3. Introduction to crisis:
Pregnancy is a time of transition-spanning.
This radical change of status is considered a crisis with
a defined period of time to work through the
preparatory psychological process that are normally
present during pregnancy and culminate with the
birth of baby.
4. In general, the emotions of a pregnant woman are
quite labile. She may have extreme reactions and
rapidly changing mood shifts. Her emotional reaction
and perception of the world may change. She may
extremely sensitive and tends to overreact. A pregnant
woman is far more open both to her internal self and
to sharing her experience with others
5. Throughout pregnancy, there is a definable sequence
of specific psychological processes that often seems to
be interrelated with the biological changes taking
place. These psychological events and processes are
identifiable by trimester of gestation, and this division
is used in the following discussion.
6. First trimester:
The first trimester is often referred to as the period of
adjustment. The adjustment the woman is making is
to the fact that she is pregnant. The acceptance of this
reality and all it means is the most important
psychological task of the first trimester.
7. Most women are upset and ambivalent about being
pregnant. Approximately 80% go through a period of
disappointment, rejection, anxiety, depression and
unhappiness
8. Sexual desire:
Women vary widely in their sexual desire during the
first trimester. Although some women experience an
increase in desire, generally speaking the first
trimester is a time of decreased libido, and this creates
a need for open and honest communication with
partners.
9. Second trimester:
The second trimester is often referred to as the period
of radiant health, a time during which women
generally feels good and is largely free from the normal
discomforts of pregnancy. The second trimester
actually subdivided into two phases:
pre-quickening
postquickening
10. Towards the end of first trimester and during the
prequickening portion of second trimester the women
undergoes a complete reliving and re-evaluation of all
aspects of her relationship with her own mother.
Included in this process is the evolution of the woman
from being a care receiver to being a care giver
(preparatory to being mother).
11. With quickening come a
number of changes, as the
pregnancy is unquestionably
verified in the woman’s
mind. Her social contacts
increasingly become other
pregnant women or brand
new mothers and her interest
and activities focus on
pregnancy, childbearing, and
preparation for a new role.
12. Quickening enables the women to conceptualize her
baby as an individual separate from herself. This new
awareness starts a change in her focus from herself to
baby.
13. Most women feel more erotic, 80% of pregnant women
experience a significant improvement in their sexual
relationship as compared with both first trimester and
before pregnancy
14. Third trimester:
The third trimester is often
referred to as the period of
watchful waiting. Now that the
woman is aware of the baby’s
presence as a separate being, she
becomes impatient for the baby’s
arrival. The third trimester is a
time of active, visible preparation
for child birth and parenthood as
the woman’s attention focuses on
the forthcoming baby. Both fetal
movement and size of uterus are
constant reminder of the baby
15. A number of fears surface during
the third trimester:
The woman may fear for her own and the baby’s life;
that she will have an abnormal baby.
labor or delivery (pain, loss of control), that she will
not know when she is in labour that the baby will not
be able to emerge since her abdomen is already
unbelievably large.
Her dreams reflect her interests and her fears.
Once again she experiences physical discomforts,
which increases as the end of pregnancy.
16. She may feel:
Awkward
Ugly
Sloppy
Need large and frequent doses of the reassurance from
her partner.
By the middle of third trimester, the heightened
sexuality of second trimester diminishes as her
abdomen become obstacle. The honest sharing
between the couple and their consultation with nurse
is essential.
18. Role of nurse in promoting
acceptance of pregnancy
Pregnancy is a time of profound
psychological, social, biological
changes that affect the parents’
responsibilities, freedom, values,
priorities, social status, relationship,
and self image. The events of the
childbearing year also may be
unpredictable. Although expectant
parents can control some events and
adopt positive attitude, they can’t
control all that happens during that
year.
19. Cheerleader for change:
The nurse must promote family adaptation to the new
family member. To achieve these goals, the nurse
should take these steps, as expertise allows:
Promote each family member’s self esteem.
Elicit questions and concerns from the family and
listen to them attentively.
