A UNICEF report highlights the severe maternal mortality rate in India, where avoidable complications claim 78,000 lives annually, predominantly in certain states. The document discusses various complementary and alternative therapies for labor pain management, such as acupuncture, reflexology, and hydrotherapy, alongside traditional methods. It also examines the advantages and disadvantages of water births and emphasizes the need for careful monitoring during this process.

3. UNICEF REPORT-2009
An Indian woman is 300 times more likely to die
in childbirth complications than USA/UK
Avoidable complications during childbirth are
killing 78,000 women in India every year
On an average,one woman die every 7 minutes
from complication of pregnancy and childbirth
In India,more than two thirds of all maternal
death occur in a handful of states ie.
UP,MP,Bihar Jharkhand,Orissa
Rajasthan,Assam,Chhatisgarh
In UP,one in every 42 women faces risk of
maternal death,compared to 1 in 500 women in

5. In bible labour pain is mentioned as “In
sorrow thou shalt bring forth the children”
– Genesis-3:16
Labour pain – sin, witch craft
Sir James Young Simpson – interpretation
of bible was wrong.
Queen Victoria – Chloroform - for the
birth of son Leopold
Entonox was introduced in 1881.
LABOUR PAIN - HISTORY

6. What is complementary therapy?
Complementary therapy is something
that complements conventional medical
treatment.
CARE = CARE

7. What are Alternative therapies?
Alternative therapies are those
which offer alternatives to
conventional therapies.

8. Therapies are as follows
1. Herbal medicine
2. Chinese medicine
3. Chiropractic
4. Naturopathy
5. Osteopathy
6. Acupuncture/Acupre
ssure
7. Homeopathy
8. Reflexology
9. Aromatherapy
10.Alexander
technique
11.Massage
14. Yogic medicine
15. Ayurvedic medicine
16 Spiritual healing
17. Iridology
18. Kinesiology
19. Meditation
20. Nutritional
medication
21. Music therapy
22. Gold therapy
23 Hydrotherapy
24. Energy healing
25. Crystal therapy

9. Complementary therapies are as
follows
1. Acupuncture 7. Birth ball
2. Acupressure 8.Aromatherapy
3. Reflexology 9. Water birth
4. Massages 10.DoulaServices
5.Music therapy 11.Yoga therapy
6. Hydro therapy 12.Homeopathy

10. How does complementary
therapy alter pain?
1. Gate closing thoery
2. Endogenous opiates theory

11. PAIN
Pain is "an unpleasant sensory and
emotional experience associated with
actual or potential tissue damage
Questions to ask about pain:
P-Pattern (onset & duration)
A-Area(location)
I-Intensity(level)
N-Nature(description)

12. P-Provocation
Q-Quality
R-Referral
S-Severity
T-Timing
PQRST FORMAT

13. LABOUR PAIN
1ST
STAGE-Visceral pain

14. 2ND
STAGE-Somatic pain

15. LABOUR PAIN PATHWAYS
 The pain of the first stage of
labour is referred to the
spinal cord segments
associated with the uterus
and the cervix T10, T11,T12
and L1.
Pain of distension of the
birth canal and perineum is
conveyed by S2-4.

16. ACUPUNCTURE
Works by normalising the”flow”of
qi”vital energy”in the body.
Pain or illness=blockages of qi
12 main channels of energy and 8
extra channels.

17. REFLEXOLOGYREFLEXOLOGY
This therapy is related to acupuncture and
involves massaging various areas of the feet in order
to stimulate channels of energy which connect with
other parts of the body.
AIM
The body has its own powerful healing
response.Reflexology aims to stimulate this into
normal functioning and to maintain homeostasis.

18. There are approximately 7200 nerve endings on
the feet and these relate to various organs and glands
within the body. A mirror image of the body has been
mapped on the feet and pressure applied on specific
reflex points on the feet can affect the corresponding
part of the body.
In Labour
It can be used during labour to increase the
strength of contractions, to calmdown contractions if
they are extremely painful.
Research has proved that birth time has been
reduced and mothers recover more quickly after birth.

19. Following treatment,
mothers are advised to
wear comfortable shoes,
drink water/
decaffeinated drinks.
This is to promote the
detoxification process
and helps the body to
eliminate the toxins that
have been released.
Reflexology effect on the body can be as powerful as
that of strong drugs.

