CHAPTER 8
Complementary Therapies
for Labour
Labour is a time when women benefit enormously from human touch, emotional support and other strategies that can help to relax them. A sense of relaxation reduces stress hormones, particularly cortisol, and enables labour hormones, notably oxytocin, to work efficiently. More than at any other time in the childbearing year, complementary therapies can be invaluable tools to help women through their labours. However, women are sometimes so keen to expedite labour that they self-administer natural remedies and apply pressure point techniques inappropriately.
This chapter explores the complementary options for preparing for birth, therapies for pain relief and alternative means of aiding progress in labour, including discussion on the following aspects:
• introduction
• preparation for birth
• pain relief in labour
• progress in labour
• retained placenta
• combining complementary therapies for labour care
• conclusion.
Introduction
Most women spend time during their pregnancies exploring options for the birth, including seeking out antenatal classes and considering ways in which they can prepare their bodies for labour. This appears to be a universal activity amongst women of all races and cultures as they turn inward-looking and concentrate on their ultimate function as a woman.
Many women actively seek out independent complementary practi-tioners for treatment of specific antenatal conditions such as backache or sickness, or for general relaxation, particularly as they near term. Group sessions such as “hypnobirthing” to help women prepare mentally and emotionally for labour, are now commonly offered, both in the conventional maternity services and by private practitioners. Exercise classes, including water-based sessions, Pilates, yoga or mindfulness training, are also popular. As labour approaches, women start to explore ways to ease the anticipated pain, and it is known that women who are relaxed as they approach term will be likely to experience less pain during the labour. Many want to avoid unnecessary interventions such as induction of labour and search for natural ways of starting labour, as well as exploring their options for after the birth, including healing the perineum in the event of stitches and establishing breastfeeding.
In years gone by, women may not have worked, or were able to stop working in the early third trimester. Decades ago, women were content to defer to the decisions of midwives and doctors but are now prepared to challenge professional expertise in order to achieve the birth they want. Some women even choose actively to decline professional help and opt for unassisted or “free-birthing”. However, the plethora of information now available to pregnant women, from other mothers, in magazines, on pregnancy Internet websites and particularly on social media, has contributed to an overload of information, much of which is either incorrect or incomplete. Nowhere is this more true than with the huge subject of complementary therapies and natural remedies for childbirth. The sheer extent of the information available can be confusing for women and sometimes dangerously misinterpreted. It also potentially causes conflict and concern for midwives when women wish to use selected remedies or complementary techniques, particularly in conjunction with conventional drugs.
Midwives enjoy being able to be “with woman”, returning to the nurturing which is so much a part of supporting a woman during arguably the most significant time in their lives. This generates an attitude which embraces the physical, emotional and spiritual aspects of birth, and has been shown, in units where complementary therapies are provided by midwives, to increase midwifery recruitment and retention (Burns et al. 2000). It is also well known that the support of a doula or birth companion contributes to a more relaxed mother and improved outcomes (Kozhimannil et al. 2013). Indeed, a study by Akbarzadeh et al. (2015) showed that doula care, combined with the application of a single acupressure point, significantly reduced maternal anxiety and duration of labour. The team also surmised that doula support and acupressure facilitated improved fetal oxygenation.
Incorporating complementary therapies into midwifery practice does not have to mean increasing the workload; indeed, it may actually reduce it if women achieve a normal labour without induction, epidural anaesthesia or Caesarean section, which also, of course, saves money (Donnelly 2016). Midwives integrating complementary therapies into their care learn how to use their time differently to engender a greater sense of satisfaction in both the women for whom they care and for themselves. Also, since so many women are now interested in complementary therapies and natural remedies in labour, offering them as part of normal maternity care fosters a greater attention to safe and appropriate use. When these “alternatives” become complementary to conventional labour care, midwives are better able to determine how they interact with mainstream medications and procedures, and to take any necessary steps to minimise risk. Midwives and doulas need to be able to advise women on appropriate ways of preparing for birth and to offer intrapartum care that includes basic complementary therapy strategies that enhance the overall experience of the mother. From a cost-saving perspective, the difference in cost between a normal birth and a Caesarean in the UK is over £1700; reducing the Caesarean section rate within a 6000-birth maternity unit from 25 per cent to 20 per cent could save 300 operative deliveries at an annual cost of over £510,000.
