Care of Mother and Child At-Risk or

with Problems (Acute and Chronic)-RLE

Module #18 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

Lesson Title: Complementary and Alternative Therapies Materials:

SAS, OB book, pens
Learning Targets:
At the end of the module, students will be able to: Reference:
1. Define the recommendations for complementary and
alternative therapies that could be use during labor Pilliteri, Adele and Silbert-Flagg, JoAnne
and delivery. (2018) Maternal and Child Health
Nursing, 8th Edition. USA: Lippincott
2. Integrate the knowledge of recommendations for
Williams and Wilkins
complementary and alternative therapies that could be
use during labor and delivery and describe specific
management on these recommendations in
formulating nursing care plan in giving quality maternal
and child health nursing care.

A. LESSON REVIEW/PREVIEW

B. MAIN LESSON
Please refer Chapter 16: The Nursing Role in Providing Comfort During Labor and Birth p. 377

COMPLEMENTARY AND ALTERNATIVE THERAPIES

RELAXATION
 is taught in most preparation for childbirth
classes but can be taught in early labor
as well.
 Relaxation keeps the abdominal wall from
becoming tense, allowing the uterus to
rise with contractions without pressing
against the hard abdominal wall.
 It also serves as a distraction technique
because, while concentrating on relaxing,
a woman cannot concentrate on pain.
 Asking a woman to bring favorite music or
aromatherapy with her to enjoy in the
birthing room, although not evidence
FOCUSING AND IMAGERY
 Concentrating intently on an object is
another method of distraction, or another
method of keeping sensory input from
reaching the cortex of the brain.
 For this technique, a woman uses a
photograph of someone important to her
or some setting she finds appealing such
as a beautiful sunset.
 She concentrates on the photo during
contractions (focusing).
 A woman can also concentrate on a
mental image, such as waves rolling onto
a beach (imagery), or chant a word or

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based, can help with relaxation.
 Remember, no aromatic candles should
be used because of nearby oxygen
outlets.
SPIRITUALITY
 For many women, prayer may be the first
measure they use to relieve a stress they
are facing.
 Provide uninterrupted time as needed.
 Women may bring helpful worship objects
such as a Bible or Qur’an into their
birthing setting to use during prayer.
 Remember, these are sacred objects; be
careful when changing sheets that you do
not accidentally throw such important
objects away or let them fall to the floor.
HERBAL PREPARATIONS
 Several herbal preparations have
traditionally been used to reduce pain
with dysmenorrhea or labor, although
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Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #18 Student Activity Sheet
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_______
Date:
________________
phrase such as the new baby’s name
during contractions, all of which help
prevent her from concentrating on the
pain of contractions.
 If a woman has never used these
techniques before, she may question how
effective they are.
 Urge her to try one of them at least for a
few contractions before she dismisses
them entirely, as evidence supports their
efficacy
 Do not ask questions or talk while a
woman is using focusing, imagery, or
chanting because that is apt to break her
concentration and let the sensation of
pain break through.
BREATHING TECHNIQUES
 Breathing patterns are taught in most
preparation for childbirth classes and are
well documented to decrease pain in
labor
 They are largely distraction techniques
because a woman concentrating on slow-
paced breathing cannot concentrate on
pain.
 Breathing strategies can be taught to a
woman in labor if she is not familiar with
their advantages before labor.
 Stay with her until she appreciates how
useful slow-paced breathing can be and
feels comfortable using this technique
independently.
AROMATHERAPY AND ESSENTIAL OILS
 Aromatherapy is the use of aromatic oils
to complement emotional and physical
well-being.

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there is little evidence-based support for
their effectiveness.
 Examples include chamomile tea for its
relaxing properties; raspberry leaf tea
(women freeze it into ice cubes to suck
on), which is thought to strengthen
uterine contractions; skullcap; and catnip,
which are thought to help with pain.
 Black cohosh (squawroot), an herb that
induces uterine contractions, is not
recommended because of the risk of
acute toxic effects such as
cerebrovascular accident to the mother or
fetus
HEAT OR COLD APPLICATION
 The application of heat and cold has
always been used for pain relief after
injuries such as minor burns or strained
muscles.
 It is only lately that their use has been
investigated as effective ways to help
relieve the pain of labor.
 Women who are having back pain may
find the application of heat to the lower
back by a heating pad, instant hot pack,
or warm moist compress extremely
comforting.
 Heat applied to the perineum is proven to
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Care of Mother and Child At-Risk or
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Module #18 Student Activity Sheet
Class number:
_______
Date:
________________
 Their use is based on the principle that
the sense of smell plays a significant role
in overall health. When an essential oil is
inhaled, its molecules are transported via
the olfactory system to the limbic system
in the brain.
 The brain then responds to particular
aromas with emotional responses such
as relaxation.
 These oils should not be applied directly
to the skin to avoid irritation but are used
in a mister so they are inhaled and then
carried throughout the body.
 The oils may be able to penetrate cell
walls and transport nutrients or oxygen to
the inside of cells. The effects of
aromatherapy can range from reducing
postcesarean incisional pain to reducing
anxiety in the first stage of labor
 The evidence regarding the efficacy of
aromatherapy continues to be studied
with mixed results.
BATHING OR HYDROTHERAPY
 Standing under a warm shower or
soaking in a tub of warm water, jet
hydrotherapy tub, or whirlpool is another
way to apply heat to help reduce the pain
of labor.
 The temperature of water used should be
37°C to prevent hyperthermia of the
woman and also the newborn at birth.
 Remind women that plastic or porcelain
tubs are slippery, so they should ask for
help stepping into and out of them.
Do not leave women unsupervised in a
tub as they could slip and have difficulty

