alternative and complementary therapy in pregnancy journal

The desire to maintain health and treat illness with natural or alternative therapies is strong in women with postpartum depression, but evidence for the effectiveness of these therapies continues to be an area of controversy. Complementary and alternative therapies have been used for hundreds and even thousands of years to treat all kinds of maladies and illnesses. Although it’s tempting to assume that natural is synonymous with safe, this is not necessarily true, and many of the less well-known CAM therapies have little or no evidence-based research to support their use. The practitioner would also include the person’s significant others in formulating a plan for treating postpartum depression (Posmontier & Teitelbaum, 2009). Types of complementary therapies Acupuncture or acupressure. Many women may use these therapies during the postpartum period, considering them natural alternatives to pharmaceutical agents (Freeman, 2009). An Ayurvedic approach to postpartum depression. Wang, J., van der Heijden, R., Spruit, S., Hankermeier, T., Chan, K. & van der Greef, J. et al. As Strouss et al. Studies have been conducted on the safety of St. John’s wort for lactating women and their infants; however, the outcomes of these studies do not provide conclusive evidence for the safety to the infant or the efficacy of the herb in the treatment of postpartum depression (Freeman, 2009; Klier, Schäfer, Schmid-Siegel, Lenz, & Mannel, 2002; Klier et al., 2006). Hale Publishing produces a yearly publication entitled Medications and Mother’s Milk that provides a scale of risk categories for pharmaceutical agents and some herbal formulations in human breast milk (Hale, 2010). Hall, H, McKenna, L & Griffiths, D 2012, 'Midwives’ Support for Complementary and Alternative Medicine: A Literature Review'. Often, women do not report feelings of sadness or depression to their health care providers due to stigma. We performed a population-based survey to aid health care workers in identifying and counseling parents who may use these remedies. Vitamins, massage therapy and relaxation techniques seemed to be the most popular choices, but just as other researchers discovered, approximately one-third of women chose not to disclose their use of CAM to their midwife. (1993). PURPOSE Alternative and complementary therapies are infrequently studied in pediatric populations. Journal of Evidence-Based Integrative Medicine, Complementary and Alternative Medicine Use in Modern Obstetrics, October 2016. If breastfeeding, the woman may be concerned about the presence of medications in breast milk. The phrases complementary therapy and alternative therapy are often used as if they mean the same thing. Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. Explanations for the presence of these contaminants are the area where the herb is grown (contaminated soil or water), purposeful addition of these elements for their chemical actions on the body, or accidental contamination during manufacturing (Weier & Beal, 2004). Midwives caring for women who choose to consult independent CAM practitioners should encourage them to check that their practitioner is adequately trained and insured. There should be more educational opportunities for midwives to become better informed, allowing them to share more information with women. By Jo Barnes. Complementary and alternative therapies can be beneficial to women during pregnancy, postpartum, and lactation. This kind of traditional medicine views health in a holistic manner, with balance among the emotional, physical, and spiritual aspects required for body maintenance and repair. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Friedman, S.H. Alternative and complementary therapies are based on a balance of body, mind, and spirit. Acupuncture is one of the most popular alternative therapies for use with low-back pain, especially during pregnancy. Various resources are available for practitioners to consult to determine the efficacy and safety of herbs and herbal products. Warriner, D S, Bryan, K K & Brown, A 2014, 'Women's Attitude Towards the Use of Complementary and Alternative Medicines (CAM) in Pregnancy'. (2010). This site complies with the HONcode standard for trustworthy health information: Verify here. Address correspondence to Sandra M. Gossler, PhD, APRN-BC, IBCLC, Assistant Professor, University of Tennessee, Knoxville, College of Nursing, 1200 Volunteer Boulevard, Office 143, Knoxville, TN 37996-4180; e-mail: .sgossler@utk.edu, Tell us what you think about Healio.com », Get the latest news and education delivered to your inbox, Journal of Psychosocial Nursing and Mental Health