When searching the literature for research evidence, it can be difficult to separate studies on birth preparation, pain relief and the onset and progress of labour since the three aspects are so closely intertwined. Women who are well prepared, physically and mentally, for labour may have a different perception of the pain and discomfort caused by the uterine contractions, with lower stress levels and improved oxytocin levels. It will therefore be seen from the following discussion that many studies measure both pain – or a reduction in the need for conventional analgesia – and progress in labour – or the reduced use of oxytocics to augment contractions.
Preparation for birth
Antenatal classes
The provision of antenatal classes to prepare women and their partners for birth and parenthood has hitherto been part of mainstream maternity services in the UK. The original intention of “parentcraft classes” which commenced in the 1960s was to introduce the women to the place where they would give birth, to provide suggestions to help them prepare for labour and motherhood and to offer the opportunity for a regular “relaxation and breathing” session that introduced techniques for use in the first stage. The emphasis was on physical preparation of the mother’s body to cope with the physical demands of labour. Nowadays there is greater acknowledgement of the psycho-emotional aspects of pregnancy, birth and early parenthood, and birth preparation needs to encompass this as well as preparation of the body.
Unfortunately, contemporary service demands and staff and financial shortages have impacted gravely on the provision of antenatal classes and often focus solely on preparation for the birth, with emphasis on physiology, pain relief and the environment. Many maternity units limit the number of sessions which are usually over-subscribed, and there is little individualisation (Gavin-Jones 2016). Sadly, even the traditional labour ward visit has commonly been replaced by an online “virtual tour” which may suit some women but limits the opportunities for others to obtain answers to their myriad questions about labour. Indeed, it could be argued that, for those women with acute fear of birth or hospitals, online viewing of the environment in which most will give birth could exacerbate their anxieties. Conversely, accessibility to online information (however correct or otherwise) enables women to investigate topics of interest to them and to ignore those about which they already have an understanding or which are not relevant to them.
Many women now choose alternative types of group activities, which provide them with opportunities to meet other like-minded women/couples and to develop relationships which often last many years. It is possible that antenatal education will be removed completely from the mainstream maternity services and become an independent service which offers women a variety of options. Young (2008) found that women desire a range of classes with some being available earlier in pregnancy, as well as after delivery in the form of “birth after-thoughts” sessions. Classes need to be offered in a variety of settings, including the workplace, so that those who continue working for most of the pregnancy have an opportunity to attend. Classes for women with or without their partners should be available, and for specialist client groups, for example teenagers, women whose first language is not English or those with particular needs such as women expecting more than one baby.
In Australia, Levett et al. (2016a) developed a programme of antenatal classes in which couples were taught how to use massage, simple acupressure techniques, breathing, yoga positions and visualisation. This “Complementary Therapies for Labour and Birth” study demonstrated that women and their partners appreciated the opportunity to learn various coping strategies and enhanced their knowledge and understanding of normal birth. The team concluded that new ways of offering antenatal classes could incorporate some of these techniques and could potentially revolutionise current preparation for birth education.
“Hypnobirthing”
“Hypnobirthing” is one of the most popular forms of group activity in which pregnant women engage, and has enjoyed a real growth since the Duchess of Cambridge effectively gave it royal patronage. “Hypnobirthing” is not, in itself, a complementary therapy but a guided form of deep relaxation using some of the principles of hypnosis, but it differs considerably from clinical hypnotherapy. See Chapter 2 for information on the differences between hypnotherapy and “hypnobirthing”.
Antenatal “hypnobirthing” is often described as a calm, focused state of consciousness similar to day-dreaming, with the aim of reducing stress hormones. It also provides a group environment in which women can practise relaxation techniques and which equips them to use them during labour to ease pain. In some respects, “hypnobirthing” is similar to the relaxation sessions included in the original parentcraft classes of the 1960s and 1970s, although additional visualisations are generally included now, with less overt muscle relaxation techniques. In addition to learning how to induce a sense of deep relaxation, the classes also offer couples an opportunity to learn about birth, with the emphasis on physiological labour.