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Section: ____________ Schedule:
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provide the dual benefits of soothing and
softening the perineum and decreasing
the risk of perineal tears.
 Caution women if they are going to heat
pads in a microwave to test the
temperature of the pad on the forearm
before applying it to their perineum.
 Pressure anesthesia (pressure to an area
of the body that interferes with pain
receptors) can dull sensation and, with an
overheated pack, patients could sustain a
perineal burn without realizing it.
 Women who become warm from the
exertion of labor find a cool washcloth to
the forehead, chest, or back of the neck
comforting. Sucking on ice chips to
relieve mouth dryness is also refreshing.
 Immediately following birth, an ice pack
applied to the perineum feels soothing,
and it helps reduce edema and swelling.
 Cultural differences exist with preference
to heat and cold.
 This may be evident in dietary choices or
compress application.
 It is imperative that nurses to provide care
that is culturally competent and respectful
of the practices of their patients.
THERAPEUTIC TOUCH AND MASSAGE
 In a classic work, Krieger (1990) defined
therapeutic touch as the laying on of
hands to redirect energy fields that lead
to pain.
 It is based on the concept that everyone’s
body contains energy fields that, when
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Care of Mother and Child At-Risk or
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Module #18 Student Activity Sheet
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_______
Date:
________________
getting their head above water.
 A support person can join the woman in a
tub or shower if she wishes and can
continue with back massage or other
measures she finds soothing.
 Timing of contractions, auscultation of
fetal heart rate, and vaginal examinations
can all be done without the woman
needing to leave the water.
 The birth environment, including the use
of hydrotherapy in labor, can help support
physiologic birth.
 Remind women that plastic or porcelain
tubs are slippery, so they should ask for
help stepping into and out of them.
 Do not leave women unsupervised in a
tub as they could slip and have difficulty
getting their head above water.
 A support person can join the woman in a
tub or shower if she wishes and can
continue with back massage or other
measures she finds soothing.
 Timing of contractions, auscultation of
fetal heart rate, and vaginal examinations
can all be done without the woman
needing to leave the water.
 The birth environment, including the use
of hydrotherapy in labor, can help support
physiologic birth.
YOGA AND MEDITATION
 Yoga, a term derived from the Sanskrit
word for “union,” describes a series of
exercises that were originally designed to
bring people closer to a divine power.
 It offers a significant variety of proven
health benefits, including increasing the

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plentiful, lead to health or, when in low
supply, result in illness.
 Effleurage, the technique of gentle
abdominal massage often taught with
Lamaze in preparation for childbirth
classes is a classic example of
therapeutic touch.
 Reiki can also promote healing.
 The term Reiki consists of two Japanese
words: rei, which means “God’s wisdom
or the higher power,” and ki, which means
“life force energy.”
 So Reiki is actually “spiritually guided life
force energy.”
 The technique includes “laying on of
hands” and is based on the theory that an
unseen “life force energy” flows through
us and is what causes us to be alive.
 If one’s life force energy is low, then a
person is more likely to get sick or feel
stress.
 If it is high, a person is more capable of
being happy and healthy.
 Although the effectiveness of therapeutic
touch is not well documented, both touch
and massage probably work to relieve
pain by increasing the release of
endorphins.
 Both techniques may also work because
they serve as forms of distraction.
 Many women find massage, especially of
the lower back or feet, helpful in the first
and second stages of labor.
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Care of Mother and Child At-Risk or
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Module #18 Student Activity Sheet
Class number:
_______
Date:
________________
efficiency of the heart, slowing the
respiratory rate, improving fitness,
lowering blood pressure, promoting
relaxation, reducing stress, and allaying
anxiety.
 Exercises consist of deep breathing
exercises, body postures to stretch and
strengthen muscles, and meditation to
focus the mind and relax the body.
 It may be helpful in reducing the pain of
labor through its ability to relax the body
and possibly through the release of
endorphins.
 Mothers who engage in yoga prenatally
have been shown to have a greater
sense of self-efficacy and may
experience fewer episodes of antenatal
depression.
 Meditation is a self-directed practice for
relaxing the body and calming the mind.
 Mindfulness-based stress reduction
(MBSR), an 8-week intervention program
developed by Dr. John Kabat Zinn for
patients dealing with issues of chronic
pain, is based on the cultivation of
intentional awareness of experiences in
the present moment.
 Transcendental meditation (TM) is a
simple, natural, and effortless activity
done while resting comfortably with the
eyes closed. Using one of these
techniques, an individual experiences a
state of deep rest that can change
physical and emotional responses to
stress.
 Women can meditate in any position.

