Implications for Midwifery Practice

Introduction

Non-pharmacological pain management strategies for labour (Sanders and Lamb, 2017) was the article, that I chose to discuss because recently many women are using holistic approaches for pain management. Midwives, who work in hospitals, support different women through the pain of labour each day, and midwives, who work in the community, work with multiple women each day to prepare them with pain management options antenatally. Therefore, I believe that, doing further research into non-pharmaceutical forms of pain relief and the physiology of pain in labour, would really help me in my future career as a midwife. If I have a clear understanding, I will be able to better advise and support women to their individual needs and preferences by using up to date evidence-based knowledge. From the research, I hope I would be able to gain women's trust, by guiding them and supporting them during their time of labour; which can be quite scary for women. I would like to be able to let a woman feeling empowered after labour by guiding her through various techniques and supporting her, so she knows that she’s in control.

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Summary of the article

This article (author year) explores several different holistic methods of pain relief for women to use during labour. It aims to educate midwives, so they are able to inform the pregnant woman about the different techniques. Some of the methods that are explored that include; water immersion, complementary and alternative medicines or therapies (CAMs), relaxation, aromatherapy, acupressure, massage and transcutaneous electrical nerve stimulation (TENS).

The article starts by defining the physiology of pain during labour. It explains the importance of the woman being informed of what it is and ways to manage it antenatally. The authors also add that, women experience pain differently, and women embrace the pain finding it empowering and tend to have a smoother labour.

The authors give a brief overview on the significance of different hormones used during the childbirth. They focus on the hormones that are produced when the women are in fear and when relaxed. All the techniques discussed, promote the production of hormones that makes the woman feel safe, relaxed and empowered. They also explain that, the price of non-pharmaceutical medicine is cheaper than pharmacological medicine.

Non-Pharmacological forms of pain relief can help in different ways, and Sanders and Lamb cover multiple ways that are becoming increasingly popular. Below are the different types of pain relief that is covered in the article;

Water

Water can be used in many ways and have multiple benefits. The benefits of using water can include; enhancing physiological birth, reducing the use of pharmaceutical forms of pain relief in labour, which has shown to lead to enhancing maternal feelings of empowerment and in turn supports midwifery practice of normality. It is nationally recommended that low risk women birth in water (Sanders and Lamb, 2017). A great alternative for women, that don’t want to use a birthing pool, is warm showers, as it can help manage discomfort, which works by the temperature of the water acting on the nerve receptors. It’s a great tool as it is easy to use, cost effective, keeps the labouring woman mobile and even her birthing partner can have an active role in supporting her.

Complementary and alternative medicines or therapies

Complementary and alternative medicine can include anything that is outside of your traditional healthcare use. The authors (2017) stresses the importance of midwives being able to support women with their pain management choices, although the guidance advises midwives not to offer or recommend certain therapies for pain relief in the latent stage of labour. If the women would like to use these tools during the latent stage of labour, they should be fully supported by her midwife.

Relaxation and visualisation

Relaxation and visualisation can include; general relaxation and breathing techniques, hypnosis and hypnobirthing, meditation, visualisation and movement. It is the role of the midwife to advise women about the benefits of these techniques and how they can decrease pain in the latent phase of labour. Relaxation and visualisation techniques can be used throughout labour, as it can prevent the labouring woman from looking for other means of managing the pain. Relaxation is known to be associated with a reduction of pain intensity in the early and active stages of labour. Also, anxiety and fear cause an increase in pain due to the labouring women muscle tension.

Relaxation and breathing techniques, if well used, can keep the woman fear free, which can prevent the production of catecholamines, cortisol and vasopressin. These hormones disrupt the production of oxytocin, which is an important hormone as it stimulates Uterine contractions.

In order to use these techniques successfully, midwives should share all the information antenatally. If the women are aware antenatally about the pain and how the pain is helping with the progression of her labour, women will be more accepting of the pain and remain fully aware.

Homeopathy

According to Sanders and Lamb homeopathy is the use of remedies created from herbs and minerals, and they are used to help the body to achieve equilibrium (2017). The use of homeopathy in the intrapartum stage is dependent on the psychological and physiological condition of the women. Some of the benefits include; physiological balance and function, soothing and relaxing the women.