Discuss roles and tasks for each family member, affirm
their efforts and inquire about and show concern for
each family member’s health care needs. Make
referrals as needed.
20. Involve all family members in prenatal visits, as
appropriate.
Offer sexual counseling to the patient and partner.
Help the patient maximize her family’s positive
contributions and minimize negative ones.
21. Good job:
The nurse should:
Praise the family’s efforts.
Offer books and material that address all family
members.
Promote the family’s prenatal bonding with the fetus
by sharing information that the fetal development and
helping the family to identify fetal heart tones and
movements. Reinforce bonding behavior, such as
patting the abdomen or talking to the fetus, by asking
the patient or her partner to note and report fetal
movements
22. Conquering conflicts: the nurse should:
Facilitate conflict resolution related to pregnancy and
child birth.
Promote conflict resolution by teaching such
techniques as personal affirmation and dream
interpretation and by suggesting literature .
23. Support adaptive coping pattern through realistic
patient and family education about pregnancy, child
birth, and the post partum period.
Discuss the challenges of parenting.
24. Proceed with the care:
Deliver culturally sensitive nursing care. Gather
information about the family’s customs and believes to
add to assessment data and individualize care.
Identify personal attitude and feelings about the child
bearing.
Avoid imposing personal values, feeling, and
emotional reaction on others.
Avoid making assumptions about the patient and her
preferences allow her to share her feeling freely.
25. Physical crisis and their
intervention:
Many women experience some
minor disorder during pregnancy.
These disorders should be treated
adequately as they may escalate
and becoming life threatening.
Minor disorders may occur due to
hormonal changes,
accommodation changes,
metabolic changes and postural
changes.
26. DIGESTIVE SYSTEM
NAUSEA AND VOMITING
Present in about 50% women
between 4th-16th
weeks of gestation.
Sickness is confined to
“Early Morning”.
Causes :
1. Medical disorders
2. Pregnancy complications:
Multiple pregnancy
Molar pregnancy
3. Large amount of human chorionic gondotrophin, estrogen,
progesterone
4. Smell of cooking
28. • Carbohydrate snacks at bed time prevents
hypoglycemia.
• Dry toast or biscuits on waking up and breakfast
after half an hour.
• Should take protein rich meals.
• Avoid fatty foods.
• Don't skip the meals
29. 2. Behaviour Modification
3. Get out of bed slowly and avoid sudden movements.
4. Avoid brushing teeth and tongue immediately after
eating.
5. Have enough rest and avoid fatigue.
6. Appropriate referral if vomiting become severe.
HEART BURN
Burning pain in mediastinal region caused by
reflux of stomach contents into esophagus.
Causes:
1. Relaxation of cardiac sphincter due to progesterone.
30. 2. Condition tends to worsen, as pregnancy
advances due to displacement of stomach
upward by enlargement of uterus.
MANAGEMENT
Avoid bending and kneeling while doing
household activities.
Take small meals frequently.
Sleeping with more pillows than usual.
Right side semi reclining position.
31. CONSTIPATION
It mainly occur due to:
Decreased physical activity
Pressure of gravid uterus on colon
Decreased peristalsis
of gut
MANAGEMENT
Increase intake of water.
Add green leafy vegetables,
fruits and bran cereals to her diet.
Take a glass of warm water
in morning before tea or breakfast.
Exercise by regular walking.
32. MUSCULO-SKELETAL SYSTEM
BACKACHE Causes:
Joint ligament laxity due
to relaxin, estrogen
Gradual weight gain
Hyperlordosis
Stretching of weak
abdominal muscles
Anterior tilt of pelvis
Faulty posture
High heel shoes
Muscular spasm
Urinary infection
Constipation
33. MANAGEMENT
Postural re-education
Advice related to comfortable positions.