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REFLEXOLOGY
 Reflexology is the practice of stimulating
the hands, feet, and ears as a form of
therapy.
 Professional reflexologists apply pressure
to specific areas of the hands, feet, and
ears to alleviate common ailments such
as headache, back pain, sinus colds, and
stress.
 The theory behind reflexology holds that
the body is divided into 10 zones that run
in longitudinal lines from the top of the
head to the tips of the toes.
 Each of the body’s organs and glands is
linked to corresponding areas of the
hands and feet.
 Application of pressure to a specific area
aims to restore energy to the body and
improve the overall condition.
 The point that corresponds to the uterus
is located on the inside ankle about
halfway between the ankle bone
(malleolus) and the heel.
 Massaging this area is believed to begin
labor or hurry labor, thus creating less
pain.
BIOFEEDBACK
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Care of Mother and Child At-Risk or
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Module #18 Student Activity Sheet
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Date:
________________
 Do not interrupt a woman using
meditation as a pain relief technique if at
all possible in order to not break her
concentration.
HYPNOSIS
 Hypnosis is yet another method that can
be used for pain relief in labor.
 A woman who wants to use this modality
needs to meet with her hypnotherapist
during pregnancy.
 At these visits, she is evaluated for and
conditioned for susceptibility to hypnotic
suggestion.
 Close to her last weeks of pregnancy, she
is given a posthypnotic suggestion that
she will experience a reduction in or
absence of pain during labor.
 Fully awake and able to participate in
labor, the woman who is susceptible to
hypnotic suggestion may find this may
provide a very satisfactory and drug-free
method of pain relief
 A woman who wants to use this system
but began labor before the posthypnotic
suggestion was given may be very
disappointed to find herself in labor
without the help she envisioned.
 Some hypnotists may visit during labor or
supply the suggestion over the telephone
so a woman can still use the method.
 Further research is needed to determine
the effectiveness of the effects of
hypnosis on pain relief in labor
TRANSCUTANEOUS NERVE

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 Biofeedback is based on the belief that
people have control and can regulate
internal events such as heart rate and
pain responses.
 Women who are interested in using
biofeedback for pain relief in labor must
attend several sessions during pregnancy
to condition themselves to regulate their
pain response.
 During these sessions, a biofeedback
apparatus is used to measure muscle
tone or the woman’s ability to relax.
 Evidence is continuing to emerge that
shows biofeedback is an effective method
for reducing the pain of labor
INTRACUTANEOUS NERVE STIMULATION(INS)
 Intracutaneous nerve stimulation (INS) is a technique of counterirritation involving the
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Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #18 Student Activity Sheet
Class number:
_______
Date:
________________
STIMULATION(TENS)
 Transcutaneous electrical nerve
stimulation (TENS) works to relieve pain
by applying counterirritation to
nociceptors.
 When two pairs of electrodes are
attached to a woman’s back to coincide
with the T10 through L1 nerve pathways,
low-intensity electrical stimulation is given
continuously or is applied by the woman
herself as a contraction begins.
 This stimulation blocks the afferent fibers,
preventing pain from traveling to the
spinal cord synapses from the uterus.
 As labor and descent progress, the
electrodes are moved to stimulate the S2
through S4 level. High-intensity
stimulation is generally needed to control
the pain at this stage.
 TENS can be as effective as epidural
anesthesia for pain relief in labor,
although some women object to being
“tied down” to the equipment.
 Women with extreme back pain may
benefit most from a TENS unit because
this type of pain is difficult to relieve with
controlled breathing exercises.
 This method may not only reduce the
need for epidural anesthesia but also
postpone the use of pharmacologic
agents
 TENS is further discussed in as it applies
to postoperative pain of a cesarean birth.
 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #18 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

