Pregnant women and health professional's perceptions of complementary alternative medicine, and participation in a randomised controlled trial of acupressure for labour onset

Humanising childbirth - Maternity acupressure training for healthcare providers at the Fernandez Foundation Hospitals, Hyderabad, India. Evaluation of program delivery in one region of India

BACKGROUND

Internationally, traditional medicine approaches are used to support humanised childbirth practices. Labour support issues in low- and middle-income countries (LMICs), include limited resources, staffing, and escalating pharmaceutical interventions. There is a strong interest in evidence-based acupressure programs, however, training and experience to implement them is limited. Maternity professionals at the Fernandez Foundation (FF) including associated hospitals in the Hyderabad region, India, sought training in acupressure to support humanised childbirth.

AIMS

To evaluate the implementation of the 'Acupressure for childbirth training program' at FF hospitals, up to 6-months post-training, including barriers and facilitators, as well as determining pregnancy and labour conditions for which the techniques are most useful.

METHODS

Pre- and post-training, and 6-month surveys, were distributed to participants.

RESULTS

Participants included a diverse group of 88 midwives, doulas, physiotherapists, educators and obstetricians. There were significant improvements in participant skills and knowledge, which persisted up to 6-months post-training (p<0.01). Participants indicated they were 'highly satisfied' with the training, and found it valuable, easy to implement, and reported extremely positive responses from women and support people. Facilitators to implementation included 'strategies and ideas', 'effectiveness of pain relief', and 'aiding labour progress'. Barriers included 'other staff and institutional challenges', 'needing more training', 'women's attitudes'.

CONCLUSION

Acupressure training as part of a humanised approach to childbirth, demonstrates significant skill and knowledge gain, usefulness of training and skills, ease of implementation, and a highly positive reception within the clinical environment. Implementation of these practices should be widespread and supported by policy makers and clinicians.

Effects of Acupressure on Maternal and Neonatal Obstetric Outcomes during Labor: Study Protocol

BACKGROUND

A Cochrane review found that there is insufficient evidence to determine the effectiveness of acupressure for pain relief. One of the problems detected is the methodological variability reported.

OBJECTIVE

To assess the impact of the application of acupressure on obstetric and neonatal outcomes of labor, pain experience, and mother's satisfaction with the experience.

METHOD

Design of a protocol to carry out a two-arm multicenter single-blinded randomized controlled trial. Intervention (pressure on LI4 of the left hand, B6 of the left leg, GB21 of the left shoulder, and then the same sequence on the right side) and placebo (application of the technique on points not identified by acupuncture as key points) will be performed by a single researcher.

RESULTS

The recruitment began in April 2021 and, to date, there has been the participation of 40 women, divided into 17 included in the experimental group and 23 in the control. Communication of future results will be made in accordance with the CONSORT checklist.

CONCLUSIONS

The designed protocol could methodologically improve some aspects of previous studies while maintaining adequate statistical power. The effectiveness of acupressure for one or more outcomes proposed (time and pain in labor) could support the inclusion of a new therapeutic tool in the clinical practice of midwives that would allow them to assist pregnant women, improving their experience both physically and psycho-emotionally.

Raspberry Leaves and Extracts-Molecular Mechanism of Action and Its Effectiveness on Human Cervical Ripening and the Induction of Labor

The gestational period is an incredibly stressful time for a pregnant woman. Pregnant patients constantly seek effective and reliable compounds in order to achieve a healthy labor. Nowadays, increasing numbers of women use herbal preparations and supplements during pregnancy. One of the most popular and most frequently chosen herbs during pregnancy is the raspberry leaf (Rubus idaeus). Raspberry extracts are allegedly associated with a positive effect on childbirth through the induction of uterine contractions, acceleration of the cervical ripening, and shortening of childbirth. The history of the consumption of raspberry leaves throughout pregnancy is vast. This review shows the current status of the use of raspberry leaves in pregnancy, emphasizing the effect on the cervix, and the safety profile of this herb. The majority of women apply raspberry leaves during pregnancy to induce and ease labor. However, it has not been possible to determine the exact effect of using raspberry extracts on the course of childbirth and the perinatal period. Additionally, it is unclear whether this herb has only positive effects. The currently available data indicate a weak effect of raspberry leaf extracts on labor induction and, at the same time, their possible negative impact on cervical ripening.

Midwifery Acupuncturists' Management of Antenatal Anxiety and Depression: Data from a Survey in Aotearoa (New Zealand)

Objective

The goal of this research was to explore how New Zealand midwifery acupuncturists manage mild-to-moderate antenatal anxiety and depression (AAD).

Materials and Methods

A survey (Surveymonkey®) on midwives' perceptions of acupuncture for treating AAD was distributed late in 2019 to midwives who completed a Certificate in Midwifery Acupuncture. Data were collected on referrals and on acupuncture and complementary and alternative medicine use for AAD and associated symptoms of concern (SoC), such as low-back and pelvic pain (LBPP), sleep issues, stress, other pain, and pregnancy issues. Descriptive analysis was used to report data.