Avoid excessive weight gain
Rest with elevation of legs
Improvement of posture
Massaging the back muscles
Wear comfortable footwear
Avoid high heel shoes
Keep the spine straight
Practicing antenatal exercises
Physiotherapy
34. LEG CRAMPS
CAUSES:
Cause is usually unknown
May be deficiency of vitamin B
Decreased level of calcium
Elevation of serum phosphorus.
Due to ischemia
Changes in pH or electrolytes
MANAGEMENT:
• Leg exercises
• Make gentle leg movements
35. Sleep with foot end of the bed elevated by 20-25 cm.
Take vitamin B-complex 30 mg daily.
Supplementary calcium therapy
Massaging the legs
Application of local heat.
36. GENITOURINARY SYSTEM
FREQUENCY OF MICTURATION
Causes: Relaxation effect of progesterone on smooth
muscles result in dilatation of uterus as well as
increase in renal blood flow.
MANAGEMENT:
Never restrict fluid intake, as it increases chances of UTI.
Consult with doctor if symptoms of UTI persist.
Antibiotics prescribed by doctor must be taken.
37. LEUKORRHEA
Increased white, non-irritant vaginal discharge.
MANAGEMENT
Frequent washing of vulva 3-4 times a day with plain
water.
Wear cotton under wears, should not be tight.
If infection such as Trichomonas is present, she
should be treated with vaginal application of
metronidazole or miconazole.
38. CIRCULATORY SYSTEM
FAINTING
CAUSES:
Vasodilatation under influence
of progesterone, in early pregnancy.
Pressure of uterine contents on
inferior venacava, in late pregnancy.
MANAGEMENT:
Avoid long periods of standing as well as sitting when she
feels slightly faint.
Advice mother not to lie on her back except during
abdominal examination.
39. VARICOSITIES
CAUSES:
Relaxation of
smooth muscles of
veins due to progesterone result in sluggish circulation.
The valves of veins become inefficient and causes
varicosities.
Family history of varicose veins.
Long standing periods.
• Varicosities: varicose veins in legs and vulva.
40. • Hemorrhoids: varicose veins in rectum.
Mainly occur in late months of pregnancy and may
causes pelvic congestion.
MANAGEMENT:
For varicosities:
Exercising calf muscles by rising onto the toes or
making circling movements with ankles
41. Resting with legs vertical against the wall for a short
time.
Wearing support thighs before rising or after resting
with legs elevated.
For hemorrhoids:
Avoidance of constipation by including fiber in diet
and adequate fluids.
Seeking medical advice for topical application.
42. ANKLE EDEMA
CAUSES:
Venous and lymphatic stasis
Excessive fluid retention
Evidence of pre- Eclampsia
Changes in osmotic pressure or blood and tissue fluids
Altered capillary permeability
43. MANAGEMENT:
Elevation of legs
Avoiding sitting with feet hanging down.
Elevate legs comfortably on foot stool or pillow while
resting.
Avoid taking diuretics because these medications
lower
blood pressure.
44. INTEGUMENTARY SYSTEM
SKIN
Itching:
It often starts over the abdomen. It have some
connection with hormones in pregnancy.
It may be due to raised billirubin level.
It clears soon after baby is born.
Comfort can be gained from local application of
antihistamine.
45. STRIAE GRAVIDARUM
Commonly develop during 2nd half of pregnancy and
affect mostly those bearing heavier fetus or with
multiple pregnancy.
Striae appear pink in color on skin of abdomen, breast,
thigh. After delivery these turn white in color but
never completely disappear.
Management:
Until now no cream is found to be effective in preventing
striae.
Keeping the skin well moisturized by applying lotion or
olive oil helps to decrease severity of striae.
46. NERVOUS SYSTEM
CARPAL TUNNEL SYNDROME
Mothers complain of numbness and pins, needles in
their fingers and hands.
Usually occur in morning.
CAUSE:
Fluid retention which causes edema and pressure on
median nerve.
Management:
• Wearing a splint at night, with hands resting on 2-3
pillows
• Restriction of salt intake
• Flexing the fingers when arm is held above head.
