Oxford Handbook of Midwifery (39 page)

and a safe alternative to external cephalic version (ECV)—the manual
technique carried out by some obstetricians.

Shiatsu

Shiatsu is an ancient form of massage used to aid relaxation and healing, also known as acupressure. Shiatsu means ‘finger pressure’, although hands, fists, and elbows, as well as fingers, may be used to apply pressure. Shiatsu follows the same principles as acupuncture, except that manual techniques, rather than needles, are applied to the acupuncture points. No drugs or oils are used, which makes it a safe therapy to use during pregnancy. The massage is undertaken over clothing.

CHAPTER 7
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134

Benefits of shiatsu

Shiatsu can:

• Help with the ailments of pregnancy
  
• Initiate a close relationship with the baby
  
• Help the woman tune in to her individual needs during pregnancy
  
• Encourage the woman to trust in the process of pregnancy and birth, and foster a positive approach
  
• Help the fetus to maintain optimal positioning, especially for labour
  
• Harness a positive and rewarding relationship with her partner, encouraging involvement during the process of pregnancy and childbirth.
  

  Many midwives are discovering the many benefits of using the gentle, rewarding art of shiatsu in their practice. It:
  

• Is a relaxing therapy to perform
  
• Enhances the midwife–mother relationship
  
• Supports normality
  
• Enables the midwife to use hands-on skills
  
• Reduces the need for obstetric interventions
  
• Promotes responsibility for health.
  

  Recommended reading
  

  Cardini F, Marcolongo A (1993). Moxibustion for correction of breech presentation: a clinical study with retrospective control.
  American Journal of Chinese Medicine
  21
  (2), 133–8.
  

  Kanakura Y, Kometani K, Nagata T,
  et al
  . (2001). Moxibustion treatment of breech presentation.
  

  American Journal of Chinese Medicine
  29
  (1), 37–45.
  

  Neri I, De Pace V, Venturini P, Facchinetti F (2007). Effects of 3 different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL. 67 acupoint at small toe on fetal behavior of breech presentation.
  American Journal of Chinese Medicine
  35
  (1), 27–33.
  

  West Z (2001).
  Acupuncture in Pregnancy and Childbirth
  . London: Churchill Livingstone. Yates S (2003).
  Shiatsu for Midwives
  . London: Elsevier.
  

  1. Cardini F, Weixen H (1998). Moxibustion for the correction of breech presentation: a randomized controlled trial.
     Journal of the American Medical Association
     280
     (18), 1580–4.
     
  2. Tiran D. (2004). Breech presentation: increasing maternal choice.
     Complementary Therapies in Nursing and Midwifery
     10
     (4), 233–8.
     
  3. Ewies A, Olah K. (2002). Moxibustion in breech version—a descriptive review.
     Acupuncture Medicine
     20
     (1), 26–9.
     

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  CHAPTER 7
  Helping women cope with pregnancy
  

  136‌‌
  

  Yoga
  

  Pre-conception or pregnancy is the ideal time to start practising yoga as it encompasses physical, emotional, and spiritual preparation that will be helpful for this unique time in a woman’s life. Many women experience deeper, instinctual, and nurturing feelings as they embark on their preg- nancy, and may find that the gentle and relaxing practice of yoga provides fulfilment for them.
  

  Many midwives are encouraging women to attend yoga classes during pregnancy, or may have undertaken training to provide this service themselves. Practitioners facilitating classes for pregnant women must have a thorough understanding of the pathophysiology of pregnancy with regard to yoga postures. Many postures are contraindicated, while others will require some modification due to the physical restrictions in pregnancy of the musculo-skeletal system. Particular care should be taken, especially if yoga is commenced during pregnancy due to the increased laxity of joints and muscles. Many yoga positions are contraindicated for symphysis pubis diastasis, particularly abductor movements. However, regular, gentle yoga practice may bring relief to many of the physiological discomforts of pregnancy including backache and provides tremendous benefits to enhance the experience of birth.
  

  Physical benefits
  

• Increased suppleness, flexibility, and strength in the joints and important muscle groups that are used in labour and birth.
  

  •
  Improved posture: helps the woman to cope with carrying the extra
  

  weight involved in pregnancy, and encourages the adoption of a favourable position for birth by the fetus, thus engagement of the fetus into the pelvis is more efficient.
  

• Helps to open up the pelvic outlet by simulating squatting and upright postures (squatting can open up the pelvic outlet by up to 30%).
  
• Pelvic floor muscles are strengthened and toned.
  
• Improved breathing and circulation; thus increased oxygen supply to the fetus.
  
• Elimination of toxins and waste material.
  
• Back pain related to pregnancy responds well to regular yoga practice.
  
• Other aches and pains and common ailments of pregnancy may be relieved.
  

  Emotional/spiritual benefits
  

• Breathing awareness encourages relaxation, the release of tension, and better sleep patterns.
  
• Pregnancy is less tiring.
  
• The woman feels more energetic.
  
• The regular practice of relaxation during pregnancy enables the woman to tap into this sensation during labour, to help her cope better.
  
• The woman feels confident, empowered, and optimistic.
  
• Creates a more sensitive and receptive relationship with the fetus.
  

  YOGA
  

  137
  

A woman who practises yoga throughout pregnancy builds confidence in her body’s ability to cope with the many adjustments that take place. She is more likely to take responsibility for her own health, and to work more harmoniously with her body during labour and birth.