Services, https://doi.org/10.3928/02793695-20100930-02, National Center for Complementary and Alternative Medicine [NCCAM], 2010b, MacPherson, Thorpe, Thomas, & Geddes, 2004, Xue, Zhang, Greenwood, Lin, & Story, 2010, Klier, Schäfer, Schmid-Siegel, Lenz, & Mannel, 2002, http://www.breastfeeding.com/reading_room/herbs.html, http://www.internationalbreastfeedingjournal.com/content/2/1/6, http://nccam.nih.gov/research/intramural/research_train.htm, http://nccam.nih.gov/health/whatiscam/#definingcam, http://nccam.nih.gov/health/whatiscam/#role, http://www.fda.gov/RegulatoryInformation/Guidances/ucm144657.htm, Managing Workplace Violence With Evidence-Based Interventions: A Literature Review. (Conventional medicine is typically considered Western or allopathic medicine.) While aromatherapy has not been thoroughly researched regarding its benefits, massage combined with aromatherapy has been shown to improve depression symptoms (Yim, Ng, Tsang, & Leung, 2009). As Hall, Griffiths and McKenna (2015) suggest, although midwives are usually supportive, how they communicate with women about the safe use of alternative therapies has received little attention. Potential side-effects and complications. Chiropractic and osteopathy are used to reduce low back and pelvic pain in pregnant women. A mini review of traditional Chinese medicine for the treatment of depression in China. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Definitive, scientific evidence of the safety and efficacy of various therapies remains inconclusive (Chabrol & Callahan, 2007; Freeman, 2009; Weier & Beal, 2004). (2014) discovered, while many healthcare providers were supportive of CAM, very few recommended it. Quality and safety of Chinese herbal medicines guided by a systems biology perspective. Medicinal herbs in the United States: Research needs. In high-risk populations, such as women who have a personal history of depression, a family history of depression, a history of significant stress or life event stress, and a lack of support, the incidence is as high as 40% to 50% (Kendall-Tackett, 2007). Traditional Ayurvedic practitioners consider different treatments depending on the person and the symptoms presented. The National Institutes of Health (NIH) consider this system of health care practices and products significant to the health of the population, and the NCCAM addresses issues related to complementary and alternative medicine. St. John’s wort (hypericum perforatum) and breastfeeding: Plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants. Because a number of these people will be your patients, it’s important for you, as a nurse, to know complementary and alternative medicine and about how to get more education if you’d like to implement them into your practice. Lead toxicity is usually cumulative; the brain, kidneys, and digestive system eventually become compromised. 14 Participants were asked to rate their level of agreement on statements about their specific use and … Acupuncture. The art of the interview is essential for nurses who care for women who may be experiencing or developing an anxiety or mental disorder during pregnancy or postpartum. However, few studies have evidenced the benefit of acupuncture for depression (Freeman, 2009; MacPherson, Thorpe, Thomas, & Geddes, 2004; Xue, Zhang, Greenwood, Lin, & Story, 2010). Patients' use of CAM: results from the Health Survey for England 2005. After delivery, the issue may be whether the drug passes into the breast milk and affects the newborn. As Tiran (2006) notes, it’s not enough to just say that a particular therapy is effective - it must also be proven to … Visha is a reactive form of Ama and occurs when the body is not cleared of digestive toxins. & Fisher, K.D. Acupuncture for depression: First steps toward a clinical evaluation. Women experiencing anxiety, postpartum depression, or other emotional or mental disorders often look to their health care provider for accurate information and to collaborate in managing their health care needs. Clinically based evidence of drug-herb interactions: A systematic review. National Center for Complementary and Alternative Medicine. Disagree? A common description of a complementary therapy is one that is used in concert with conventional medicine. Safety and efficacy of St. John’s wort (hypericum) during pregnancy and lactation. (2014) also note the popularity of CAM in pregnancy, suggesting that 50 to 70% of pregnant women studied were found to use at least one type of CAM. (2014) suggest, with such a wide array of therapies available - each of which carries a unique set of risks and benefits - it can be difficult for maternity staff to maintain sufficient knowledge to safely guide or advise their patients. While alternative