intradermal injection of sterile water or saline along the borders of the sacrum to relieve low
back pain during labor.
 Although some women find the technique helpful, there is little evidence as to its
effectiveness; other women prefer to bear back pain or relieve it by massage rather than
submit to injections.
ACUPUNCTURES ACUPRESSURE
 Acupuncture is based on the concept that  Acupressure is the application of
illness results from an imbalance of pressure or massage at these same
energy. points.
 To correct the imbalance, needles are  It seems to be most effective for low back
inserted into the skin at designated pain.
susceptible body points (tsubos) located  A common point used for women in labor
along meridians that course throughout is Co4 (Hoku or Hegu point), which is
the body to supply the organs of the body located between the first finger and
with energy. thumb on the back of the hand.
 Activation of these points (which are not  Women may report their contractions feel
necessarily near the affected organ) lighter when a support person holds and
results in a release of endorphins, which squeezes their hand because the support
makes this system helpful, especially in person is accidentally triggering this point.
the first stage of labor.  Acupressure can reduce maternal anxiety
 Acupuncture may also decrease the as well as the length of labor when
duration of labor specific pressure points are used

Check for Understanding

You will answer these questions below and it will be recorded as your quiz.

1. Marissa a laboring woman becomes anxious during the transition phase of the first stage of labor
and develops a rapid and deep respiratory pattern. She complains of feeling dizzy and light-headed.
The nurse's immediate response would be to:
A. encourage the woman to breathe more slowly.
B. help the woman breathe into a paper bag.
C. turn the woman on her side.
D. administer a sedative.

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 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #18 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

2. Reychel is experiencing back labor and complains of constant, intense pain in her lower back. An
effective relief measure is to use:
A. counterpressure against the sacrum.
B. pant-blow (breaths and puffs) breathing techniques.
C. effleurage.
D. biofeedback.

3. Nurses should be aware of the difference experience can make in labor pain, such as:
A. sensory pain for nulliparous women often is greater than for multiparous women during early labor.
B. affective pain for nulliparous women usually is less than for multiparous women throughout the first stage of
labor.
C. women with a history of substance abuse experience more pain during labor.
D. multiparous women have more fatigue from labor and therefore experience more pain.

4. With regard to what might be called the tactile approaches to comfort management, nurses should
be aware that:
A. either hot or cold applications may provide relief, but they should never be used together in the same
treatment.
B. acupuncture can be performed by a skilled nurse with just a little training.
C. hand and foot massage may be especially relaxing in advanced labor when a woman's tolerance for touch
is limited.
D. therapeutic touch (TT) uses handheld electronic stimulators that produce sympathetic vibrations.

5. It is based on the belief that people have control and can regulate internal events such as heart rate
and pain responses:
A. Acupuncture
B. Acupressure
C. Biofeedback
D. Intracutaneous Nerve Stimulation

6. It the application of pressure or massage at these same points and it is the most effective for low
back pain:
A. Acupuncture
B. Acupressure
C. Biofeedback
D. Intracutaneous Nerve Stimulation

7. It is based on the concept that illness results from an imbalance of energy and to correct the imbalance,
needles are inserted into the skin at designated susceptible body points (tsubos) located along meridians that
course throughout the body to supply the organs of the body with energy:

This document is the property of PHINMA EDUCATION

 Care of Mother and Child At-Risk or
with Problems (Acute and Chronic)-RLE
Module #18 Student Activity Sheet

Name: Class number:

_________________________________________________________________ _______

Section: ____________ Schedule: Date:

________________________________________ ________________

A. Acupuncture
B. Acupressure
C. Biofeedback
D. Intracutaneous Nerve Stimulation

8. Mia Thermopolis is having labor and she was instructed by the Nurse-Midwife to stand under a warm
shower or soaking in a tub of warm water, jet hydrotherapy tub, or whirlpool is another way to apply
heat to help reduce the pain of labor: You as a Student Nurse knows that this is:
A. Yoga and Meditation
B. Application of Heat and Cold
C. Therapeutic Touch and Massage
D. Hydrotherapy

9. It offers a significant variety of proven health benefits, including increasing the efficiency of the
heart, slowing the respiratory rate, improving fitness, lowering blood pressure, promoting relaxation,
reducing stress, and allaying anxiety
A. Yoga and Meditation
B. Application of Heat and Cold
C. Therapeutic Touch and Massage
D. Hydrotherapy

10. It is based on the concept that everyone’s body contains energy fields that, when plentiful, lead to
health or, when in low supply, result in illness:
A. Yoga and Meditation
B. Application of Heat and Cold
C. Therapeutic Touch and Massage
D. Hydrotherapy

C. LESSON WRAP-UP
AL Strategy: Minute Paper
1. Please prepare a question or write a question in an index cards or half-sheets of paper to write
feedback to the following questions:
a. What was the most useful or the most meaningful thing you have learned this session?
b. What question(s) do you have as we end this session?

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