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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. (1999). Committee opinion no. 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. With the availability of information from multiple sources, whether accurate or not, women may be using these therapies inappropriately. 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. This article provides a brief overview of complementary and alternative therapies that may be used by women during pregnancy and postpartum. Two overarching issues have repeatedly been stated in the literature: the issue of purity and regulation of herbal supplements and the use of alternative therapies without discussion with a health care provider. & Seely, D. (2010). Mercury toxicity can cause damage to the brain, kidney, and lungs. Anne is a freelance lecturer and medical writer at Mind Body Ink. Chiropractic and osteopathy are used to reduce low back and pelvic pain in pregnant women. As a former Midwife, Anne has a natural passion for writing about fertility, pregnancy, birthing and baby care. acupuncture, moxibustion, and massage, or more therapeutic modalities, i.e. A common description of a complementary therapy is one that is used in concert with conventional medicine. To access the article, you may purchase it or purchase the complete back file collection here. Coelho, H.F., Boddy, K. & Ernst, E. (2008). Warriner, D S, Bryan, K K & Brown, A 2014, 'Women's Attitude Towards the Use of Complementary and Alternative Medicines (CAM) in Pregnancy'. Some of the herbal preparations may include Gotu kola, Bacopa monnieri, Shankapushpi, Celastrus paniculatus, Ashoka, or Terminalia arjuna (Posmontier & Teitelbaum, 2009). Due to the potential stigma of mental illness, many new mothers do not inform their obstetrician or pediatrician of their sadness, mood changes, or concerns about their feelings. Over 70% of obstetricians and midwives considered massage, acupuncture, vitamins, yoga, meditation and hypnosis to be useful and safe to use during pregnancy. These issues are important and sometimes critical for practitioners to address with the mother. 38, No. Traditional Chinese medicine: An update on clinical evidence. Strouss et al. & Resnick, P.J. In addition, more women are educating themselves about the potential side and adverse effects of prescriptions drugs and are exploring complementary and alternative therapies. Clients may seek complementary and alternative therapies due to concerns about medications and adverse reactions. Information about the toxicity of some herbs and herbal formulations is limited, but alkaloids and terpenes have been found (Wang et al., 2009). Send an e-mail to the Journal, at jpn@slackinc.com. Some herbs inhibit specific enzymes or decrease the efficacy of certain drugs, which can cause harm. Mantle, F. (2002). 453: Screening for depression during and after pregnancy. 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. Disagree? An Ayurvedic approach to postpartum depression. (2008). 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. Massage therapy for the treatment of depression: A systematic review. Midwives caring for women who choose to consult independent CAM practitioners should encourage them to check that their practitioner is adequately trained and insured. Often, women do not report feelings of sadness or depression to their health care providers due to stigma. This chapter introduces the concept of complementary medicine and explores some of the theories that support it. Chabrol, H. & Callahan, S. (2007). Acupuncture for depression: First steps toward a clinical evaluation. 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). These kinds of therapies have been used with varying degrees of effectiveness. However, the efficacy of most of these treatments has not been proven in clinical trials and there is little reliable information on their safety if used during pregnancy. 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. As the discussion continues, the practitioner should inquire, using direct questions if needed, about what strategies are currently being used to help manage symptoms. (2004). Strouss et al. Potential side-effects and complications. The use of complementary and alternative therapies during lactation is another area of potential concern. While some drug-herb interactions were negligible or the herb enhanced the drug, the authors maintained that significantly more research must be done to determine safety in drug-herb interactions (Kennedy & Seely, 2010). Pregnant women can experience various pregnancy-related complaints or other conditions, such as coughs and colds, for which herbal medicines and complementary therapies may present an attractive treatment option. 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). PURPOSE Alternative and complementary therapies are infrequently studied in pediatric populations. Kolcaba's theory of holistic comfort is proposed as a framework for guiding nurses to use alternative and complementary therapies in the comfort care of laboring women. Briggs, G.G., Freeman, R.K. & Yaffe, S.J. (2014) suggest that although there are a wide range of therapies that women can use either independently or alongside conventional care, they can broadly be classified into the following five categories: Based on recent surveys conducted by the Royal College of Midwives (2014), it’s thought that as many as 87% of women use natural remedies at some point during their pregnancy, either self-administering or via a private consultation with a trained practitioner. Elviss, N.C., Little, C.L., Hucklesby, L., Sagoo, S., Surman-Lee, S. & de Pinna, E. et al. Complementary and alternative medicine for perinatal depression. This allows staff to be aware of their use and avoid adverse reactions or interactions with conventional care and pharmaceutical preparations. (2010). PATIENTS AND METHODS We retrospectively surveyed the parents of 583 pediatric patients diagnosed with cancer in British Columbia between 1989 and 1995. Medicinal herbs in the United States: Research needs. The heart contains the shen, or spiritual aspect of the person, which is also affected by insomnia, a common symptom in depression (Mantle, 2002). Many women may use these therapies during the postpartum period, considering them natural alternatives to pharmaceutical agents (Freeman, 2009). As Strouss et al. Alternative and Complementary Therapies is the leading Journalzine® delivering practical and evidence-based research on integrating alternative medical therapies and approaches into private practice or hospital integrative medicine programs. The practitioner would also include the person’s significant others in formulating a plan for treating postpartum depression (Posmontier & Teitelbaum, 2009). The practitioner should discuss the anxiety symptoms and what triggers reactions. 