Royal Society of Medicine Forum. The best of both worlds: Complementary therapies for mothers and babies.
This is a report of a meeting of the Forum on Maternity and the Newborn of the Royal Society of Medicine, held on Thursday 8th November 2001. The meeting was chaired by Roxanne Chamberlain of the National Childbirth Trust.

“Natural birth? But how?” Crisis prevention versus crisis intervention – the Jeyarani Birth Method.
Dr. Gowri Motha, holistic obstetrician and founder of the Jeyarani Birth Method.

There are three terms which the average medical mind finds confusing: holistic, alternative, and complementary. In responding to public outcry over national birth outcomes I asked myself “Why is birth so unsatisfactory for many mothers? How can their expectations be fulfilled?”

Driven by curiosity, compassion, and enthusiasm I felt the need to achieve more balance in parenting classes, which although useful tend to be weighted towards information. A programme of treatments which I have called The Jeyarani Way gentle birth method, based on observation of many pregnancies, has been developed over a 15 year period; beneficial outcomes are expected in relation to the frequency of treatments during pregnancy. For example primigravid labours average 14 hours where less than three treatments have been received, and 10½ hours for more than nine treatments. The objective is to achieve fitness for birth through knowledge, physical training, confidence building and the removal of fear.

The programme, which runs parallel with normal antenatal care, comprises various physical treatments. Some of these, directed at the body and some of its organs (heart, pancreas, liver, spleen, thyroid, hiatus hernia) and at muscles and ligaments important to the birth process, are termed Creative Healing and are a form of massage. Others have been adapted from their wider uses: reflexology – pinpoint foot massage; Bowen therapy, a subtle body aligning technique, for the pelvis at 39 weeks and, if necessary at 41 weeks for the coccyx to initiate labour; cranio-sacral therapy, fine tuning body rhythms; Reiki, a hands-on treatment transmitting energy and calmness, given four times during pregnancy; and Yoga, which is practised for 20 minutes daily.

Bowen Therapy.
Thomas A. Bowen (1916-1982) developed this technique in Geelong, Australia. After serving in World War 2, he became interested in ways to alleviate human suffering and began to notice that certain moves on the body had particular effects. Bowen Therapy is unique in that it was developed without its originator having previous training in any health discipline. In fact, he frequently stated that his work was 'simply a gift from God.'
Bowen Therapy is a simple but effective body balancing system. Through gentle moves on soft tissue at a series of key points on the body it stimulates energy flow that releases tension, strains and blockages, empowering the body's own resources to re-balance and heal itself naturally. The treatments have an integrated healing effect on all the body's systems. There is no manipulation or adjustment of tissue; the treatment is very gentle, relaxing and safe for all ages. It can be performed through light clothing with each session lasting approximately 30-45 minutes. In essence Bowen Therapy facilitates the body's return to its natural, balanced and healthy state.

Reiki.
Reiki is a Japanese technique for stress reduction and relaxation that also promotes healing. The word Reiki is made of two Japanese words - Rei which means "God's Wisdom or the Higher Power" and Ki which is "life force energy". It is administered by "laying on hands" and is based on the idea that life is an energy flow. If this energy is low, then we are more likely to become sick or feel stress, and if it is high we are more capable of being happy and healthy.
Reiki treats the whole person including body, emotions, mind and spirit and has many beneficial effects including relaxation and feelings of peace, security and well-being. It is through the attunement to higher knowledge or spiritual consciousness (REI) that we are able properly to guide our life energy (KI) to affect positive change.
A Reiki healing is very simply performed. The practitioner places his or her hands upon the person to be healed with the intent for healing to occur, and then the energy begins flowing. The energy manages its own flow to and within the recipient, drawing through the healer exactly that amount of energy which the recipient needs, without the healer's conscious intervention. His/her job is to get out of the way, keep the healing space open, and to watch and listen for signs of what to do next.

Additionally both parents are offered training in autohypnosis to be used in conjunction with an audiotape, to promote deep muscle relaxation and body-mind programming for birth, Ayurvedic herbs to be taken from the 16th week, and oils to be applied from week 20 for general comfort and to the perineum and vagina from 36 weeks to promote an intact perineum. Detailed dietary advice is given on a common-sense basis, in particular limiting carbohydrate and wheat intake. A book, video tape, and other audiotapes and a compact disc are also available. I supervise progress with antenatal appointments early in pregnancy and at 28 and 36 weeks, and specify the timing of these treatments, which is important for their effectiveness in achieving, as intended, all round birthfitness.

Practitioners attend the clinic to observe and learn. I am currently collecting data on the outcomes for mothers using the Jeyarani Way; these will include rates of induction of labour, spontaneous vaginal delivery, episiotomy/intact perineum, instrumental and caesarian delivery, and epidural analgesia. A paper is in preparation.

At present the programme is only provided on a private basis, the package costing £600.