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Herbal medicine

Herbal medicine has its routes in history and folklore. In recent years it has regained popularity, however there is still much ignorance of its use amongst lay people. Self-medication with herbs may be appropriate using weaker doses in tablets and tinctures, however in pregnancy extreme caution should be used. Medicinal herbs are often quite potent and poten- tially toxic, so should only be prescribed by medical herbalists whose practice is subject to regulation.

Research has revealed that many herbal remedies may interact with conventional drugs, by either inhibiting or potentiating their effect. All herbal remedies should be discontinued at least 2 weeks prior to planned surgery as many may potentially affect blood clotting mechanisms.

Table 7.2 highlights the possible interactions of herbal medicines and conventional drugs that may be used during pregnancy.

Raspberry leaf tea

• Raspberry leaf tea is often recommended for pregnant women during pregnancy to tone the uterus and prepare for labour. It is known for its therapeutic properties as a uterine and circulatory tonic. Studies suggest that it may also have an antispasmodic effect.
  
• It is thought to aid ripening of the cervix, enhance uterine activity in labour, and promote involution, although this tends be anecdotal evidence rather than robust studies.
  
• It should not be taken throughout the whole of pregnancy, but
  commenced at about 32 weeks’ gestation.
  
• Taken as a tea the amount is gradually increased, tablet form is also
  

  available.
  

• If Braxton Hicks contractions become strong and repetitive the dose should be reduced or discontinued.
  
• Raspberry leaf is contraindicated in the following conditions:
  
  • Uterine scar
    
  • History of preterm labour
    
  • Placenta praevia
    
  • Planned lower segment caesarean section (LSCS)
    
  • Bleeding from the genital tract.
    

    Recommended reading
    

    Mills S, Bone K. (2005)
    The Essential Guide to Herbal Safety
    . St Louis, Missouri: Elsevier.
    

    HERBAL MEDICINE
    

    139‌
    

    

    Table 7.2
    Interactions between herbal medicines and conventional drugs
    

    Drugs—reason for use in pregnancy, labour and after the birth
    

    Drugs used for severe morning sickness and for nausea in labour
    

    Aspirin for pain relief or to prevent problems of severe pre-eclampsia
    

    Ibuprofen and similar drugs used for pain relief
    

    Herbal remedies and dietary supplements to AVOID
    

    Co-enzyme Q10; kava kava (withdrawn from sale in UK)
    

    Ginger; feverfew; gingko biloba Ginger; feverfew
    

    Contraceptive pill St John’s wort; ginseng; liquorice; chasteberry (
    Vitex agnus castus
    )
    

    Steroids—used in premature labour to mature the baby’s lungs
    

    Drugs to treat high blood pressure including pre-eclampsia
    

    Anaesthetic drugs—stop all herbal remedies 2 weeks before surgery including planned Caesarean section
    

    Chromium; liquorice; ginseng
    

    Ginseng; St John’s wort
    

    Ginger, gingko biloba, ginseng; liquorice
    

    

    Antidepressants (MAOIs) St John’s wort; ginseng; kava kava (withdrawn from sale in UK)
    

    Bromocriptine—may be used in infertility treatment
    

    Blood-thinning/anticoagulant drugs (e.g. warfarin)—best to avoid herbal remedies completely except
    

    with expert advice
    

    Drugs to treat immune system problems—best to avoid herbal remedies completely
    

    Drugs to treat epilepsy—best to avoid herbal remedies completely except with expert advice
    

    Drugs used to treat diabetes—best to avoid herbal remedies completely
    

    Drugs to treat heart conditions—to avoid herbal remedies completely except with expert advice
    

    Chasteberry (
    Vitex agnus castus
    )
    

    Dong quai; feverfew; garlic; ginger; gingko biloba; ginseng; papaya extract
    

    Echinacea; garlic; ginseng; St John’s wort
    

    Grapefruit juice; echinecea; goldenseal; liquorice; St John’s wort; evening primrose oil
    

    Gingko biloba; ginger; ginseng; co-enzyme Q10
    

    St John’s wort; ginger; motherwort; magnesium; ginseng; liquorice; black pepper essential oil; peppermint essential oil; passiflora (passion flower) co-enzyme Q10
    

    From M
    www.expectancy.co.uk. Copyright © Tiran D (2005), reprinted by permission of the publisher. MAOI, mono-amine oxidase inhibitor.
    

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    The need for social support
    ‌‌
    

    Chapter 8
    

    141
    

    Social support
    142
    

    Screening for domestic abuse
    144
    Recognition of sexual abuse
    148
    Management of substance misuse
    150
    Preparing the parents for birth
    152
    The birth plan
    153
    

    

    Preparation for infant feeding
    154
    

    CHAPTER 8
    The need for social support
    

    142‌‌
    

    Social support
    

    Social support is a flexible concept which is consequently difficult to define. Schumaker and Brownell
    ¹
    define it as ‘an exchange of resources between at least two individuals perceived by the provider or recipient to be intended to enhance the well-being of the recipient.’ The three key components of social support are:
    

• Emotional support, this may be a warm and caring relationship, a presence or companionship, or a willingness to listen
  
• Informational support, which is the giving of good advice or information
  
• Practical or tangible support which may be financial or could be physical comfort support during labour.
  

  Most social support is provided by friends, family, and community but social support by health professionals is important. It has been shown to have a positive impact on general health and well-being.
  

  How does social support work?