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Complementary Therapy for IOL


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Complementary Therapy for IOL

  1. 1. Complementary therapy for IOL Pippa Nightingale Consultant midwife January 2011
  2. 2. Aims <ul><li>To implement complementary therapy into clinical practice in a format where the outcomes are measurable. </li></ul><ul><li>To reduce our IOL rate in an attempt at reducing our C/s rate. </li></ul><ul><li>Our overall aim to reduce the IOL rate by 2% to increase the vaginal delivery rate further. </li></ul>
  3. 3. Background <ul><li>2009 at West Middlesex was an eventful year we expanded from a delivery rate of 3800 to a delivery rate of 4600, along with the opening of the Natural Birth Centre which has been a success and delivered 923 women in it 2010. </li></ul><ul><li>Complementary therapy was being used in the labour setting but staff had not been trained and there were no policies. </li></ul><ul><li>We were successful in an education grant to train 15 midwives in Aromatherapy and reflex zone techniques, we also had Christine Grabowska on board who trained us on Moxibustion. </li></ul><ul><li>We then wrote a policy for the use of complementary therapy and Moxibustion to turn breech. </li></ul>
  4. 4. Why IOL <ul><li>Although we planned to use complementary therapy in the labour setting we wanted to also use it in a frequent controlled setting to gain our confidence and experience. </li></ul><ul><li>We were also aware that as in all medical settings outcomes need to be measurable to prove its success which we knew we would be asked to do. </li></ul>
  5. 5. Research/ Regulations <ul><li>NMC permits suitably trained midwives to administer complimentary therapies as part of their practice, they must produce documentary evidence of adequate and appropriate training and education. </li></ul><ul><li>Pinn and Pallett (2002) report the up to 55% of pregnant women use complimentary therapies in pregnancy. </li></ul><ul><li>Burns et al (2000) reported that aromatherapy in pregnancy and labour can have benefits such as preventing induction of labour and reducing analgesia requirements </li></ul>
  6. 6. NICE regulations <ul><li>An care pathway promotes Cx sweep at 41 weeks to encourage spontaneous labour. </li></ul><ul><li>As in all clinical change and innovations use all the national data and research to promote and support the change. </li></ul>
  7. 7. The service <ul><li>2 clinics a week staffed by 2 dual trained midwives </li></ul><ul><li>Women referred by Mw, Dr and seen at T+4 then repeated if not delivered at T+11 </li></ul><ul><li>Reflex zone techniques applied. </li></ul><ul><li>Aromatherapy massaged using 1% clary sage, 1% lavender, and 1% jasmine. </li></ul><ul><li>Cx sweep </li></ul>
  8. 8. Women who are post dates and want complementary therapy, Referred to clinic at T+4 Information leaflet given to then The pre treatment check list on the complementary therapy induction Performa will be completed which indicates any risk factors or contraindications for the treatment. T he woman’s EDD will be confirmed using the first trimester dating scan or if not performed the woman’s LMP. Palpation will be performed to confirm presentation and position of fetal head then a cervical sweep performed, the Fetal heart will be auscultated following this. The 3 pressure points (Gall bladder 21, Colon 4 and spleen 6) will be stimulated. A reflexology treatment will then be performed stimulating the pressure points of the pituitary gland, sacroiliac joint, bladder 60 and solar plexus. A foot massage using a blend of 1% lavender, 1% clary sage and 1% jasmine in a carrier oil will be performed. An appointment to return in 7 days if not delivered. If it is the second treatment ensure an induction appointment has been made with labour ward for the next day at term +12 and explain the induction process and give the IOL leaflet.
  9. 9. Success of Treatments In total we performed 296 treatments in 2010 Overall success is 81%
  10. 10. Number of Treatments
  11. 11. Overall IOL rates Overall 2.2% reduction in the IOL rate with a 2.7% reduction in the post dates IOL rate and a 4% reduction in the Pg2E IOL rate
  12. 12. Mode of Delivery of the Women Treated Overall a 80% vaginal delivery rate
  13. 13. Place of Birth
  14. 14. Comparison of Vaginal delivery rates overall Overall 2% increase in our SVD rate with a 1% reduction in our C/s rate
  15. 15. Conclusion <ul><li>A fully implemented complementary therapy service </li></ul><ul><li>Measurable outcomes to demonstrate success </li></ul><ul><li>No conflict of its use in the clinical setting </li></ul><ul><li>Helped recruit staff from outside already trained in complementary therapy </li></ul><ul><li>Excellent user satisfaction </li></ul><ul><li>Midwives job satisfaction </li></ul><ul><li>Excellent information giving ability on latent phase and IOL </li></ul><ul><li>2% increase in SVD rates </li></ul><ul><li>1% reduction in our C/s rates </li></ul><ul><li>2.2% reduction in overall IOL rates </li></ul><ul><li>2.7% reduction in post dates IOL </li></ul><ul><li>4% reduction in Pg2E IOL </li></ul>
  16. 16. User satisfaction <ul><li>The service was evaluated well with the women who used the service. </li></ul><ul><li>97% of women surveyed said they would recommend the service to a friend. </li></ul><ul><li>96% reviewed the service as excellent, 2% as good and 2% as satisfactory. </li></ul><ul><li>Comments </li></ul><ul><li>“ cant believe this service is free of charge on the NHS its amazing” </li></ul><ul><li>“ This is a fantastic service a real commitment from the hospital to natural birth” </li></ul><ul><li>“ Amazing service even though it didn’t work for me I enjoyed the service and felt I was very well prepared and informed about my induction.” </li></ul>
  17. 17. Further Steps <ul><li>To train more midwives. Through train the trainer. </li></ul><ul><li>To develop more clinics so all women can be seen </li></ul><ul><li>Consider moving this into the research phase to compare the difference between no treatment, cervical sweep alone and the combined package as there is currently no research that had done this. </li></ul><ul><li>To collate the information on the use of Moxibustion in a similar style. </li></ul>
  18. 18. Thank You <ul><li>Any Questions???? </li></ul>[email_address]