therapies may improve women’s well-being, they can also pose significant health risks and should be used with caution and in collaboration with a health care provider. Arsenic toxicity disrupts cellular electrolyte function, which damages the circulatory and central nervous systems. & Lee, A. et al. 3 Do you agree with this article? The practitioner might initially recommend dietary changes, such as eating foods that are fresh and easily digested (e.g., turkey, cooked grains, fruits, nuts) and avoiding foods that are highly processed, frozen, or microwaved. They may also be combined into one phrase – complementary and alternative therapies (CAMs). The use of complementary and alternative therapies during pregnancy, postpartum, and lactation is an issue of growing interest for practitioners who care for women in these stages of life. vibrating foam roller, low-level laser therapy, cold water immersion, and Kinesiology tape, are applied on fatigued athletes. A desire to maintain a more naturalistic approach to health care and illness prevention, as well as the increasing cost of health care, has helped create an interest in complementary and alternative therapies. Hall, H, Griffiths, D & McKenna, L 2015, 'Complementary and Alternative Medicine: Interaction and Communication Between Midwives and Women'. Read the latest articles of Complementary Therapies in Nursing and Midwifery at ScienceDirect.com, Elsevier’s leading platform of peer-reviewed scholarly literature Klier, C.M., Schäfer, M.R., Schmid-Siegel, B., Lenz, G. & Mannel, M. (2002). & Resnick, P.J. Aromatherapy is also considered an acceptable alternative therapy for depression. & Seely, D. (2010). As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. Most midwives seemed to take an open-minded and positive approach to the use of CAM because they considered the therapies to be philosophically congruent, providing safe alternatives to medical interventions and supporting the woman's autonomy (Hall, McKenna & Griffiths 2012). Some herbs inhibit specific enzymes or decrease the efficacy of certain drugs, which can cause harm. Lack of knowledge, language barriers and workplace constraints mean that in most cases, it remains up to pregnant women themselves to initiate any CAM based conversations. The practitioner also needs to know the kind and dosage of dietary supplements, herbs, and herbal formulations (and their source), and whether the woman is consulting an alternative medicine practitioner. (2009). National Center for Complementary and Alternative Medicine. The use of complementary and alternative therapies for depression is an issue of growing interest for practitioners who care for women. The most common complementary and alternative medicine therapies used or recommended during pregnancy were herbalism, massage therapy, chiropractic, mind-body interventions (hypnosis, biofeedback, and relaxation techniques), and acupressure. Midwives should ask women directly about their use of complementary or natural therapies. The importance of the provider’s trust, honesty, and communication with the client cannot be overstated. Conclusion The majority of clinician's held positive views towards CAM and considered some complementary therapies to be useful and safe for use during pregnancy. (2009). For example, for each therapy it’s important to know: As Strouss et al. St. John’s wort (hypericum perforatum)—Is it safe during breastfeeding? (2010a). The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support. Some of the milder adverse reactions were headache, nausea, vomiting, diarrhea, constipation, dizziness, and abdominal pain. While it may not completely alleviate the symptoms, it may provide some relief and may be used in conjunction with antiemetics for an enhanced response. (2007). Xue, C.C., Zhang, A.L., Greenwood, K.M., Lin, V. & Story, D.F. Posmontier, B. St. John’s wort is known to increase photosensitivity and inhibit monoamine oxidase. Ayurvedic practitioners recommend combinations of diet, sleep, massage, herbs, and herbal formulations (i.e., combinations of herbs) to rid the body of toxins and restore balance to all aspects of the body (Mantle, 2002; Posmontier & Teitelbaum, 2009). NCCAM is also responsible for conducting rigorous scientific research on these practices and products and disseminating the findings to professionals and the general public (NCCAM, 2010c). The use of complementary and alternative therapies during lactation is another area of potential concern. A systematic review of drug-herb interactions by Kennedy and Seely (2010) found very few studies performed with herbs and only 37 studies conducted on a collection of selected drug-herb interactions in healthy volunteers. Not all women have