Although there isn’t much evidence to support this technique in the intrapartum stage, women still have reported finding it useful.

Aromatherapy

Aromatherapy is very similar to homeopathy, except it’s the use of essential oils derived from plants to enhance the body’s sedative, stimulate and relaxing properties. This is a good tool to utilise, as it can be used in a bath, or for massage which can be especially beneficial in the latent or early stages of labour.

Aromatherapy is very versatile as different oils have different uses. The different oils can be used for relaxation, pain reduction, uterine activity, to reduce anxiety etc. This technique should not be offered by midwives, but if a woman is keen to try this technique, it should be fully supported by the midwife, as aromatherapy oils are thought to be harmless, with a possibility it may cause skin irritation, so patch testing prior is advised.

Acupressure & Reflexology

Acupressure is a well-known Chinese medicine, known to treat illness and ease pain by stimulating acupuncture points.

Reflexology is a technique based on stimulating zones and reflex areas on the feet. This technique is based on the notion that zones and reflex areas on the feet connect to different parts of the body. Stimulation and gentle manipulation have been known to soothe pain and initiate relaxation, reduction in fear and improve circulation.

Although this technique is low cost and non-intrusive there are some concerns around the safety, and midwives need to be fully trained in order to use such techniques on the women.

Massage is a therapy that manipulates the bodies soft tissue and can be really useful during the early stages of labour. Depending on the areas manipulated and the women, benefits can include; pain relief, stress reduction and anxiety and increase relaxation. According to the article, research suggests that massage during labour can reduce the use or pharmacological forms of pain medication. and a shorter labour.

In addition to the author highlighting the benefits of non-pharmaceutical forms of pain relief they discuss that it is a part of the midwife’s role to inform the woman and support her with whichever decision she makes. Sanders and Lamb (2017) stated that, if women are supported, encouraged and informed about the forms of pain relief by their midwife during the antenatal period, they are more likely to achieve a good childbirth experience. Also, as more women are increasingly using non-pharmaceutical medicines, it is important that midwives stay up to date.

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Relevance to my future role

The number of women turning away from pharmaceutical pain relief is increasing. Sanders and Lamb (2017) cover a wide range of natural techniques, that midwives can use to improve their knowledge and skills to support their women to the best of their ability. According to Macdonald et al. (2017A), Midwifery is a career of lifelong learning; which means the learning process doesn’t necessarily stop once qualified. The Nursing and Midwifery Council (NMC) (2015) has put steps in place to facilitate lifelong learning, for example midwives are required to keep a portfolio which has now been developed further to Revalidation. Revalidation has to be completed with a manager every three years to enable a midwife to remain registered (NMC, 2017). There is also ‘The continuing professional development plan’s (CPD), which will benefit my role as a midwife because Midwifery is always adapting with the times enabling us to provide the best evidence supported care to all the women.

Going into a career of Midwifery, it is important to know the physiology of pain during labour (Saunders and Lamb, 2017) and to prepare the women for this antenatally. As all women are entitled to their own personalised care (NMC, 2018), it is beneficial to have a broad knowledge of the non-pharmacological pain management methods. Furthermore, its popularity is increasing with the majority of women now wanting to experience labour without pharmacological pain relief (Snow et al, 2016). Each woman has a preference as to what kind of support they would like when in labour. The Nursing and Midwifery Council (2018) state that midwives should not make assumptions about a woman's choice and should take into consideration diversity, and a person's individual differences and preferences. The authors (author year) discuss that labour pains can also differ depending on several factors; psychological, physiological and cultural perspectives. From further research into this area, it has given me a better understanding of what personalised care is and this will help me when in practice as it will enable me to treat each woman as an individual and give the best personalised care I can so that it can meet the needs and preferences of the women. The importance of listening to the women and responding to their individual preferences and concerns (NMC, 2018) is vital to us for supporting them. The author emphasises throughout the article (author year) that the role of a midwife is to support the women and improve the women's overall labour experience.