47. INSOMNIA
Common in late pregnancy
Causes:
Discomfort caused by fetal movements
Frequency of micturation
Difficulty in finding comfortable position.
Some deep seated anxiety or fear
Management:
• Take rest in afternoon
• Drink glass of warm milk at bed time
• Tuck a pillow under the abdomen
• Talk about her fears and anxities.
49. High risk pregnancy:
High risk pregnancy is defined as one
which is complicated by factor or
factors adversely affects the
pregnancy outcome-maternal and
perinatal or both.
All pregnancy and deliveries are
potentially at risk. However there are
certain categories where the other,
the fetus or the neonate is in a state
of increased jeopardy. About 20-30
per cent pregnancies belong to this
category.
50. Screening of high risk pregnancy:
The cases are assed at the initial antenatal
examination, preferably in the first trimester of
pregnancy. This examination may be performed in a
big institution or in a peripheral health centre. In rural
areas, the initial screening may be done by properly
trained paramedical personnel. From the peripheral
areas the high risk cases are sent to referral hospitals in
sub division, districts or cities for management by
specialists.
51. Initial screening
History:
Maternal age: pregnancy below the age of 17 or above the
age of 35 years. Primigravidae above the age of 30 years.
Pregnancy is safest between 20-29 years. Pregnancy
following a long infertility and after induction of ovulation.
Reproductive history: second and third pregnancies after a
normal first delivery carry a low risk.
The high risk factors in reproductive history are:
Two or more previous abortion or previous induced
abortion.
Previous stillbirth, neonatal death or birth of babies with
congenital abnormality
52. Previous preterm labour or birth of a small for date
baby or, weight of baby 3.5 kg or more.
Grand multiparity
Previous caesarean section or hysterotomy.
Pre-eclampsia, eclampsia
Anaemia
Third stage abnormalities –this has a particular
tendency to recur.
Previous infant with Rh-isoimmunisation or ABO
incompatibility.
54. Family history:
Family history of
diabetes, hypertension,
multiple pregnancy,
congenital
malformation.
55. Socio-economic status:
patients belonging to poor families have a higher
incidence of anaemia, preterm labour,growth
retardation of babies.
Working women who have long road journeys, have
higher incidence of recurrent abortion or premature
labour.
56. General physical examination
Height: below 150 cm particularly below 145cm in our
country
Weight: overweight or underweight
Body mass index: weight/(height)2,20-24 accepted as
normal.
High blood pressure
Anaemia
Cardiac or pulmonary disease.
Orthopaedic problems
57. Pelvic examination
Uterine size-disproportionately smaller or bigger
Genital prolapse
Laceration or dilatation of the cervix
Associated tumors
Pelvic inadequacy.
58. Complication of labour:
the cases should be reassessed during late pregnancy
and labour . Attention is turned to detect the risk that
may develop during labour. Some important points to
be considered:
Patient having no antenatal care
Anemia, eclampsia, pre- eclamsia.
Premature or prolonged rupture of membrane
Meconium stained liquor.
Abnormal presentation and position
59. Disproportion, floating head in
labour.
Multiple pregnancy
Premature labour.
Abnormal fetal heart rate.
Rupture uterus
Patient admitted with prolonged
or obstructed labour.
60. Certain complication may arise during labour and
place mother or baby at a high risk.eg.
Intrapartum fetal distress.
Delivery under general anesthesia.
Difficult forceps or breech delivery
Failed forceps.
Prolonged interval from the diagnosis of fetal distress
to delivery. If more than 30 minute elapse from the
recognition of fetal distress to delivery, the mortality
rate increases threefold.
Post partum hemorrhage or retained placenta.
61. Post partum complications:
An uneventful labour may suddenly turn into an
abnormal one in the form of PPH , retained placenta,
shock, sepsis may develop later on.
The following categories of neonate are at high risk:
Apgar score below 7.
Hypoglycemia.
Anaemia.
Birth weight less than 2500 or more than 4kg.