an equal interest or ability to access these therapies, however. Some herbs and herbal formulations may have serious adverse effects or interactions with other pharmaceutical agents (Matthews, Lucier, & Fisher, 1999; Posmontier & Teitelbaum, 2009; Weier & Beal, 2004). The Journal provides a global platform for discussion, perspectives and research on traditional and Complementary medicine. Some of the herbal preparations may include Gotu kola, Bacopa monnieri, Shankapushpi, Celastrus paniculatus, Ashoka, or Terminalia arjuna (Posmontier & Teitelbaum, 2009). Traditional Chinese medicine: An update on clinical evidence. For many years now, the complementary and alternative medicine (CAM) movement has been driven by consumer demand, leaving midwives with the task of developing comprehensive evidence-based knowledge of the potential benefits and risks of some of the more popular therapies. … Some studies suggest acupuncture may help to reduce backache or pelvic pain in pregnant... Chiropractic and osteopathy. 14, No. Strouss, L, Mackley, A, Guillen, U, Paul, D & Locke, R 2014, 'Complementary and Alternative Medicine Use in Women During Pregnancy: Do Their Healthcare Providers Know?'. Because of these fears and concerns, many new mothers turn to complementary or alternative therapies for help and relief (Weier & Beal, 2004). These therapies need to be discussed so the client and practitioner can collaborate on the course of therapy for postpartum anxiety or depression. This could include body-mind therapies, manipulation therapies, acupuncture, and others. The ACOG, Committee on Obstetric Practice (2010) recently released a statement encouraging all obstetricians to screen pregnant and postpartum women for depression. Postpartum depression: An update. Mantle, F. (2002). Defining complementary and alternative therapies is difficult because the field is diverse and covers a wide range of care systems, products, and practices. Microbiological study of fresh herbs from retail premises uncovers an international outbreak of salmonellosis. A common herb used for depression, including postpartum depression, is St. John’s wort (Hypericum perforatum). National Center for Complementary and Alternative Medicine. The American College (renamed “Congress”) of Obstetricians and Gynecologists (ACOG), Committee on Obstetric Practice (2010) states that between 5% and 25% of women will experience postpartum depression at some time. In addition, the postpartum period constitutes a time of highest risk for the development of emotional and mental disorders. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. The practitioner needs to know whether the woman is using complementary therapies, such as massage, acupuncture, or aromatherapy, and what relief, if any, she is experiencing. A systematic review of available literature provided very weak evidence for the safety of the use of St. John’s wort during pregnancy and lactation (Dugoua, Mills, Perri, & Koren, 2006). Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment Have a comment or questions? In addition, some herbs and herbal formulations have been found to contain heavy metals, such as mercury, arsenic, and lead (Posmontier & Teitelbaum, 2009). Safe and effective policies should be developed based on the best available evidence with clear parameters of practice. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy-related complaints and symptoms. Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. (1999). For many years now, the complementary and alternative medicine (CAM) movement has been driven by consumer demand, leaving midwives with the task of developing comprehensive evidence-based knowledge of the potential benefits and risks of some of the more popular therapies. Kendall-Tackett, K. (2007). In addition, Kennedy and Seely (2010) found significant differences in dosages and duration of treatments involving herbs. Given the rise in popularity of CAM in recent years, many midwives are now asking if knowledge of complementary therapies should be included within basic midwifery training. A secondary focus is to generate a call to action for further research in this area to improve the health of all women. Complementary and alternative medicine for perinatal depression. Other alternative or complementary … (2004). Send an e-mail to the Journal, at jpn@slackinc.com. Information about the toxicity of some herbs and herbal formulations is limited, but alkaloids and terpenes have been found (Wang et al., 2009). & Teitelbaum, M. (2009). These issues are important and sometimes critical for practitioners to address with the mother. Kennedy, D.A. 3 June 2010 | Focus on Alternative and Complementary Therapies, Vol. Specific herbs or herbal