Setting up a complementary therapy service in maternity care.
Mandy Curry, Assistant general manager, Women and Child Service Unit, Peterborough Hospitals NHS Trust.

At a time when complementary therapies were gaining in popularity Sonia Gent, a midwife trained in Chile and qualified in the treatments used, was key in introducing our service in 1997. She pressed the case for change with enthusiasm, and I listened and supported her and her idea. She presented a business case to clinicians, to myself, and to the trust; its four key points were
1. Therapies would be offered within clear guidelines.
2. The service would be evidence based.
3. The practitioners would complete a certificated course of training.
4. Client satisfaction would be evaluated.

Peterborough has only one hospital; women in the area have little choice of place of delivery, so that the notion of a service which promised to give women a little extra control and choice in their pregnancies was appealing. We believe that the holistic approach of complementary therapies – treating each client as an individual – enhances the development of a truly woman-centred service. The confidence of the consultant obstetricians grew with time and the development of clear guidelines, and is now complete. Eligibility criteria require women to be 37 weeks pregnant, with a singleton pregnancy and cephalic presentation, not taking regular medication and with normal blood pressure. Guidelines also cover record keeping and the storage of materials and equipment. The key to the success of introducing a new service lies in gaining the support of the entire multidisciplinary team.

From the outset the emphasis has been on training and establishing the competence of the providers of the service, limiting the therapies and substances used to those for which evidence of effectiveness is available. Being provided by midwives, the service lies within the purview of the supervisor of midwives. Safety and support for the staff have been a high priority. We have been reluctant to produce statistics on outcomes, fearing prejudice and being aware of the vulnerability of the service.

Three therapies are offered: aromatherapy (using six essential oils), massage, and reflexology, which is offered mostly by referral in the last month of pregnancy; the emphasis is on the alleviation of anxiety. Our physiotherapy department is short-staffed at present, and we have found that women who might have been referred for physiotherapy in pregnancy have been appropriate for treatment with reflexology, relieving the pressure on our physiotherapist colleagues and helping us to continue to provide a valuable service for the pregnant. Although popular with the mothers, reflexology holds the least interest for the staff. This part of the service is currently run by one dedicated midwife. Aromatherapy is offered to women in labour and in the postnatal period; one third of the midwives are trained for this. Massage is available antenatally and in the labour ward, and has found a place in relieving staff stress also.

The 10-week basic training course in complementary therapies focuses on massage and aromatherapy, and this course has also been offered to special care baby unit and children's ward staff as part of their training. The obstetric unit funds the courses of reflexology training at an academic centre. Assessment of skills is rigorous throughout, with emphasis on professional accountability, which is a priority in the current climate of litigation risk in obstetrics. The formal consent of the mothers is required. Parents are given some instruction as part of the preparation for labour, and they can be taught massage for babies over four weeks old; this is particularly popular. The unit's policy on the provision of the service is tightly prescribed, for the protection of the staff. Who may offer therapies, and what they may offer are laid down in a framework which has the support of the supervisor of midwives.

Funding of the service, resourced as it is almost entirely within the maternity budget, is vulnerable to interruption; for example the two-day midwife secondment for treatments and training has been suspended temporarily due to a shortage of midwives within the unit. Clients referring themselves for reflexology are charged £15 for a half hour, but charges are waived in cases of need.

The benefits accruing from the complementary therapies service are not to be ignored. These include improved staff morale, recruitment and retention of staff. It has made the maternity unit attractive to families and increased the satisfaction of the women who use it, and by its links with other disciplines the unit's profile has been raised. The service has necessarily had to face up to problems, at present that of the succession to the midwife whose enthusiasm led to the service's initiation in 1996, as she has retired. Interest in reflexology is inclined to flag with resulting difficulty in maintaining this element of the service. When training courses compete for time and resources the service is seen as a “softer side” option, and in a period when staffing levels are threatened its priority for staff allocation is in doubt. And as always the service has had to deal with resistance from its critics. Nevertheless the opportunity for a service to develop in a way that benefits its client group as well as its staff is one which any manager should embrace with enthusiasm.

References.

Curry M (1997) Complementary therapies in Peterborough. Changing Childbirth Update September 1997 Issue 10

Curry M (1998) Complementing practice – the introduction of complementary therapies into a maternity service. The Practising Midwife May 1998 1:5;10 - 12

Traditional medicine and childbirth.
Michael McIntyre, Chairman, European Herbal Practitioners Association.

A visit to Ghana, where there is a traditional healer for every 400 members of the population and only one doctor per 30,000, provided food for thought on this subject. Every country, each culture, has its traditional including herbal medicines; herbs for pregnancy and childbirth are invariably among these. Interesting examples are the herbal remedies of the native Americans and those favoured by Chinese traditional medicine. The instinctive habits of animals should not be ignored; they turn to herbal medicines when sick. Chimpanzees are known to travel for miles to find an African plant with antibiotic properties. When the cows from a nearby farm broke into my garden, they went straight for the raspberries – the leaf is said to increase milk production.

