus oils.
     

AROMATHERAPY DURING LABOUR

249

Recommended reading

Burns E, Blamey C, Ersser S (2000). The use of aromatherapy in intrapartum midwifery practice: an observational study.
Complementary Therapies in Nursing and Midwifery
6
, 33–4.

Lawless J (1992).
The Encyclopaedia of Essential Oils
. Shaftesbury, Dorset: Element Books Limited. Price S, Price L (1995).
Aromatherapy for Health Professionals
. London: Churchill Livingstone.

Tiran D (2000).
Clinical Aromatherapy for Pregnancy and Childbirth
, 2nd edn. London: Churchill Livingstone.

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Reflexology during labour

Reflexology is one of many complementary therapies that can assist with the mother’s coping abilities during labour. The woman may be attended by a midwife/reflexologist or have arranged for an independent reflex- ology practitioner to attend her during labour. It is important that all practitioners are fully conversant with the physiology of labour and the potential problems. Reflexology is a powerful tool and can have a dynamic therapeutic effect when used wisely. The overall care of the woman rests with the midwife or doctor in charge and, in the event of complications, complementary therapy may not always be appropriate. Midwives may have received in-house training to perform specific techniques in reflex- ology relating to labour care—untrained personnel should never dabble.

• Encourage the woman to adopt a comfortable, well-supported position appropriate to labour, to prevent postural hypotension while maintaining good eye contact and communication. Adjust your posture to accommodate the mother’s varying positions throughout labour.
  
• Familiarize yourself with the woman’s relevant medical and obstetric history and present labour circumstances.
  
• Obtain consent from the woman.
  
• Adhere to the local policy for treatment using complementary therapies.
  

  Uses in labour
  

• General relaxation.
  
• Relief of stress and anxiety.
  
• Helps to relieve the pain of contractions and backache.
  
• Minimizes nausea and vomiting.
  
• Relief of cold feet in labour.
  
• Encourages strong rhythmic contractions—may assist with augmentation. It is important to work within local policy and liaise with medical staff if used as a measure to augment labour.
  
• Induction of labour should not be undertaken by a midwife or practitioner unless there is a local policy clearly stating the conditions when complementary therapies can be used for induction of labour, or with the agreement of the woman’s consultant.
  
• For the third stage of labour, reflexology may be used in uncomplicated retained placenta.
  

  •
  Treatments may consist of general reflexology massage for relaxation or shorter, more specific treatments focusing on a particular area,
  

  e.g., the ankles pertaining to the pelvic area or the pad of the thumb pertaining to the pituitary gland.
  

• Treatments should be recorded in the woman’s notes.
  
• Reflexology is also very useful in the postnatal stage. Some of the conditions that respond to treatment are:
  
  • Retention of urine
    
  • Painful perineum
    
  • Breast engorgement
    
  • Constipation
    
  • Inadequate lactation
    
  • Oedema.
    

    REFLEXOLOGY DURING LABOUR
    

    251
    

    Recommended reading
    

    Mackereth PA, Tiran D (2002).
    Clinical Reflexology
    —
    A Guide for Health Care Professionals
    . London: Elsevier.
    

    Tiran D (2004). Midwives enthusiasm for complementary therapies: a cause for concern?
    

    Complementary Therapies in Nursing and Midwifery
    10
    (2), 77–9.
    

    Tiran D (2006). Midwives responsibilities when caring for women using complementary therapies during labour.
    MIDIRS Midwifery Digest
    16
    (1), 77–80.
    

    

    Tiran D (2009).
    Reflexology for Pregnancy
    —
    A Definitive Guide for Healthcare Professionals
    . London: Elsevier.
    

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    Acupuncture in labour and childbirth
    

    Some midwives may be qualified acupuncturists, or an acupuncturist prac- titioner may attend a woman; however, it is important that the practi- tioner has in-depth knowledge of the appropriate points to use in labour and how to needle them effectively. Insight into a woman’s behavioural patterns and emotional needs will also influence the choice of points used to maximize effective treatment for the individual.
    

    Four patterns of disharmony that may be manifested in labour have been identified:
    ¹
    

• Deficiency of Qi and blood
  : this may be due to premature rupture of membranes to labour or it can be the result of heavy periods or blood loss following previous deliveries.
  
• Kidney deficiency
  : this may be due to multiple pregnancies or
  in vitro
  fertilization (IVF) pregnancies; short gaps between pregnancies deplete the kidney energy.
  
• Spleen and stomach deficiency
  : this may be due to a lack of proper nourishment prior to labour.
  
• Ki and blood stagnation
  (
  liver Qi stagnation
  ): this is due to emotional problems or bad premenstrual tension prior to pregnancy.
  

  Acupuncture offers many benefits to the labouring woman, it helps to release endorphins, which will enhance relaxation, aid pain relief, and assist with coping mechanisms. A variety of techniques may be used, from traditional needling of the points, moxibustion, electro acupuncture, and ear acupuncture; shiatsu techniques may also be utilized.
  

  First stage of labour
  

• In early labour the points used are to facilitate uterine action and help with general pain relief.
  
• As labour progresses acupuncture may be used to augment weak or irregular contractions.
  
• Specific pain relief, as in posterior position and backache.
  
• Helps to boost and maintain energy levels.
  
• Helps to dispel fear and anxiety at any stage.
  
• Helps with the difficulties associated with the transition stage.
  

  Second stage of labour
  

• Helps to alleviate exhaustion.
  

  •
  Helps to dispel fear and anxiety, which blocks the mother’s energy network.
  

• Augments contractions if they are becoming too far apart.
  
• Many of the points forbidden in pregnancy will be used during labour as they generally have a strong downwards movement of energy in the body, which greatly enhances the birthing process.
  

  Third stage of labour
  

• Chinese philosophy dictates that vessels are depleted of blood following birth and therefore are vulnerable to attack from external pathogens. Very often tonifying treatment to build up the blood is commenced soon after birth.
  
• Retained placenta: points that have a strong downwards movement will be used to initiate uterine action.
  
• Others points may be used help to regulate uterine action and stimulate the movement of blood.
  

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  253
  

  The main disadvantage of acupuncture treatment in labour is that it cannot be used in conjunction with water birth. Some women may find needling a little bit painful, and some points may not be accessible due to the variety of positions and restlessness of the woman at times.
  

  Shiatsu
  

  Shiatsu helps the woman to tune into the powerful and changeable energy patterns associated with labour, which makes it an ideal therapy to comple- ment normal midwifery practice and provide individual and woman-centred care. The main focus is to help the woman’s energies to flow freely from the onset of labour, rather than waiting until the energies become blocked. Various techniques may be used to move or balance energy, such as strong pressure and holding of key points along the meridian lines, knuckling, hooking, stroking and massage to selected areas or acupoints. Shiatsu can be used throughout the whole of labour if the woman wishes, and will certainly be extremely beneficial if used in this way.
  

  Benefits in labour
  

  Shiatsu shares the same benefits as previously mentioned in the acu- puncture section as it is a manual form of acupuncture, accessing the key meridian lines and points without needles. This makes it less invasive and easily combined with normal midwifery care given by the midwife. In addi- tion Shiatsu has the following benefits: