INTRODUCTION 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. (1).These methods are popular because they emphasize the individual personality, and the interaction between mind, body and environment (2). 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. ALTERNATIVE THERAPIES Alternative therapies are used instead of conventional or mainstream therapies for examples, the use of acupuncture/acupressure rather than analgesics to relieve pain. COMPLEMENTARY THERAPIES Complementary therapies are those used in conjunction with conventional therapies for example meditation used as an adjunct to analgesics drugs. Nature of Pain During Labor and Delivery A scientific definition of pain is ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage . Acute pain such as labor pain has two dimensions: a sensory or physical dimension, with the transmission of information, the pain stimuli, to the brain, and an affective dimension due to interpretation of these stimuli through the interaction of a wide variety of emotional, social, cultural and cognitive variables unique to the individual. Components of pain 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 ce

1. ALTERNATIVE
AND
COMPLEMENTARY
THERAPIES
IN LABOR
ANCY ABRAHAM

2. ALTERNATIVE THERAPIES
Alternative therapies are used instead of
conventional or mainstream therapies for examples,
the use of acupuncture/acupressure rather than
analgesics to relieve pain.

3. COMPLEMENTARY THERAPIES
Complementary therapies are those used in conjunction
with conventional therapies for example meditation used as
an adjunct to analgesics drugs.

4. ALTERNATIVE
APPROACHES

5. 1. HYPNOSIS
• The word hypnosis originates from the Greek “Hypnos” which means
sleep. Hypnosis is not sleep but a state of attentive and focused
concentration in which the patient can be relatively unaware, yet not
completely blind to their surroundings.
• Hypnotic focus on diminishing the awareness of pain as well as fear
and anxiety.

6. Self hypnosis can be taught at various
hypnosis training centres on special childbirth
classes that teach the technique of positive
statements and concentrating on beautiful
images of child.

8. 2. BIOFEEDBACK
Biofeedback is a treatment that uses
monitoring instruments to provide
visual or acoustic feedback to
patient’s physiological information of
which they are normally unaware

9. • . It puts the patient in control and
gives them a sense of self-reliance
that is an important factor for
laboring woman. For example
childbirth classes or childbirth
classes plus video session about
coping with labour pain etc.

11. 3. YOGA
Yoga, a method of Indian origin, proposes
control of mind and body. Between the
different types of yoga, ‘energy yoga’ can be
applied to pregnancy and delivery. Through
special training of breathing, it achieves
changes in levels of consciousness,
relaxation, receptivity to the world and inner
peace.

12. According to professionals who
use this technique for delivery,
yoga shortens the duration of
labor, decreases pain and reduces
the need for analgesic medication.

13. 4. SOPHROLOGY
The word sophrology derives from two Greek words, ‘sos’
harmony or serenity and ‘phren’ conscience or spirit. This
technique derived from Indian yoga was introduced in Europe
during the 1960s.
Its purpose is to improve the control of body and spirit through
three degrees of dynamic relaxation: concentration,
contemplation and meditation.

14. Applied to obstetrics, better control of
the delivery process is expected.
Patients individually report a high degree
of satisfaction with this experience of
relaxation during prenatal classes and
delivery, but there is no controlled
evaluation in the literature.

16. 6. MUSIC THERAPY
The use of music to relieve pain and decrease anxiety has
been known to be helpful for the relief of postoperative pain
for same time. Research regarding the use of music to
reduce labour pain has also demonstrated that music may
be used to promote relaxation during the early stages of
labour and as a stimulant to promote movement during
later stages, when physical exertion is required for bearing
down process.

17. Phumdoung and Good 2003, in their study
described music consistently provided
significant relief from severe pain across 3
hours of labour and delayed the increase of
affective pain for 1 hour, it also delayed
increase in distress of pain for an hour and for
some, relief was fairly substantial.

