The practitioner would also include the person’s significant others in formulating a plan for treating postpartum depression (Posmontier & Teitelbaum, 2009). See Educator Profile. 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). 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. Nurses With Substance Use Disorders: Where We Are and What Needs To Be Done. In complementary and alternative medicine, many therapeutic skills, i.e. For example, insomnia is thought to be connected to the kidneys, liver, and stomach. Complementary and alternative therapies can be beneficial to women during pregnancy, postpartum, and lactation. Postpartum depression is a serious and debilitating illness that affects many women, their infants, and families. Massage and relaxation therapies have been used for hundreds of years to relieve tension, increase circulation, and calm pain receptors in the body (Field, 2000). 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. Coelho, H.F., Boddy, K. & Ernst, E. (2008). Visha is a reactive form of Ama and occurs when the body is not cleared of digestive toxins. Defining complementary and alternative therapies is difficult because the field is diverse and covers a wide range of care systems, products, and practices. 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. American College of Obstetricians and Gynecologists, Committee on Obstetric Practice. 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. (2014) discovered, while many healthcare providers were supportive of CAM, very few recommended it. As Tiran (2006) notes, it’s not enough to just say that a particular therapy is effective - it must also be proven to … Many women are using alternative therapies for general depression and then continue using these same therapies for depressive symptoms that occur during the postpartum period (Weier & Beal, 2004). Association of Complementary and Alternative Therapies With Mental Health Outcomes in Pregnant Women Living in a Postdisaster Recovery Environment Freeman, M.P. (2010b). Additional resources that provide information on herbs and herbal formulations include Hale Publishing ( http://www.ibreastfeeding.com), the United States Breast-feeding Committee ( http://www.usbreastfeeding.org), and Breastfeeding.com ( http://www.breastfeeding.com/reading_room/herbs.html). 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). Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. Strouss et al. Because Ayurvedic medicine and TCM use herbs and herbal formulations, consumers are cautioned to obtain these products only from qualified practitioners (Posmontier & Teitelbaum, 2009). Not all women have an equal interest or ability to access these therapies, however. In addition, more women are educating themselves about the potential side and adverse effects of prescriptions drugs and are exploring complementary and alternative therapies. This could include body-mind therapies, manipulation therapies, acupuncture, and others. 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). She is a former midwife and nurse teacher with over 25 years’ experience working in the fields of healthcare, stress management and medical hypnosis. Because of these fears and concerns, many new mothers turn to complementary or alternative therapies for help and relief (Weier & Beal, 2004). 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. 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. 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. 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. Tiran, D 2006, 'Complementary Therapies in Pregnancy: Midwives’ and Obstetricians’ Appreciation of Risk'. 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). Zhao, H., Wan, X. 14 Participants were asked to rate their level of agreement on statements about their specific use and … If breastfeeding, the woman may be concerned about the presence of medications in breast milk. 453: Screening for depression during and after pregnancy. 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. 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. Journal of Evidence-Based Integrative Medicine, Complementary and Alternative Medicine Use in Modern Obstetrics, October 2016. 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). Safe and effective policies should be developed based on the best available evidence with clear parameters of practice. Dietary supplements, such as omega-3 polyunsaturated fatty acids, have been shown to have beneficial effects on depression; however, possible contamination of fish with heavy metals continues to be an issue of concern (Freeman, 2009; Weier & Beal, 2004). 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. Yim, V.W., Ng, A.K., Tsang, H.W. 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. An Ayurvedic approach to postpartum depression. Ama consists of partially digested food in the digestive tract that slows digestion and allows toxins to form. The role of alternative medicine in treating postnatal depression. Her recent publications include The Health Factor, Coach Yourself To Better Health and Positive Thinking For Kids. The practitioner may prescribe specific herbal creams depending on the symptoms presented. Therapies such as herbs and herbal formulations should be used with caution because purity and strength are not always known or regulated. Friedman, S.H. This statement recognizes the significance of this disorder and its impact on women and their families. Alternative and complementary therapies are based on a balance of body, mind, and spirit. These issues are important and sometimes critical for practitioners to address with the mother. American College of Obstetricians and Gynecologists, Approaches to Limit Intervention During Labor and Birth, February 2017. & Teitelbaum, M. (2009). 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. 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. A mini review of traditional Chinese medicine for the treatment of depression in China. Information about the toxicity of some herbs and herbal formulations is limited, but alkaloids and terpenes have been found (Wang et al., 2009). Gaffney, L & Smith, C 2004, 'Use of Complementary Therapies in Pregnancy: The Perceptions of Obstetricians and Midwives in South Australia'. PATIENTS AND METHODS We retrospectively surveyed the parents of 583 pediatric patients diagnosed with cancer in British Columbia between 1989 and 1995. Hall, H, McKenna, L & Griffiths, D 2012, 'Midwives’ Support for Complementary and Alternative Medicine: A Literature Review'. In addition, the postpartum period constitutes a time of highest risk for the development of emotional and mental disorders. (2004). The authors found that ingredient analysis was conducted on only 35% of the herbs used in the studies. 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. Medicinal herbs in the United States: Research needs. 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. 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. The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. St. John’s wort is known to increase photosensitivity and inhibit monoamine oxidase. 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. (2009). 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). Clinically based evidence of drug-herb interactions: A systematic review. 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). 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. 2. & Beal, M.W. Strouss et al. (2008). Send an e-mail to the Journal, at jpn@slackinc.com. (Medical condition overview) by "Journal of the Australian Traditional-Medicine Society"; Health, general Alternative medicine Research Pregnancy Pregnant women Weier, K.M. Matthews, H.B., Lucier, G.W. (2010a). 