Major congenital abnormalities
63. Management of high risk
pregnancy:
If we desire to improve our obstetric result, the high
risk cases should be identified and given proper
antenatal, intranatal, and neonatal care.
It is necessary that all expectant mothers are covered
by the obstetric service of a particular area.
The services of trained community health workers
and assistant nurse cum midwife of the health
centers should be utilized to provide primary care and
screening in rural area and urban or semiurban
pockets.
64. . a simple check list should be prepared for them to fill
up, arrangement should be made for early examination
of high risk cases by medical officer of health center
.the health centers of periodic specialist cover from
teaching or non teaching hospitals,as well as district
and subdivisional hospitals.
The general practitioner decides, what type of cases
can be managed at home or health centers.
Cases with significantly higher risk should be referred
to specialized referral centers.
Cases from rural area may be kept at maternity waiting
homes close to referral centers.
65. The organizational aspect may be summarized as
follows:
Strengthen midwifery skills, community participation
and referral system.
Proper training of resident, nursing personnel and
community health workers.
Arranging periodic seminars, refresher courses with
participation of workers involved in the care of these
cases.
Concentration of cases in specialized centers for
management.
Community participation, proper utilization of health
care manpower and financial resources where it is
mostly needed.
66. Availability of perinatal laboratory for necessary
investigation , availability of good paediatric services
for the neonates.
Lastly, improvement of economical status, literary and
health awareness in community.
Cases having previous unsuccessful pregnancy should
be seen and investigated before another conception
occurs .investigations like hysterogram, hysteroscopy,
laproscopy, transvaginal ultrasonography should be
performed to rule out abnormality.
Complete investigation for:
Hypertension, diabetes, kidney disease, thyroid
disorders, sexually transmitted disease, cervical tear.
67. Folic acid therapy(4 mg/day) :
It should be started in the prepregnant state and is
continued throughout the pregnancy. Necessary
advice should be given regarding diet, activities, rest
and medicine. Minimum medicine should be taken
during the pregnancy.
68. Assessment of maternal and fetal
well being:
Assessment of maternal and fetal well being: this
should be done at each antenatal visit.
Patient with the history of previous first trimester
abortion should be advised rest and to refrain from
sexual intercourse. Vaginal examination should be
avoided in first trimester in these cases.
69. Patient suspected to have cervical incompetence
should have sonographic evaluation early in second
trimester so that cervical encirclage, if necessary, may
be performed at appropriate time.
Patient having premature labour, unexplained still
birth, intrauterine growth restriction and many other
abnormalities are benefited by prolonged rest in
hospital with close supervision.
70. Management of labour:
It is evident that the elective caesarean section is
necessary in a high risk pregnancy. Those cases who go
into labour spontaneously or after induction, need
close monitoring during labour for the assessment of
progress in labour or for any evidence of fetal hypoxia.
71. The condition of the fetus can be assessed by :
Fetal heart rate monitoring.
By stethoscope, fetoscope, or Doppler
Passage of meconium in liquor
Examination of fetal scalp blood for pH values.
72. complementary and
alternative therapies
Classification of complementary and alternative
therapies:
Group 1:
This group has been classified as those therapies that
are professionally organized, with good standards of
basic and ongoing education, national statutory or
voluntary self regulation and disciplinary code of
practice. These are homeopathy, herbal medicine,
acupuncture, osteopathy, chiropractic.
73. Group 2:
This group is classified as those therapies that are
considered to be complementary to other form of
health care. It includes aromatherapy, reflexology,
massage, nutrition, hypnotherapy, yoga,
meditation,healing etc.
Group 3:
Traditional Chinese medicine ,crystal therapy,
iridology, radionics, naturopathy.
74. Accupuncture:
It is based on the principle that the body has energy
lines called meridian, flowing through it from top to
hand or toe. most of these pass through a major organ,
after which meridian is named.eg. kidney meridian.
there are total 12 major meridian and 365 points on
these.
75. Use:
Many antenatal conditions respond well to
acupuncture or acupressure, including many of the
physiological symptoms of pregnancy.