18. In another study done decades ago by Hanser,
Larson, O’ Connell 1983 indicated that mothers
recorded fewer pain responses in the music versus
no music groups and that music aided
concentration, relaxation, cued breathing and
diverted attention from pain. It indicated that music
made from a positive contribution to the child
bearing experience for mothers.

19. 7. ACUPUNCTURE
• Acupuncture is well known Chinese practice. In
this one uses needles inserted at specific points to
relieve pain this therapy is found beneficial and
relaxing during pregnancy.
• It is used to relieve pain and also to reduce
morning sickness.

20. The placement of the needle will depend on
which stage of labor patient is and kind of pain.
• Advisable to take this treatment with
experienced certificate practitioners.
• The basic theory include altering the body’s
levels of chemical neurotransmitters and
influencing the natural electrical currents or
electromagnetic fields

22. 8. ACUPRESSURE SYSTEMS
• Acupressure is a descendant of Chinese
manipulative therapy in which points are
stimulated by pressure, using hands, fingers
and thumbs .

23. 9. HOMEOPATHY
• There are homeopathic drugs that may help to lessen the pain
of natural child birth. These are pills with no side effects to be said that
have to be taken at regular intervals throught out the labour.
• Though homeopathy is not recognized as a way of curing an
ailment or pain quickly, it can start from the later months of
pregnancy, with the aim of reducing the eventual labour pain. These
drugs only be taken by recognized homeopathy practitioner and
obstetrician.

24. 10. THERAPEUTIC TOUCH
The purpose of therapeutic touch in labor is to
communicate caring and reassurance. Painful contractions
of the uterus can be treated by the application of pressure
with the hands to the woman's back, abdomen, hips, thighs,
sacrum or perineum.

25. Whether touch is perceived as positive or not is dependent on
who is touching the patient: in one study, touching was
perceived positively by 94% of patients when they were touched
by a relative or friend, 86% by their husbands, 73% by a nurse
and 21% by a physician (32). Anxiety is reported to be reduced
in patients who receive reassuring touch. In a retrospective study
of 30 patients, 77% experienced ‘less pain’ when they were
touched during labor, and 40% reported less need for pain
medication.

27. 11. MASSAGE THERAPY
Touch and manipulation with the hands has been used in
the practice of medicine since its inception. The value of
touch and massage and its positive effect is well
documented.
Massage therapy can incorporate in nursing practice
throughout labour to promote relaxation and stress
reduction.

28. Massage is thought to have a physiological basis, blocking
pain impulses by increasing A-fiber transmission or by
stimulating the local releases of endorphins, stimulating large-diameter
nerve fibers to close a gate of pain, stimulating
mechanoreceptors, stimulating circulation with resultant
increased oxygenation to tissues and facilitating the excretion
of toxins through the lymphatic system.
Massage has been shown to be factors in promoting
labour progress, decreasing pain perception and increasing the
woman’s ability to cope with labour.

30. 12. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION
This is a method of pain management in which
electrodes fitted at the back, to pass electric
current into the body. This stimulates the natural
secretion of endorphins, the body’s painkillers. This
usually used in the early stages of pregnancy and
has no known side effect..

32. 13. STERILE WATER INJECTION
This is relatively new technique for curbing back pain
during labour. Using this technique allows the mother to
remain fully conscious during labour. She can move
and may not need an epidural in the later stage.
Counter-irritation is the process by which localized
pain felt in one part of the body may be relieved by
irritating the skin in same dematomal distribution with
either a hot, cold scratchy or electrical Stimulus.

33. Pure sterile water is injected into 4
specific locations on the lower back of
the back of the mother. This may cause
a stringing pain 20-30 seconds, but relief
lasts for an hour, are more and
procedure can be repeated any
number of times.

34. 14. HYDROTHERAPY
• The use of hydrotherapy during labour, whether
in a shower or a tub, is a proven means of relaxation
and pain relief. The warm water stimulates the
release of endorphins, relaxes muscles to decrease
tension, stimulates large diameters nerve fibers to
close gate on pain, and promotes better circulation
and oxygenation.