Results

Of 119 midwives, 66 responded (55.5%). For AAD and SoC, midwives mostly referred patients to general practitioners and counselors, and administered acupuncture themselves. Acupuncture was most accessed for LBPP (n = 38; 70.4%), sleep (n = 31; 57.4%), anxiety (n = 27; 50.0%); stress (n = 26; 48.1%), and other pain (n = 20, 37.0%). Massage was second most-accessed for LBPP (n = 36; 66.7%), sleep (n = 25; 46.3%), and stress (n = 24; 44.4%). For depression, treatments were herbs (n = 16; 29.6%), homeopathy (n = 14; 25.9%), and acupuncture and massage (both n = 13; 24.1%). Acupuncture was most used for other pregnancy issues: birth preparation (n = 44, 88.0%); assisted labor induction (n = 43; 86.0%): nausea and vomiting (n = 43; 86.0%); breech (n = 37; 74.0%); and headaches/migraines (n = 29; 58.0%).

Conclusion

Acupuncture is commonly used by midwife acupuncturists in New Zealand to treat a range of pregnancy issues, including anxiety, SoC for AAD, and other pregnancy issues. Further research would be beneficial.

Phytotherapy in obstetrics - therapeutic indications, limits, and dangers

The wide access to varied, attractive, and aggressively promoted information can induce pregnant women to think that any form of complementary therapy can be a saving solution for a medical problem because these therapies are natural, therefore, harmless. Updated information from literature about indications, benefits, limits, and risks of phytotherapy in pregnancy was presented. Valuable therapeutic resources with proven clinical efficacy (evidence-based medicine) were presented for each trimester of pregnancy, during labor, postpartum, but also during breastfeeding. For some phytotherapeutics, there are scientific studies. There is also a detailed presentation about some possibilities for therapeutic errors, which should be avoided during pregnancy. Positive results of phytotherapy deserve to be known and applied by the obstetrician for the certain benefit of future mothers.

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Despite the proliferation of research exploring complementary and alternative medicine (CAM) use in maternity care and midwifery practice, there is a gap on midwives' level of CAM knowledge and education/training. This national survey investigated Australian midwives' knowledge and education/training in CAM. A total of 571 midwives completed the survey (16%). Over half (54.3%) had some level of CAM education/training (self-learning to diploma) and with multiple CAM modalities. The top four modalities that midwives had received education/training were acupressure (66.5%), aromatherapy (60.3%), massage (45.5%), and reflexology (37.7%). There was a significant correlation between midwives attending a CAM workshop with competency-assessment (p < 0.000) and confidence to discuss CAM options with pregnant women compared with participants who have not. There are no other health-related therapies used by women consumers with such frequency where clinicians are not expected to have baseline knowledge and understanding. Midwifery education programs need to include evidence-based information on CAM modalities.

Biophysical effects, safety and efficacy of raspberry leaf use in pregnancy: a systematic integrative review

Background

Childbearing women have been using various herbs to assist with pregnancy, labour and birth for centuries. One of the most common is raspberry leaf. The evidence base for the use of raspberry leaf is however under-developed. It is incumbent on midwives and other maternity care providers to provide women with evidence-based information so they can make informed choices. The aim of this study was to review the research literature to identify the evidence base on the biophysical effects, safety and efficacy of raspberry leaf in pregnancy.

Methods

A systematic, integrative review was undertaken. Six databases were searched to identify empirical research papers published in peer reviewed journals including in vitro, in vivo, human and animal studies. The search included the databases CINAHL, MEDLINE, Cochrane Library, Scopus and Web of Science Core Collection and AMED. Identified studies were appraised independently by two reviewers using the MMAT appraisal instrument. An integrative approach was taken to analysis.

Results

Thirteen studies were included. Five were laboratory studies using animal and human tissue, two were experiments using animals, and six were human studies. Included studies were published between 1941 and 2016. Raspberry leaf has been shown to have biophysical effects on animal and human smooth muscle including the uterus. Toxity was demonstrated when high doses were administered intravenously or intaperitoneally in animal studies. Human studies have not shown any harm or benefit though one study demonstrated a clinically meaningful (though non-statistically significant) reduction in length of second stage and augmentation of labour in women taking raspberry leaf.

Conclusions

Many women use raspberry leaf in pregnancy to facilitate labour and birth. The evidence base supporting the use of raspeberry leaf in pregnancy is weak and further research is needed to address the question of raspberry leaf’s effectiveness.

Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

BACKGROUND

Many women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women's views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women's views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women's decisions and choices and to inform guidelines, policy, and practice.

METHODS

We searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women's accounts of different pain relief methods.

RESULTS

From 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural (n = 12), opioids (n = 3), relaxation (n = 8) and massage (n = 4) - all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. 'Desires for pain relief' illuminates different reasons for using pharmacological or non-pharmacological pain relief. 'Impact on pain' describes varying levels of effectiveness of the methods used. 'Influence and experience of support' highlights women's positive or negative experiences of support from professionals and/or birth companions. 'Influence on focus and capabilities' illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, 'impact on wellbeing and health' reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes.

CONCLUSION

Women report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.