Nausea and vomiting: one condition that has been
well researched is nausea and vomiting, which can be
treated simply by exerting pressure on the
pericardium6 (PC6) also called Neiguan, point on
inner wrist.
76. Moxibustion:
The use of moxibustion for
breech presentation is
gaining popularity. In this
technique, a stick of dried
mugwort herb is used as a
heat source over the
bladder67 acupuncture
point on the outer edges of
the little toes.
77. This is thought to stimulate adrenocortical output,
resulting in increases in placental lactogens and
changes in prostaglandin levels and leading to both
increased myometrial sensitivity and contractility. This
in turn lead to rise in fetal heart rate and fetal
movements, so causing the fetus to turn itself to
cephalic.
78. Homeopathy:
Arnica: Newly delivred
mothers with perineal trauma
would benefit from
administration of arnica
tablets to reduce trauma.
Although the cream should
not applied to the open
wound, only to bruising
surrounding the perineum.
79. Pulsatilla: pulsatilla is also
beneficial in pregnancy and
seems to be suited to women
with a mild and tearful
disposition who are
apprehensive. Hemorrhoids ,
varicosities and heart burn
often respond well to a short
course of pulsatilla, and slow
progress in labour can be
corrected in women with
poor uterine contraction.
80. Advice on correct administration:
Take only one ramady at a time.
Remedies must be choosen according to the precise
nature of the individual’s symptoms.
Tip the tablet into the lid of the bottle-don’t allow
anyone other than the patient to handle it.
Do not use metal spoon, as metal inactivate the
remedy.
The mouth should be clear of food, drink,toothpaste
and cigarettes for 15min before and after taking any
remedy.
81. Tablet should be dissolved under the tongue, not
swallowed.
Normal dose is one tablet 3-4 times a day.
To increase the dose tablets should be taken more
frequently, not by taking more tablets each time.
If there is no improvement in 5 days,stop the remedy
and consult an expert.
Inappropriate or prolonged use of an incorrect remedy
can cause a ‘reverse providing’ in which the patient
start to develop the symptoms for which the remedy is
intended.
82. Herbal medicine
St john’s wort: one of the herbal remedies that has
been much debated in the professional and public
press is St john’s wort which has gained the reputation
but it is not safe for women who are taking
contraceptive pills, are pregnant or breastfeeding.
83. Raspberry leaf: raspberry leaf
is a popular remedy that has
long been advocated by
pregnant women as helping
them to prepare for the birth. It
has an effect on the uterine
muscle, making it more
efficient, possibly preventing
post maturity, easing
discomfort in labour and
enhancing uterine action.
84. The nurse should guide the women on safe use of
raspberry leaf that:
It is not necessary for multipara to take raspberry leaf
routinely if the uterus has worked efficiently in
previous labours.
Raspberry leaf should be used not raspberry fruit; the
tea is more effective than the tablets.
Do not start before third trimester: ideally commence
at about 30-32 weeks.
Increase the amount gradually over the several weeks
from a cup/tablet daily to maximum of 4 cups/tablets
daily.
85. If very strong Braxton Hicks contraction occur, reduce
the amount or frequency.
Avoid if previous caesarean section or other uterine
scar , or if an elective caesarean is planned.
Avoid if there is history of preterm or precipitate
labour, antepartum haemorrhage or low lying
placenta.
Avoid in case of multiple pregnancy, hypertension,
breech presentation, grand multipara.
Avoid if the mother is anemic or taking iron, calcium,
magnesium supplements or is on antidepressants.
86. Nausea and vomiting
Peppermint, spearmint or comomile tea, ginger
Peppermint ginger
93. Role of nurse in safe use of herbal remedies in
pregnancy:
The nurse should ask at booking if the mother is taking any
other herbal remedy.
As a general rule,avoid herbal remedies in the first
trimester unless the expert advice.
Explain that culinary use of herbs and herbal tea are
generally safe in normal amounts.