20. HOMEOPATHY
Induction of labour
Blue cohosh roots carries
significant amount of oxytocin
Black cohosh roots helps in labour
progress

21. AROMATHERAPY
Essential oils form the base of aromatherapy and
influence the mind, body and spirit.
These oils are the concentrated extracts of plants
and their roots, stems, flowers and fruits.
Essential oils are concentrated and must be diluted
by mixing up with carrier oils before application. . Only a
few pure essential oils like lavender and tea tree can be
applied directly to the skin.

22. Massaging the oil onto the body is the most common
method of getting the benefit of aromatherapy oils,
since skin is the largest absorption organ that we
have.
Commonly used essential oils
1.Bergamot- Originally from Italy, is obtained from the
kind of the bitter orange. It is pale green in colour, with
sharp, orangey and refreshing fragrance.
It is a happy uplifting oil, works well against
tensions, headaches and anxiety.

23. 2. Chamomile
This is oil for women and children. It relieves cramps
and spasms and a good painkiller for dull aching pain.
German Chamomile is a great oil for children. Soothes
child’s colic or stomach upsets, alleviates nappy
rashes and skin irritation.
3. Eucalyptus
Versatile oil with origins in Australia. It helps to
relieve bad cold and fever. It is also an effective insect
repellent.
4. Tea tree
It has antibacterial, antifungal, antiseptic and
antiviral properties. Heals blemishes without any side
effects such as dryness, itching, stinging, burning or
redness.

24. Aromatherapy oils can be used for lower back
massage with
 Jasmine
Juniper
Geranium
Clery sage
Rose
Lavender
Have been reported to provide subjective
benefits in labour

25. MUSIC THERAPYMUSIC THERAPY
Physical effects of music
Louder and faster noises tend to raise both heart rate
and blood pressure. Slower, soften and more regular
tones produce the opposite result.
 It also relieves muscle tension and improves motor
skills.
Levels of endorphins are increased while listening to
music and levels of stress hormones are decreased.
 It is used to create feelings of calmness, excitement or
romance.

26. Lullabies have long
been popular for
soothing babies to
sleep.

27. BIRTH BALLSBIRTH BALLS
It is a large [65 cm in diameter]
air filled ball.
During pregnancy it can be
used as an exercise aid for
pelvic muscles.
Research on the use of the ball
demonstrates a significant
improvement in core muscle
stability, including the muscles
of the chest and abdomen,.
These muscles are instrumental
in the labour process for deep
breathing and pushing

28. 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
for securities.

29. 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, stimulate large
diameter nerve fibre and to close the gate on pain,
and promotes better circulation and oxygenation.

30. WATER BIRTHWATER BIRTH

31. Water birth is the process of giving birth in
a tub of warm water. Some women choose
to labour in the water and get out for
delivery. Other women decide to stay in the
water for the delivery as well. The theory
behind water birth is that the baby has been
in the amniotic sac for 9 months and
birthing into a similar environment is gentle
for the baby and less stressful for the
mother.
DEFINITION

32. WHAT ARE THE POTENTIAL BENEFITS OF
WATER BIRTH?
Benefits for Mother:
Water is soothing, comforting and relaxing.
In the later stages of labor, the water seems to
increase the woman’s energy.
The buoyancy lessens her body weight, allows free
movement and new positioning.
Buoyancy promotes more efficient uterine
contractions and better blood circulation
Immersion in water often helps lower high blood
pressure caused by anxiety.
Water seems to alleviate stress-related hormones,
allowing the mother’s body to produce endorphins,
which are pain-inhibitors.

33. Greater comfort and mobility.
Reduction of pressure on the abdomen.
Helps mother to conserve her energy.
Promotes deeper relaxation.
Water relaxes the pelvic floor muscles
Water minimises the pain
Water stimulates the touch and temperature nerve
fibres in the skin.

34. Water can reduce the need for drugs to artificially
stimulate labour.
Lowering of blood pressure.
Easier breathing.
Water causes the perineum to become more elastic and
relaxed
Being in the tub reduces the possibility of intervention
by birth attendants.
Skin to skin time is facilitated.