According to ‘The Cochrane Database of Systematic reviews’ (2003) women are more likely to have a smoother spontaneous vaginal delivery with no assistance from pharmaceutical pain relief or instruments if she has continuous support throughout her labour from someone close to her. The article (author year) states that midwives should be encouraging women to express their concerns antenatally so that the midwife can give the best care to both the woman and partner. This is very important to take on board for my future career as a midwife because we will be caring for woman regularly. Unfortunately, not all women are able to have a birthing partner so Macdonald et al. (2017C) stated that, in order to form good relationships; trust, respect and communication, improved empathy is required. In the case, a woman doesn’t have a birth partner, it’s even more important that, this relationship is formed between the woman and the midwife as women tend to feel very vulnerable during labour. Women report their views of the characteristics of a good midwife which include but not limited to; being respectful, provide support and companionship, good communicators, it can also create rapport and establish a more social relationship (Macdonald et al, 2017C).

Sanders & Lamb (2017) mentioned that, a key benefit of women experiencing labour without pharmaceutical pain relief is, women tend to leave the hospital feeling empowered and in control. Macdonald et al (2017B) stated that, there is a connection between a women’s sense of control and positive labour experience. Macdonald et al (2017C) also added that, the Midwives can accommodate a woman’s sense of control in any setting, by keeping the woman well informed and involved in her decision making. As a student of midwife, I believe that, this will be crucial and will consider this when qualified.

The article also mentions various different kinds of non-pharmaceutical forms of pain relief. Water immersion was one of the techniques used to ease the pain during lab labour. Tournaire & Theau-Yonneau (2007) found that, the women reported pain relief, increased levels of satisfaction and self-esteem after giving birth in water. The authors also opined that, statistically there was a significant reduction in the use of analgesia among the women in the study who had a water birth. As a student of midwife, it is important to know the benefits, and the criteria the women need to meet in order to have a safe water birth. In the NHS, women, who are considered ‘low risk’, are offered the pool. Although hydrotherapy has lots of potential benefits, women need to be fit enough to be able to birth safely.

Before reading this article, I was unaware of how the use of holistic medicine has

increased and how they work. Now I gather more knowledge as it has prompted me to do further research into different methods so that I can provide extra support and

information to the women. This is supported in the NMC (2018) code that healthcare

professionals should be able to recognise and work within the limits of their competence (2018). Going forward I will make sure that I stay current with evidence-based research and relay the knowledge I gain to the women and partner antenatally (or as needed) in a non-biased way. She can then make decisions that are best suited to her. Even if the woman is sceptical about the idea of natural forms of pain relief, studies have shown that woman's outlook after trying it, can change them into believers (Finlayson. K, et al. 2015).

Conclusion

Sanders and Lamb (2017) emphasised the benefits of more natural forms of pain relief, the importance of individualised care that midwives provide to the women and their birthing partner, and, the importance of understanding the physiology of pain during labour, so that the midwives can support and explain to women about what is happening through the labour. After doing some further research, I can conclude that, women take a more natural approach to labour, tend to have a smoother vaginal delivery and end up feeling empowered and happy about their labour experience. Holistic forms of pain relief are an area, in which I am very passionate about and now I have a clearer understanding about natural ways of managing the pain that comes with labour. This article covers some key areas in midwifery, which I will come across every day in my future career as a midwife; physiology of pain in labour, natural forms of pain relief and the role of a midwife.

References

Finlayson K, Downe S, Hinder S, Carr H, Spiby H, & Whorwell P (2015) ‘Unexpected

consequences: women’s experiences of a self-hypnosis intervention to help with pain relief

during labour’ BMC Pregnancy and Childbirth, BMC Pregnancy and Childcare, Accessed on 15/04/2019, 15(229).

Hodnett E D, Gates S, Hofmeyr G J, Sakala C (2003) ‘Continuous support for women during childbirth’ The Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003766. Url: 10.1002/14651858.CD003766. Last accessed: 23/05/19.

Macdonald S, Johnson G & Warwick C (2017A) ‘Mayes’ Midwifery' pp. 85-86, 15TH edition, Elsevier Ltd, UK.

Macdonald S, Johnson G & Warwick C (2017B) ‘Mayes’ Midwifery' pp.189, 15TH edition, Elsevier Ltd, UK.

Macdonald S, Johnson G & Warwick C (2017C) ‘Mayes’ Midwifery' pp. 194-197, 15TH edition, Elsevier Ltd, UK.

Tournaire M, & Theau-Yonneau A (2007) ‘Complementary and Alternative Approaches to Pain Relief During Labor’ US National Library of Medicine,

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