COMPLEMENTARY THERAPY

IN MATERNITY NURSING AREA

Dr. Wenny Artanty Nisman, S.Kep.,Ns.,M.Kes
What are complementary therapies?

• Complementary therapies adalah terapi yang bukan bagian dari perawatan

medis standar yang biasanya diresepkan oleh dokter medis. Ada banyak jenis
terapi komplementer, antara lain akupunktur, pijat, jamu, dll.

• Terkadang terapi ini dapat digambarkan sebagai 'alternatif'. Terapi alternatif

digunakan sebagai pengganti pengobatan konvensional dari dokter,

• Tetapi terapi komplementer terkadang diberikan bersamaan dengan terapi

medis

• Terapi bisa berbahaya jika tidak terbukti secara bisa juga menimbulkan efek
samping.
Why do women use complementary therapy during
pregnancy?
• Beberapa wanita beralih ke terapi complementer selama kehamilan untuk membantu
mengurangi gejala seperti mual dan muntah dan nyeri punggung bawah, nyeri
panggul dan nyeri punggung, sembelit, kecemasan, mulas, dan insomnia.
• Beberapa wanita mungkin juga menggunakan terapi ini untuk mempersiapkan
persalinan dan untuk meningkatkan peluang mereka untuk melahirkan tanpa
komplikasi.
• Terapi komplementer populer di kalangan ibu hamil, dengan banyak wanita
melihatnya sebagai 'aman dan efektif’.
• Selama kehamilan, wanita disarankan untuk menghindari banyak obat konvensional
karena kemungkinan efeknya pada anak mereka yang belum lahir.
• Oleh karena itu, beberapa wanita mungkin mempertimbangkan pengobatan
'alternatif' dalam 'kepercayaan yang terkadang keliru bahwa terapi komplementer
lebih aman daripada obat-obatan’.
• Obat-obatan herbal dianggap alami dan aman padahal isi/komponen dari obat-
obatan tersebut belum terbukti secara klinis
Is complementary therapy right for you?

• Ask your doctor or nurse about the effectiveness and safety of any
complementary therapy, and whether they would support you trying it.

• You can also ask your doctor or nurse for recommendations of

complementary health practitioners.
Assessment questions should I ask complementary health
practitioners?
• What are your qualifications? How long have you been practising?

• How does this treatment work? Is there evidence this treatment is

effective?

• What risks or side effects are involved?

• How long should this treatment be used for? How will I know if it’s working?