35. Initial breast contact is also easier to initiate
The cord continues to pulse strongly for an extended
period resulting in baby receiving his full blood volume.
Benefits for Baby:
Provides a similar environment as the amniotic sac.
Eases the stress of the birth, providing reassurance and
security.
As the laboring women relaxes physically she is able to
relax mentally, concentrating her efforts inward on the
birth process.

36. Recommended Criteria for the
use of a water pool
An uncomplicated pregnancy of at
least 37 weeks of gestation.
Established active labour (i.e. good
regular contractions; dilation of the
cervix and descent of the presenting
part).

37. Potential Advantages of Water Immersion
The buoyancy of water enables a mother to move
more easily;
Blood pressure is lowered;
Comfort & relaxation may be enhanced;
Maternal sense of control may increase, which in
turn enhances emotional well-being;
Pain may be diminished;
The need for pharmacological pain relief may be
reduced;
Length of labour may be reduced;
Improved perineal stretching may reduce trauma;
Operative births may be reduced.

38. Potential Disadvantages
Decrease in uterine contraction strength and frequency,
especially if used before active labour is established;
Neonatal water aspiration; at least two cases have been
recorded
Maternal hyperthermia may contribute to fetal hypoxemia;
Neonatal hypothermia is possible if water temperature is
too cool;
Cord immersion in warm water may delay vasoconstriction,
increasing red cell transfusion to the newborn and
promoting jaundice;
Blood loss estimation and assessment is difficult in the
water;
Maternal and Neonatal infection may be increased; not
supported by the evidence

39. Contraindications for birth in a
water pool
Pre-term labour;
Maternal infection with a blood borne pathogen
such as Hepatitis B or C or HIV 1 ;
A woman who has meconium-stained amniotic
fluid may use a water pool for immersion during
labour, as long as close monitoring of the fetal
heart takes place and findings are reassuring. She
should be asked to get out of the pool for the
birth of the baby to facilitate suctioning of the
oral and nasal pharynx once the head is born.

40. Caution should be used when
considering water immersion if
sedation has been administered to the
woman. Individual responses to
sedation vary; the woman must be able
to get in and out of the tub without
difficulty and be fully conscious and
aware of her surroundings while in the
water. She should never be left alone.
Risk of maternal water embolus;
Risk of acquiring blood born infection
or sustaining back injury for caregivers

41. Recommendations for the use of
water immersion for labour and birth
Midwives should discuss the potential advantages
and disadvantages of water immersion for labour and
birth with each woman prior to labour.
The woman's vital signs and the fetal heart rate must
be within normal limits.
The fetal heart should be monitored according to
accepted guidelines. Use of a waterproof Doppler
device is recommended.
The water temperature should be monitored and
maintained between 36 and 37.5 C to prevent hypo or
hyperthermia. The temperature may be monitored
with a floating thermometer.

42. The woman's temperature should be monitored and
she should leave the water if her temperature exceeds
37.5 degrees C.
The woman should be encouraged to maintain
adequate hydration and leave the pool to urinate at
regular intervals.
The woman should be asked to leave the water if
there are any concerns about her or her baby's well
being.
An alternative birth place should be set up close to
the pool.
The water should be kept as clean as possible. Stool
and blood clots must be removed from the tub
immediately. The tub should be drained, cleaned and
refilled if the pool is being used over a number of
hours or if contaminants cannot be easily removed.

43. The baby should be born completely
underwater with no air contact until the head
is brought to the surface, as air and
temperature change may stimulate breathing
and lead to water aspiration.
At birth the baby's head must be brought to the
surface immediately. Care should be taken to
avoid undue traction on the cord. There have
been reports of cord tearing. Some authors
recommend early clamping of the cord to prevent
polycythemia and reduce the risk of fetal blood
loss if the cord integrity is compromised.

44. Care should be taken to maintain the newborn's
temperature to prevent hypothermia.
The placenta is best delivered outside of the tub
to accurately assess maternal bleeding.
Birth pools that are being used in hospital or
that will be used again by another birthing
mother should be cleaned between uses with a
chlorine-releasing agent to kill any blood born
pathogens.
As when caring for any mother or newborn, the
midwife is responsible for using her clinical
judgment, responding appropriately to problems
that may arise, and for documenting her actions.