Keep in mind that herbal remedies act pharmacologically,
therefore may interact with prescribed medication.
Ask the women not to take the herbal remedy routinely as a
prophylactic or for long period of time as side effect may
occur
94. Avoid all herbal remedies if there is history of clotting
disorders or bleeding, e.g. APH, or if taking
anticoagulant or NSAIDs.
Advice the women to avoid all herbal remedies if there
is history of diabetes, epilepsy, cardiac disease,
hypertension.
Avoid all herbal remedies with pre eclampsia, multiple
pregnancy, IVF pregnancy.
Discontinue all herbal remedies at least 2 weeks before
elective caesarean or other surgery
95. Osteopathy and chiropractic
The both forms of treatment involve rebalancing of
the neuromuscular system so that the whole body can
be in alignment.The main difference between
osteopathy and chiropractic is that osteopaths are
concerned with mobility of joints whereas
chiropractors deal with relative position of joints.
96. Use:
Both osteopathy and
chiropractic are useful
for treating a range of
problems in
pregnancy, including
sickness, heartburn,
constipation .other
problem caused by
relaxin and
progesterone such as
groin pain and general
pelvic instability will
also respond well to
treatment.
chiropractic
osteopathy
97. Aromatherapy:
Aromatherapy is the use of highly concentrated
essential oils extracted from plants.
Use:
A small selection of essential oils for relief of pain and
other discomfort in pregnancy and labour. The
incident of side effects was less than 1%, all of which
were minor and none of which affected the fetus or
babies. Dale and Cornwell demonstrated the value of
lavender oil for perineal discomfort after episiotomy .
98. The correct essential oils should be
prescribed and administered:
To the correct person .
At the correct time.
In the correct dose.
By the correct route.
In the correct frequency.
Record accurately.
99. Reflexology:
Reflexology or reflex zone therapy involves a
precise manipulation of the feet, which are
thought to represent the map of the whole body.
Every part of body is reflected on one or both
feet and therefore by working on specific parts of
the body ,other areas of the body can be treated.
100. During pregnancy, reflexology can be effective in relieving
physiological discomfort as well as specific complaints, and
in labour is invaluable in easing pain. Antenatal condition
that respond particularly well include :
Constipation
Headaches
Migraine
Heart burn
Insomnia
Stress
Anxiety
Backache
Hypertension
101. Massage:
Massage is applied use of touch. Massage has been
shown to be very relaxing, reducing blood pressure
and increasing excretory process,however it is also not
without risk.
In labour it assists in reducing pain, aiding relaxation,
easing fear and tension
102. Precautions and contraindications to massage in
pregnancy:
First trimester sacral and suprapubic massage.
Brisk heel massage in pregnancy-this corresponds to
the reflexology zone for the pelvic area.
Acupressure points contraindicated in pregnancy(gall
bladder 21, large intestine 4, spleen 6)
Abdominal massage if the history of antepartum
haemorrhage/ placenta praevia.
103. Severe hypotension,fainting episodes; take care when
sitting up after massage.
Caution with pre-existing medical conditions.
Maternal wishes
Professional doubts.
104. Professional accountabilities of a
midwife
Midwife wishing to incorporate CTs in their practice
must work within nursing and midwifery
council(NMC) guidelines.
The midwife must be able to demonstrate that she is
adequately/appropriately trained to use the therapy,
although it does not mean that she should be a fully
qualified practitioner
105. Informed maternal consent is essential, although it
can be verbal consent.
Women have right to use and self administer the
natural remedies, the midwife should act as mother’s
advocate.
In the units where midwife wish to implement the use
of therapy alongside their existing practice, protocols
and policies should be developed.
106. Bibliography:
Sheth s shirish, “Essentials of obstetrics” published by
jaypee brothers medical publishers (p) ltd, edition 2nd
(2011),
Dutta D.C.,”Textbook of Obstetrics”, published by new
central book agency,edition sixth (2004)
Myles. Textbook of midwives. Ed 12th. London,
England. ELBS British Government. 1996.
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