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). In addition, Briggs, Freeman, and Yaffe (2008) published Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk to inform practitioners about the safety of pharmaceutical agents and herbal formulations in breast milk. Furthermore, caution is advised with the use of St. John’s wort as there is a potential for drug interaction for the mother and potential side effects in the infant (Conover & Buehler, 2004; Dugoua et al., 2006; Klier et al., 2002, 2006). Purpose: The objective of this study was to determine if complementary and alternative medicine therapies are associated with mental health in postdisaster environments.Design: Pregnant women (N = 402) were interviewed between 2010 and 2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care.Methods: Symptoms of depression (Edinburgh Postnatal … Complementary and alternative therapies can be beneficial to women during pregnancy, postpartum, and lactation. They may not be as costly as modern therapies and medications. Safety and efficacy of St. John’s wort (hypericum) during pregnancy and lactation. Tiran, D 2006, 'Complementary Therapies in Pregnancy: Midwives’ and Obstetricians’ Appreciation of Risk'. She has a special interest in integrating complementary medicine into conventional healthcare settings and is currently an Associate Tutor, lecturing in Health Coaching and Medical Hypnosis at Exeter University in the UK. 14 Participants were asked to rate their level of agreement on statements about their specific use and … The ACOG, Committee on Obstetric Practice (2010) recently released a statement encouraging all obstetricians to screen pregnant and postpartum women for depression. (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. Alternative and complementary therapies are based on a balance of body, mind, and spirit. Dong, J.T. Hall, H, Griffiths, D & McKenna, L 2015, 'Complementary and Alternative Medicine: Interaction and Communication Between Midwives and Women'. & Beal, M.W. Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. Kendall-Tackett, K. (2007). Acupuncture has been shown to relieve anxiety and is considered a safe alternative as it does not adversely interact with drug therapies (Dong, 1993). St. John’s wort (hypericum perforatum)—Is it safe during breastfeeding? The role of alternative medicine in treating postnatal depression. 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. (1993). & Fisher, K.D. Because Ayurvedic medicine and TCM use herbs and herbal formulations, consumers are cautioned to obtain these products only from qualified practitioners (Posmontier & Teitelbaum, 2009). Some women have multiple concerns in using prescription drugs, especially if they are breastfeeding their infants. (2009). 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. U.S. Food and Drug Administration. Acupuncture, aromatherapy, supplements, and the like—more and more people across the nation are using these therapies. Complementary and alternative therapies have been used for hundreds and even thousands of years to treat all kinds of maladies and illnesses. Ama consists of partially digested food in the digestive tract that slows digestion and allows toxins to form. Wang, J., van der Heijden, R., Spruit, S., Hankermeier, T., Chan, K. & van der Greef, J. et al. She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. 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. Kennedy, D.A. 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. Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment (Conventional medicine is typically considered Western or allopathic medicine.) 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. (2009). Klier, C.M., Schäfer, M.R., Schmid-Siegel, B., Lenz, G. & Mannel, M. (2002). Before a midwife can prescribe, advise or endorse the use of CAM in pregnancy, many considerations must be taken into account, especially for those therapies with a pharmacological action that may interact with prescribed medications (RCM 2014). Xue, C.C., Zhang, A.L., Greenwood, K.M., Lin, V. & Story, D.F. A common herb used for depression, including postpartum depression, is St. John’s wort (Hypericum perforatum). To date, there is still relatively little high-quality evidence-based research on the safety and efficacy of many of these therapies, yet, the use of CAM in pregnancy clearly remains a growing trend that midwives are trying to embrace. The articles prior to January 2014 are part of the back file collection and are not available with a current paid subscription. 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. Clinically based evidence of drug-herb interactions: A systematic review. 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. Matthews, H.B., Lucier, G.W. Seventeen statements on individual complementary and alternative medicine therapy use in pregnancy were derived from the American Congress of Obstetricians and Gynecologists (ACOG) Clinical Updates in Women’s Health Care booklet titled Complementary and Alternative Medicine. Patients' use of CAM: results from the Health Survey for England 2005. Klier, C.M., Schmid-Siegel, B., Schäfer, M.R., Lenz, G., Saria, A. 