45. Evidence:
Eight trials are included (2939 women). No
trials were identified that evaluated
immersion versus no immersion during
pregnancy, considered different types of
baths/pools, or considered the management
of third stage of labour. There was a
statistically significant reduction in the use of
epidural/spinal/paracervical
analgesia/anaesthesia amongst women
allocated to water immersion water during
the first stage of labour compared to those
not allocated to water immersion (odds ratio
(OR) 0.84, 95% confidence interval (CI) 0.71 to
0.99, four trials).

46. There was no significant difference in vaginal
operative deliveries (OR 0.83, 95% CI 0.66 to 1.05, six
trials), or caesarean sections (OR 1.33, 95% CI 0.92 to
1.91). Women who used water immersion during the
first stage of labour reported statistically
significantly less pain than those not labouring in
water (40/59 versus 55/61) (OR 0.23, 95% CI 0.08 to
0.63, one trial). There were no significant
differences in incidence of an Apgar score less than
7 at five minutes (OR 1.59, 95% CI 0.63 to 4.01),
neonatal unit admissions (OR 1.05, 95% CI 0.68 to
1.61), or neonatal infection rates (OR 2.01, 95% CI
0.50 to 8.07

47. PROFESSIONAL WATER BIRTH
ACCESSORIES POOL KIT
 Electric Air Pump
 Submersible Water Pump
 Underwater Flashlight
 Floating Thermometer
 Handheld Water Mirror
 25 Foot Water Hose
 Protective Floor Plastic

48.  Y-Adapter with Cap
 Faucet Adapter
 Debris Net
 Anti-Bacterial Sponge
 Detailed Instructions
 2 sheets
 6 towels , trays
 Flash light & batteries Q-tips
 6 old washcloths
 Other towels and washcloths
 Several pillows

49.  A bowl or pot for the placenta (2 qt. size)
 Paper towels
 Large thick plastic trash bags (at least 4)
 flannel-backed rubber sheet
 Flash light & batteries Q-tips
 Baby bathtub or small tub
 A clean hose 6 baby receiving blankets
,Diapers

50. ACUPRESSURE IN LABOURACUPRESSURE IN LABOUR
It is an ancient healing art developed in
Asia over 5000 years ago (sushrut samhitta) that
uses the fingers to press key points on the
surface of the skin to stimulate the body’s natural
self-curative abilities.
The technique is based on the TCM system that
emphasizes the concept of holism, that is that
mind, body and spirit are integrated.
The belief of TCM is that channels of
energy called Qi (chi) run through out the entire
body. Qi flows through channels, or meridians,
improving blood circulation nourishing tissues
and promoting normal function.

51. Hegu- LI - 4
Location: This point lies between the
first and second metacarpal bones.
The highest point formed when the
thumb is brought to rest against the
index finger.
Uses:
1. To provide general pain relief in labour
2. To stimulate efficient uterine contraction.
3. To regulate uterine contraction.
4. During 2nd
stage of labour to aid body's effort to
move the baby down through birth canal.

52. Sanyinjiao – SP- 6
Location: 4 fingers width
(woman’s) above the tip of
the medial mallelous of the
border of the tibia.
Uses:
1.Aid in the dilatation of the cervix.
2.Aid in strengthening uterine contraction.

53. Ciliao BL - 32
Location: Centre of second sacral foramen, of the mid
point of posterior superior iliac and posterior midline.
Uses:
1.Aid in the descent of the baby
2.Produce a pleasant anaesthetising effect on the
uterine contractions.

54. Jianjing GB - 21
Location: when you draw an
imaginary line between the
bony prominence of the neck
(C7) and the top of the shoulder
joint (acromion process), this
point lies midway along the
curved line, at the highest point
of the shoulder muscle.
Technique: pressure is applied of the beginning of each
contraction.
Uses:
1.To aid in the descent of the baby at the first and second
stage of labour.
2.To stimulate uterine contractions.

55. Zhiyin UB - 67
Location: This point lies on the
little toe, just on the out side
aspect of the toe nail.
Uses:
1.To correct abnormal positions like occipito posterior
positions.
2.In all acute emergencies, difficult labour, and
malpositions of the fetus.
3.For spontaneous version of breech presentation into
cephalic. Apply pressure 1 or 2 minutes once or twice a
day. Immeidately afterwards get into knee chest postiion
for 15 minutes. Treatment can be started from 33 weeks
of getation.