• What’s the cost of the treatment? Can I claim the cost on Medicare or from
my health fund?
 Extent of the evidence for different therapies
Acupuncture
Acupuncture involves the insertion of very thin needles through your skin
at strategic points on your body. A key component of traditional Chinese
medicine, acupuncture is most commonly used to treat pain. Increasingly,
it is being used for overall wellness, including stress management.
Extent of the evidence for different therapies
Acupressure
• In acupressure, muscular tension is released by applying
pressure with hand at specific acupoints or pressure of the
thumbs on specific points or the application of pressure to
acupoints is used to balance the flow of the physiological energy.
 Extent of the evidence for different therapies
Acupuncture or acupressure
• Some studies suggest acupuncture may help to reduce backache
or pelvic pain in pregnant women. Acupuncture or acupressure is also
used to bring on labour, although its effectiveness is uncertain.
Acupuncture or acupressure is generally safe when performed by a
trained acupuncturist. Mild pain from the needles is the most common
side effect.
• A number of studies have been carried out including some using rigorous
methods. However, safety and effectiveness still needs to be
demonstrated for most of the conditions examined in this briefing.
• A review of three studies, published more recently than the Cochrane
review, did not find significant evidence of benefit.
Extent of the evidence for different therapies
Acupunture
• There is a Cochrane review on Acupuncture for Insomnia,
published in 2007, but this is not limited to treatment of pregnant
women. Seven studies were eligible for inclusion in the review
(590 participants). The authors concluded that ‘The studies were
of low methodological quality and were diverse in the types of
participant, acupuncture treatments and sleep outcome measures
used, which limited the ability to pool the findings and draw
conclusions
Extent of the evidence for different therapies
Aromatherapy
• Aromatherapy is the practice of using essential oils for
therapeutic benefit. Aromatherapy has been used for centuries.
When inhaled, the scent molecules in essential oils travel from the
olfactory nerves directly to the brain and especially impact the
amygdala, the emotional center of the brain.
Extent of the evidence for different therapies
Aromatherapy
• ‘There is currently very little direct evidence for the
safety of essential oils in pregnancy and that ‘there are
many oils which should be avoided in pregnancy, either
because they cause miscarriage or affect the developing
fetus’.
Extent of the evidence for different therapies
Aromatherapy
• Although it appeared that aromatherapy might have a mild
temporary effect in reducing anxiety, the authors
concluded that the studies were ‘all sufficiently flawed to
prevent firm conclusions from being drawn’
Extent of the evidence for different therapies
Herbal medicine
• Herbal medicines are one type of dietary supplement. They are sold as
tablets, capsules, powders, teas, extracts, and fresh or dried plants.
• Herbal medicine is the use of plants to treat disease and enhance
general health and wellbeing. Herbs can interact with other pharmaceutical
medications and should be taken with care
Extent of the evidence for different therapies
Herbal medicine
• This is an area of particular concern as women may
consider herbs to be safer than pharmaceutical drugs.
Herbal medicine ‘Natural’ does not necessarily mean ‘free
of side effects’…there are reports of misuse through lack
of knowledge. There are many plants which are thought to
be unsafe to use in pregnancy
Extent of the evidence for different therapies
Herbal remedies
• No randomized controlled trials or reviews of such trials on herbal remedies
in pregnant women were found, possibly due to the risks of running such a
trial. A large-scale review of non-prescription sleep treatment research
found a lack of rigorous scientific data for the majority of herbal
supplements.
• The authors found that, ‘Studies are limited by small numbers of participants
and, in some instances, inadequate design, lack of statistical analysis, and
sparse use of objective measurements.
• The paper highlighted significant potential risks associated with the use of
Jamaican dogwood and kava kava, and did not address safety for pregnant
women
Extent of the evidence for different therapies

Homeopathy
• Homeopathy is a "treatment" based on the use of highly diluted substances,
which practitioners claim can cause the body to heal itself. A 2010 House of
Commons Science and Technology Committee report on homeopathy said
that homeopathic remedies perform no better than placebos (dummy
treatments).
• Homeopathy is an alternative medicine based on the theory of treating 'like
with like'. Homeopathy claims to stimulate healing responses to diseases by
administering substances that mimic the symptoms of those diseases in
healthy people. The effectiveness of homeopathic preparations is disputed
within medical science.
Extent of the evidence for different therapies