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). The need for sleep and setting specific goals for achieving restorative sleep would likely be discussed. (2007). Journal of Evidence-Based Integrative Medicine, Complementary and Alternative Medicine Use in Modern Obstetrics, October 2016. 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. 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. However, with so many specialities on offer, it can be difficult to keep up to date with current knowledge and identify which therapies are safe for use during pregnancy, and which could potentially cause harm. Postpartum depression: An update. (2018), the top five CAM therapies recommended by midwives were: Midwives were also more likely to discuss alternative approaches to pregnancy care if they had used CAM themselves or were less experienced in their role. Weier, K.M. Midwives should ask women directly about their use of complementary or natural therapies. This particular herb contains several components including hypericin, hyerin, biflavonoids, and phloroglucinols and may vary in strength based on where the plant was grown, season of harvesting, and the combination of components. (2009). Despite the popularity of many forms of CAM, midwives remain at risk of overstepping their boundaries of professional accountability if they have not undertaken relevant training (RCM 2014). In addition, any person using herbs or herbal formulations is strongly urged to consult with their primary care provider before considering the use of these products. Posmontier, B. One of the reasons complementary therapies are becoming so popular is that they offer a holistic approach to pregnancy, allowing women to maintain personal control outside of the biomedical model. They may also be combined into one phrase – complementary and alternative therapies (CAMs). St. John’s wort is known to increase photosensitivity and inhibit monoamine oxidase. Acupuncture. 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). Prevention and treatment of postnatal depression. 3 June 2010 | Focus on Alternative and Complementary Therapies, Vol. 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. The phrases complementary therapy and alternative therapy are often used as if they mean the same thing. Some of the milder adverse reactions were headache, nausea, vomiting, diarrhea, constipation, dizziness, and abdominal pain. Acupuncture is one of the most popular alternative therapies for use with low-back pain, especially during pregnancy. National Center for Complementary and Alternative Medicine. 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. However, little clinical evidence shows that massage therapy is effective for depression treatment (Coelho, Boddy, & Ernst, 2008). … In addition, some herbs and herbal formulations have been found to contain heavy metals, such as mercury, arsenic, and lead (Posmontier & Teitelbaum, 2009). 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). Nurses With Substance Use Disorders: Where We Are and What Needs To Be Done. American College of Obstetricians and Gynecologists, Approaches to Limit Intervention During Labor and Birth, February 2017. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. A microbiological study of the safety of fresh herbs was conducted in the United Kingdom and found that a number of contaminants, such as Salmonella and Escherichia coli were common in herbs from Israel, Spain, and other unknown sources (Elviss et al., 2009). Her background includes working as a hospital midwife, Critical Care nurse, lecturer in Neonatal Intensive Care, and as a Clinical Nurse Specialist for a company making life support equipment. 3 After delivery, the issue may be whether the drug passes into the breast milk and affects the newborn. Two major concerns in using complementary and alternative therapies are the purity and safety of the herbs and herbal formulations and the potential lack of communication between the client and health care provider. These findings seemed to be typical across a range of research studies, which found that pregnant women often relied on advice from non-healthcare providers such as friends and relatives when deciding to use complementary or alternative therapies. St. John’s wort (hypericum perforatum) and breastfeeding: Plasma and breast milk concentrations of hyperforin for 5 mothers and 2 infants. (Medical condition overview) by "Journal of the Australian Traditional-Medicine Society"; Health, general Alternative medicine Research Pregnancy Pregnant women 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?'. Yoga, a popular alternative therapy, requires only a mat. Daily gentle massage may be recommended to reduce stress and improve blood flow. Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. Clinical training programs offered by NCCAM (2010a) are integrated within the NIH and include the NIH Inter-Institute Endocrine Training Program, domestic and international postdoctoral fellowship programs, the Howard Hughes Medical Student Program, post-baccalaureate and summer student research programs, and the NIH-Duke Clinical Research program. As Tiran (2006) notes, it’s not enough to just say that a particular therapy is effective - it must also be proven to … vibrating foam roller, low-level laser therapy, cold water immersion, and Kinesiology tape, are applied on fatigued athletes. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms. 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 converse is also true: The client needs to inform the practitioner because a well-informed practitioner will be able to discuss all possibilities with the client and better formulate a mutually agreeable plan of care. A new paradigm for depression in new mothers: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. Parameters of practice and alternative therapies have been used with caution because purity and strength are available... Article, you may purchase it or purchase the complete back file collection.... Of complementary and alternative medicine utilization in pregnancy: a systematic review NCCAM conducts research on reduction of and... 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