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. Daily gentle massage may be recommended to reduce stress and improve blood flow. Given the prevalence of this potentially incapacitating health issue, it is important to address screening and treatment of all pregnant and postpartum women. (2006). A common description of a complementary therapy is one that is used in concert with conventional medicine. 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. As the discussion continues, the practitioner should inquire, using direct questions if needed, about what strategies are currently being used to help manage symptoms. Various resources are available for practitioners to consult to determine the efficacy and safety of herbs and herbal products. Kendall-Tackett, K. (2007). 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. 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. 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. Posmontier, B. A review on the effects of aromatherapy for patients with depressive symptoms. Wang, J., van der Heijden, R., Spruit, S., Hankermeier, T., Chan, K. & van der Greef, J. et al. (2009). A common herb used for depression, including postpartum depression, is St. John’s wort (Hypericum perforatum). 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. 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 fourth toxin is exposure to electromagnetic radiation, known as Indra Varjra Bhijanya Visha (Posmontier & Teitelbaum, 2009). They may also be combined into one phrase – complementary and alternative therapies (CAMs). (Conventional medicine is typically considered Western or allopathic medicine.) Definitive, scientific evidence of the safety and efficacy of various therapies remains inconclusive (Chabrol & Callahan, 2007; Freeman, 2009; Weier & Beal, 2004). Of concern, herbs of foreign origin can be shipped to and sold in other countries, including the United States. 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. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms. 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). (2007). 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. During pregnancy, complementary and alternative therapies may be a prudent choice for women, as some pharmaceutical agents cross the placental barrier. For example, for each therapy it’s important to know: As Strouss et al. 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). & Lee, A. et al. Klier, C.M., Schäfer, M.R., Schmid-Siegel, B., Lenz, G. & Mannel, M. (2002). Acupuncture. Anne has also studied many forms of complementary medicine and has extensive experience in the field of clinical hypnosis. The importance of the provider’s trust, honesty, and communication with the client cannot be overstated. 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 reasons for the increasing use of complementary therapies and natural remedies in pregnancy and childbirth are explored, together with the growing interest in its use amongst midwives and other maternity professionals. 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. In addition, some herbs and herbal formulations have been found to contain heavy metals, such as mercury, arsenic, and lead (Posmontier & Teitelbaum, 2009). Despite this, few women were asked about alternative therapies by their care team and once again, one-third of women chose not to disclose that they sought help and support outside of the traditional healthcare model. Many women may use these therapies during the postpartum period, considering them natural alternatives to pharmaceutical agents (Freeman, 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. Massage. Alternative and complementary therapies used in postpartum depression include acupuncture, dietary supplements, herbs, massage, aromatherapy, and relaxation therapy. The Journal provides a global platform for discussion, perspectives and research on traditional and Complementary medicine. (2009). Anne is a freelance lecturer and medical writer at Mind Body Ink. PURPOSE Alternative and complementary therapies are infrequently studied in pediatric populations. Over 70% of obstetricians and midwives considered massage, acupuncture, vitamins, yoga, meditation and hypnosis to be useful and safe to use during pregnancy. 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. The need for sleep and setting specific goals for achieving restorative sleep would likely be discussed. 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. Some of the milder adverse reactions were headache, nausea, vomiting, diarrhea, constipation, dizziness, and abdominal pain. With regard to the effectiveness of TCM in the treatment of depression, a study in China showed that it was ineffective. 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. Massage therapy for the treatment of depression: A systematic review. Often, women do not report feelings of sadness or depression to their health care providers due to stigma. 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. Mercury toxicity can cause damage to the brain, kidney, and lungs. Complementary therapies as adjuncts in the treatment of postpartum depression. 2 The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical Distress Journal of Obstetric, Gynecologic & Neonatal Nursing, Vol. Microbiological study of fresh herbs from retail premises uncovers an international outbreak of salmonellosis. 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?'. Warriner, D S, Bryan, K K & Brown, A 2014, 'Women's Attitude Towards the Use of Complementary and Alternative Medicines (CAM) in Pregnancy'. & Chen, J.X. 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). 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. By Jo Barnes. 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 … As Strouss et al. Allaire says, "About 76% of those nurse-midwives who used herbal therapies used them for labor stimulation." The practitioner should discuss the anxiety symptoms and what triggers reactions. Quality and safety of Chinese herbal medicines guided by a systems biology perspective. (1993). After delivery, the issue may be whether the drug passes into the breast milk and affects the newborn. 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. (2010c). 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. They may not be as costly as modern therapies and medications. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Chiropractic and osteopathy are used to reduce low back and pelvic pain in pregnant women. Traditional Ayurvedic practitioners consider different treatments depending on the person and the symptoms presented. The NCCAM conducts research on these kinds of therapies, performs clinical trials on the products and procedures, and provides training for researchers. Acupuncture has been shown to relieve anxiety and is considered a safe alternative as it does not adversely interact with drug therapies (Dong, 1993). Other sources identify one in seven mothers as being affected by postpartum depression (Friedman & Resnick, 2009). Hall, H, Griffiths, D & McKenna, L 2015, 'Complementary and Alternative Medicine: Interaction and Communication Between Midwives and Women'. Elviss, N.C., Little, C.L., Hucklesby, L., Sagoo, S., Surman-Lee, S. & de Pinna, E. et al. 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. Types of complementary therapies Acupuncture or acupressure. These kinds of therapies have been used with varying degrees of effectiveness. That being said, many women simply choose not to tell their care provider that they are using CAM therapies at all, in fear of judgement or discouragement (Warriner, Bryan & Brown 2014). 38, No. You can read more about her work at www.MindBodyInk.com. Mantle, F. (2002). 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