Western societies find the subject controversial, although their citizens are turning to herbal remedies with increasing frequency. There is a pressing need for research and for the necessary funding for it, which some are addressing. There is too little research in the UK, much in Germany, and a lot in the Orient. It has provided evidence of both benefit and harm. Aside from the validation of herbal therapies researchers may find themselves facing substances which will have uses in the field of orthodox medication. But what is the place of the anecdotal evidence from thousands of years of traditional use? This too needs evaluation.

Beware: “natural” does not correlate with “safe”; water hemlock, for example, induces fits, paralysis, and coma. Licorice may boost prostaglandin production and thus hasten delivery. A report from Finland showed that women who consumed at least 250 grams of black licorice sweets weekly (not unusual among young women in Finland) were more than twice as likely to deliver before 38 weeks gestation. Blue Cohosh, (caulophyllum thalictroides) otherwise known as Squaw Root or Papoose Root, has been used in pregnancy to promote efficient labour and to correct inert labours, but is now known to contain an oxytocic alkaloid and has been linked to fetal hypoxia; its use by herbalists has been discontinued.

Many not entitled to them are only too free with their opinions, which may support the natural or the spread of scare stories. A controversial study, published by Chemical Research in Toxicology last year, claimed that pregnant women who consume ginkgo extracts (Ginkgo biloba) may run the risk of accumulating the natural chemical colchicine in their placentas, thereby causing potential harm to the fetuses. The American Botanical Council and a literature search have determined that the original research study is seriously flawed and that the resulting alarm generated about ginkgo is groundless.

Until the research is done it is fair to consider that diet and exercise remain the safest aids to health. Dr Ann Walker, senior lecturer in human nutrition at the University of Reading and a registered medical herbalist, has said that pregnant women should take extreme care about what they put into their bodies. "To use over-the-counter herbs during pregnancy is crazy. The rule is that women should never take any medication during pregnancy unless it is absolutely necessary."

The following information demonstrates benefit from herbal treatment.
Research1,2 suggests that raspberry leaf can be consumed by women during their pregnancies to shorten labour, with no identified side effects for the women or their babies. Ingestion of the herb may also reduce the likelihood of premature and post-term birth. An unexpected finding of this study seems to indicate that women who ingest raspberry leaf may be less likely to need artificial rupture of the membranes, or to require instrumental delivery, than women in the control group.
Mugwort (artemisia) is administered percutanously as a sedative in labour, as also are cinnamon and lavender.
Ginger has been confirmed to be effective in morning sickness.
Black Cohosh (cimicifuga racemosa) has the same use as raspberry leaf, and is effective in inert labour. For this, but only during labour, acupuncture is useful – point Spleen 6 (4 fingers breadth above the medial malleolus, behind the tibial border, using needles or pressure).

Partridgeberry (mitchella ripens) and Wild Yam (dioscorea villosa) are worthy of research for use in pregnancy.

For morning sickness the herbs and spices commonly found in the kitchen should not be neglected. Acupuncture point Pericardium 6 (midline of the forearm, 3 fingers breadth above the wrist crease) can also give relief. This is helpful both with needles and by acupressure, which can be combined with electrical stimulation; ear acupuncture is effective too.

State registration of acupuncturists and herbalists is expected (and much needed and desired) within the next three years. Meanwhile it is worth recording that the training in these disciplines is as rigorous as the medical course, with numerous failures to qualify; training schools can and sometimes do fail their validation. Twelve universities offer courses in herbal medicine, and there are four degree courses in acupuncture; all of these have research modules. GP trainees are interested and enthusiastic; the Open University has a course in complementary therapy awareness; by these and other means we work to prevent the subject being sidelined.

References.

(1) Raspberry leaf and its effect on labour: safety and efficacy. Parsons M,Simpson M, Ponton T. J Aust Coll Midwives 1999 Sept; 12:(3);20-5
(2) A national survey of herbal preparation use by nurse-midwives for labour stimulation. Review of the literature and recommendations for practice. McFarlin BL, Gibson MH, O'Rear J, Harman P. J Nurse Midwifery, 1999 Nov-Dec

Discussion.

A reflexology trainer has 2½ years experience of a training module involving a qualified midwife, now required for those working with the pregnant.

A midwife reported the misuse of Shiatsu (acupressure); the wrong points were used at 16 weeks gestation, and the client passed a piece of placenta.

It has been the Birth Plan which introduced many of us midwives to complementary therapy. A midwife described its satisfactory blending with orthodox practice.

Michael McIntyre emphasized the value of working intuitively, warning against policing, registering and auditing everything.

Gowri Motha regretted the tendency of maternity units to sabotage the hypnotic concepts by using words such as “pains” rather than “contractions”; as always in health care language must be used sensitively. 1