56. Kunlun BL 60
Location : Level with
prominence of the
lateral malleolus
Uses:
1. To correct occiputo posterior position together
with Sp6
2. For progession of labour in occipito posterior.

57. To identify correct point
While applying the pressure there should
be a distinct feeling around or at the site of
pressure. This may be felt as tension,
numbness, warmth, aching or buring sensation.
N.B Do not use these points during pregnancy.

58. To induce labour : Points Li-4, Sp6,
BL32
L14 & Sp6 can be used in combination. Apply
pressure for 1 minute hourly or 2 hourly
intervals. BL-32 apply pressure and strokes
through to buttocks 5 minutes twice a day. Start
the treatment 1 week or 3-4 days before EDD.

59. Posterior Positions : Points – Kunlun Bl-60
in combination with Sp6. These points can be
used together. Apply pressure on BL-60 for 2
minutes followed by pressure on SP6 for 2
minutes. Preferably both legs are used
Or
BL-67 apply pressure for 2 minutes with end of
a ball pen or finger nail.

60. Pain relief in Labour : Points LI-4, SP6
Apply pressure with index finger or thumb for 1
to 2 minutes on one leg at a time. After 20 – 30
minutes apply pressure on the opposite leg.
Once the labour has become established (the
contractions are regular and efficient)
acupressure can be discontinued.

61. Un established labour or failure to
progress:
Point SP6 & LI4
Acupressure can be used for several minutes
on each point. Apply pressure on LI 14 on one
hand and SP6 on opposite leg. Ten minutes
later this combination can be repeated on the
opposite leg and hand.

62. Cervical Lip : Points Sp6 & BL32
When the cervix has not fully dilated and the
woman feels the urge to push, pressure on
these points can be used. Apply pressure on
BL-32 for upto 10 minutes. If possible apply
pressure in combination.

63. How Acupressure works?
The nervous system is stimulated to release
neurotransmitters in the body. Acupressure decreases
pain by to mechanisms
1.Release of endorphins
2.Gate control theory

64. Massage in labour
Women who have experienced skilful
massage during labour often say afterwards
how helpful and pain relieving it was.
Effleurage - it is a light, rhythmic stroking
techniques
Petrisage - kneading techniques
Uses
1. Soothing sensory input from
stroking and kneading activates the gate
closing mechanism at spinal level.
Tissue manipulation (deep sacral kneading)
to stimulate the release of endogeneous
opiates.

65. Back Massage
Back pain experienced in the lumbo
sacral region and it intensifies as labour
progresses.
Stationery kneading
Single handled or reinforced with one hand over
the other, applied slowly and deeply to the
painful area if often helpful.

66. Double handled kneading with loosely clenched fists
directly over the sacroiliac joints can give relief

67. Massage from the sacrococcygeal area, up and
over the iliac crests can be soothing.

68. Slow, rhythmical, longitudinal stroking from
occiput to coccyx, can relieve tension.

69. The abodmen
Pain is most commonly experienced over the lower
half of the abdomen, particularly in the supra public
region.
Deep massage totally unacceptable

70. Light finger- stroking/brushing from one
anterior superior iliac supine to the other, is
often appreciated.

71. Double handled stroking ascending either side
of the midline and across to the iliac crests. This can
be synchronized with easy breathing.

72. Perineal massage
Midwives will massage a mother’s perineum
in the first and second stage of labour in an effort
to encourage stretching of the skin and muscle to
prevent tearing.

73. The doula’s most important role is to
provide nurturing, continuous support and
reassurance in helping the mother have
the birth how she wants. She will support
the mother throughout the labour.
DOULA SERVICES
ONE TO ONE LABOUR
SUPPORT

74. DOULA SERVICES
1. Smile Exercises
2. Establish eye contact
3. Use Mother’s name
4. Give your undivided attention
5. Match speech
6. Mirror the person’s body language

75. 7. Show that, without any shadow of doubt,
you respect and accept the person.
8. Don’t show any hesitance on your face

76. 9. Appreciation of good effort
10. Have Patient/ customer-friendly voice