Homeopathy
• No research was found during this review on homeopathy.
• Homeopathy is based on the idea that if a substance
causes symptoms in a healthy person, tiny doses of the
substance can treat the symptoms in someone who is
unwell. There are no health conditions for which there is
reliable evidence that homeopathy is effective.
Extent of the evidence for different therapies
Reflexology
• Reflexology is a type of therapy that uses gentle pressure on specific points
along your feet (and possibly on your hands or ears as well) to help you feel
better. The theory is that this eases stress, and that helps your body work
better.
• Reflexology Therapy for Stress, Anxiety, Pain, and Fatigue
Extent of the evidence for different therapies
Reflexology
• Much of what is written is anecdotal or case study based.
Information is sparser than for other complementary therapies.
Caution is advised when using reflexology during the first
trimester, although it is unclear whether this is evidence-based or
purely to avoid the association of reflexology with a miscarriage.
• Pregnant women might use reflexology — where a therapist uses
hands, fingers and thumbs to stimulate certain areas of the feet
— to reduce low back or pelvic pain. It is reported to be safe.
Extent of the evidence for different therapies
Massage therapy
• In massage therapy, a massage therapist rubs and kneads the soft tissues of your
body. The soft tissues include muscle, connective tissue, tendons, ligaments and
skin. The massage therapist varies the amount of pressure and movement.
• Help reduce stress. Lessen pain and muscle tightness. Increase relaxation.
• Improve the work of the immune system.
• Reducing stress and increasing relaxation. Reducing pain and muscle soreness and
tension. Improving circulation, energy and alertness. Lowering heart rate and blood
pressure.
• One small-scale trial on 26 women reported decreased anxiety after five weeks of
massage therapy with a reduction in level of norinephrine in the urine in the
massage group. A larger study (n=84) by the same author group on the effects of
massage therapy on pregnant women with depression found lower levels of anxiety
and depressed mood, reduced cortisol and norinephrine, higher dopamine and
serotonin.
Extent of the evidence for different therapies
• Massage therapy
• One trial has been found on massage therapy. It was neither included by
the Cochrane review nor specified as an excluded study. Twenty-six
pregnant women were assigned to a massage therapy or a relaxation
therapy group for five weeks. Only the massage therapy group, reported
less back pain by the last day of the study. This is a small study and can
only indicate the need for more research on this topic
Extent of the evidence for different therapies

Massage Therapy
• Twenty-six pregnant women were assigned to a massage therapy
or a relaxation therapy group for five weeks. Both groups
reported feeling less anxious after the first session but only the
massage therapy group reported reduced anxiety.
• Another study, described as a systematic review and including six
small studies described as ‘trials or ‘clinical trials’. The
methodological quality of the studies varied considerably,
including methods of randomization and blinding. The studies did
not include pregnant women and no outcome statistics were
reported.
Extent of the evidence for different therapies

Massage Therapy
• A small study (n=26) looked at massage therapy compared to relaxation
therapy over a five week period. The massage therapy group reported better
sleep by the last day of the study
Extent of the evidence for different therapies
Hypnosis
• Hypnotherapy is a heightened state of concentration and focused attention.
Guided by a trained, certified hypnotist or hypnotherapist, hypnosis allows
you to be more open to suggestions to making healthful changes in your
perceptions, sensations, emotions, memories, thoughts or behaviors.
• Hypnosis can be effective in helping people cope with pain, stress and
anxiety. Keep in mind, though, that health care providers typically suggest
other treatments, such as cognitive behavioral therapy, for those conditions
before or along with hypnosis
Extent of the evidence for different therapies
Hypnosis
• In a study of 25 pregnant women who defined themselves as anxious,
relaxation induced by hypnosis was found to be associated with increased
foetal movements. Self-hypnosis (n = 16) and physician induced hypnosis (n =
9) were both found to be associated with increased fetal movements,
p<0.005 and p<0.01, respectively.
• The women reported that these techniques for inducing relaxation helped
them to feel less tense. The authors concluded that hypnotherapy may have
reduced maternal anxiety and catecholamine release, and as a consequence
there was an improvement in placental blood perfusion and fetuses moved
into a more active state.
Combination therapy
• Acupressure and ginger for morning sickness
These therapies may work. There are no reported side effects for acupressure.
The safety of ginger is less clear cut. The Cochrane review found no adverse
side-effects, however Tiran cautions that it should not be used in large doses
or for prolonged periods because of its anti-coagulant properties. It is difficult
to control the composition of ginger supplements due to lack of regulation.
• Acupuncture for back and pelvic pain in pregnancy
May be effective but effects demonstrated were small, so more research is
needed.
• Massage and aromatherapy for anxiety
May have a beneficial effect but more research is needed.
Recomendation

• The use of complementary therapy should consider the

main health of the mother and fetus.
• Choose complementary therapy that already has good
evidence
• Ask your doctor, nurse or midwife for advice
TERIMA KASIH