formulations targeted to specific areas of the body in need of balance are typically recommended after the initial dietary and schedule changes are made to promote adequate sleep and lowered stress (Posmontier & Teitelbaum, 2009). With the availability of information from multiple sources, whether accurate or not, women may be using these therapies inappropriately. As the discussion continues, the practitioner should inquire, using direct questions if needed, about what strategies are currently being used to help manage symptoms. One of the major issues with the studies of TCM is the lack of systematic, randomized controlled trials and quality of the studies (Zhao, Wan, & Chen, 2009). You can read more about her work at www.MindBodyInk.com. Clients may seek complementary and alternative therapies due to concerns about medications and adverse reactions. 2 The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical Distress Journal of Obstetric, Gynecologic & Neonatal Nursing, Vol. Issues of safety and purity of the herbs and herbal formulations, as well as the potential for unsafe levels of the herb passing from the breast milk to the infant, must be considered. An alternative therapy is one that is used instead of a conventional therapy or medicine (National Center for Complementary and Alternative Medicine [NCCAM], 2010b). As Tiran (2006) notes, it’s not enough to just say that a particular therapy is effective - it must also be proven to be safe before it can be used in maternity care. Committee opinion no. Allaire says, "About 76% of those nurse-midwives who used herbal therapies used them for labor stimulation." Coelho, H.F., Boddy, K. & Ernst, E. (2008). Massage therapy for the treatment of depression: A systematic review. Bearing all these factors in mind, the Royal College of Midwives (2014) have published the following recommendations to help guide midwives in their conversations about CAM: As Gaffney and Smith (2004) note, there is a need for much more research before complementary therapies can be considered safe for use during pregnancy. The NCCAM conducts research on these kinds of therapies, performs clinical trials on the products and procedures, and provides training for researchers. Traditional Chinese medicine (TCM) views the person in a holistic manner with energy, emotion, and physical aspects of the body (Mantle, 2002; Weier & Beal, 2004; Xue et al., 2010). A Swedish report published several years ago showed that low back pain, which affects up to three-quarters of all women during pregnancy, can be greatly relieved by acupuncture. One of the most widely researched therapies: studies have detailed the usefulness of … The role of alternative medicine in treating postnatal depression. A Traditional Chinese herbalist will use combinations of herbs depending on the person’s symptoms and which organ of the body is connected to the person’s emotional status. Helen SKOUTERIS, Eleanor H. WERTHEIM, Sofia RALLIS, Susan J. PAXTON, Leanne KELLY, Jeannette MILGROM, Use of complementary and alternative medicines by a sample of Australian women during pregnancy, Australian and New Zealand Journal of Obstetrics and Gynaecology, 10.1111/j.1479-828X.2008.00865.x, 48, 4, (384-390), (2008). Mollart, L, Skinner, V, Adams, J & Foureur, M 2018, 'Midwives’ Personal Use of Complementary and Alternative Medicine (CAM) Influences Their Recommendations to Women Experiencing a Post-date Pregnancy'. Practitioners should familiarize themselves about the use of complementary and alternative therapies during pregnancy, postpartum, and lactation to provide clients with accurate and current information. Massage. Instead, the focus is to generate an intellectual curiosity and inquiry regarding complementary and alternative therapies used during this time in a woman’s life. The electronic Journal of Traditional and Complementary Medicine (eJTCM) is a bimonthly open-access journal that covers the fields of traditional medicine, herbal medicine, and dietary therapy. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. Massage, aromatherapy, and abdominal pain or depression to their health care workers identifying... Nurses and health systems same thing and lactation ( 2004 ) one phrase – complementary and alternative (. Mind body Ink is a serious and debilitating condition that affects many women as! With low-back pain, especially if they are breastfeeding their infants body is not of... Formulations ( Weier & Beal, 2004 ) toxins include drugs,,! Milk and affects the newborn including the United States: research Needs R.K. & Yaffe, S.J,. And stomach this article provides a global platform for discussion, perspectives and research reduction! 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