35. Hydrotherapy can promote increased diueresis,
decreased edema, decreased blood pressure,
enhanced fetal rotation due to increased
buoyancy faster labour, less use of intramuscular
and intravenous medications, less use of
epidural, episiotomies and increased satisfaction
with birth experience. Prior to implementing
hydrotherapy procedures and protocols should
be developed.

36. A common question asked by providers is whether
hydrotherapy can or should be used when
membranes are ruptured. Several studies have
looked at the risks of using hydrotherapy after
rupture of membranes. Finding gave shown no
increase in choriomnionitis, postpartum
endometritis, neonatal infections etc., however
precautions needed to reduce infection

38. 15. BIRTH BALL
The Swiss Ball has been used in physical therapy and
exercise programs for decades. Birth balls were originally
developed by physiotherapists and used for treating ortho-neural
disorders, but using them has been found equally
beneficial for a pregnant woman. Research on the use of
ball demonstrates a significant improvement in core muscle
stability, including the muscles of the chest, abdomen and
pelvis

39. . These muscles are instrumental in the labour process
for deep breathing, pushing and general movement
Rocking and movement can be accomplished on a
birthing ball during labour not only does the ball
facilitate the physiologic benefits of movements to help
the fetus find its best ffit through the pelvis but also
promotes comfort and can decrease pain by
stimulating mechanoreceptors and joint receptors.

40. The ball should be used with the following
precautions:
The woman should never use the balls
unless her support person is with her
The woman should always have a firm
support in front of her to hold on to for security
A policy should be written outlining their
use, cleaning and storage.

42. 16. AROMATHERAPY
• Aromatherapy is the therapeutic use of plant
derived essential oils to promote physical and
psychological wellbeing
• .Essential oils are lipid soluble and are rapidly
absorbed when applied externally or are inhaled.
• They are excreted through kidneys or expired
through the lungs.
• For labor therapeutic grade oils in low doses for
massage or as an environmental fragrance is
increasing in health care settings.

43. • For labor therapeutic grade oils in low doses for massage
or as an environmental fragrance is increasing in health
care settings.
• For labour , therapeutic grade oils such as lavender
or jasmine can promote relaxation and perception
of pain
• peppermint oil may be effective in decreasing
nausea and vomiting
• To use aromatherapy effectively , nurses should
have basic understanding of the chemical

45. 17. BREATHING
• Controlled, rhythmic breathing has
been found to be relaxing by women
dealing with labour pain.
• If women takes deep breathing it can
help to calm and distract from the pain.

46. • It can also help to
diminish the natural
instinct to hold the
contractions.

47. 18. POSITION
• Different positions during labour have different
ways of helping to relax and be more
comfortable.
• To avoid pain many nurses and doctors suggest
mothers adopt
• semi-reclining position or
• lie on their side.

48. A walk, squatting position or
fetal position can help case
pain. What ever position in
which woman find
comfortable can be good for
her.

49. 19. HEAT THEORY
• Sometimes a simple heating pad
may work wonders to relieve the
pain felt while giving birth.
• Pads are available in different size
and shapes suitable for almost all
women and are easy to use.

50. • If not available heat
therapy can be done by
using warm water bag or
even a warm pack or
soak

51. 20. REFLEXOLOGY
• Another ancient practice is which pressure in
applied to specific body parts, specifically the
soles of the other parts of body. During labour, a
reflexologist can help woman cope with pain and
speed the process of childbirth by pressure and
stoking specific ankle points, which are said to
stimulate the pituitary glands to release pain killing
hormones. Reflexology should only be performed
by an experienced practitioner.

53. 21. DISTRACTION
• In this a woman in pain can
take her mind off of the
contractions and labour by
reading a book, listening to
music, walking, talking to a friend
or watching TV. These activities
are simple to do and provide
distraction from pain.

54. THANK
YOU