When compared to contemporary conventional antenatal classes, “hypnobirthing” appears to produce a more positive mental outlook in women and an improved expectation of childbirth (Streibert et al. 2015). An Australian study concluded that the women most likely to use “hypnobirthing”, or self-hypnosis in labour, tend to be those who are familiar with other complementary modalities and who generally opt to give birth in a birthing centre or at home (Steel et al. 2016). Women who practise more, especially in conjunction with their intended birthing companions, generally cope better with labour pain than those who do not practise or who expect only to start self-hypnosis as they approach term. Learning self-hypnosis is useful for women from all types of background, including adolescent mothers, one particular study demonstrating reduced complications and length of in-patient stay in this client group (Martin et al. 2001).
When using “hypnobirthing” during labour, there is often an emphasis on the use of “appropriate” language (as determined by the teacher), with practitioners expected to avoid the use of words such as “pain” and “contraction” (the latter being referred to as “surges”) and on enabling the mother to labour as she wishes without being touched. Using hypnosis principles to encourage women to feel “pressure” instead of “pain” increases their self-confidence in their ability to birth their babies, and is thought to enhance maternal satisfaction and decrease fear (Abbasi et al. 2009). However, this emphasis on the use of “correct” language may, on occasions, cause difficulty for midwives who are unfamiliar with the concepts of “hypnobirthing”, especially when classes are not offered by midwives in the local area. McAllister et al. (2017) surveyed 129 midwives, obstetricians and anaesthetists to determine their knowledge and attitudes to the use of “self-hypnosis” in labour. They found that midwives’ apparent knowledge was higher than doctors’ and that those who would personally use hypnosis in childbirth were both more amenable to and better informed about its use. However, this study failed adequately to differentiate between “hypnobirthing” and true clinical hypnosis and perpetuates the confusion that is rife amongst maternity professionals.
There are, in fact, several different types of what is now generically termed “hypnobirthing”, a word that implies a system specifically aimed at preparing for birth. Most birth preparation methods available in the UK are fairly similar, the names often being commercially trademarked. The Mongan method, devised by the American hypnotherapist Marie Mongan, claims to be the first style to use the term HypnoBirthing™. The Mongan method has, however, been accused of being too rigid in its format and is often adapted by midwives in the UK to make it more appropriate for the culture in which it is used. KG Hypnobirthing is the method adapted by Katharine Graves, another hypnotherapist, and classes for expectant parents also include simple massage techniques for use in labour. Maggie Howell, a hypnotherapist who offers Natal Hypnotherapy classes for birth preparation as well as individualised hypnotherapy sessions for women with particular antenatal problems, uses a flexible individualised approach that is more closely aligned to clinical hypnosis than standardised birth preparation self-hypnosis classes. Most types of “hypnobirthing” aim to relax and calm women, providing “birth affirmations” to be practised during pregnancy and used in labour, as well as encouraging them to develop more confidence in the potential of their bodies to give birth to their babies without perceptions of excessive pain and in as normal a way as possible.
There are still relatively few studies assessing the use of “hypnosis” for labour and childbirth, a strategy which warrants further investigation (Beebe 2014). Most trials evaluate the effects of “hypnobirthing” used in labour by couples who have learned it antenatally, rather than intrapartum clinical hypnosis delivered by a practitioner in which individualised therapeutic cues are used. A systematic review by Madden et al. (2016) found that self-hypnosis may reduce the overall use of inhalational and intramuscular analgesia during labour, although an earlier review (Cyna et al. 2013) disputed this. Furthermore, Werner et al. (2013) and Downe et al. (2015) did not demonstrate any significant difference in the use of epidural anaesthesia between hypnosis and control groups. Conversely, a review of 13 controlled studies by Landolt and Milling (2011) concluded that both self-hypnosis learned during pregnancy, and intrapartum hypnosis guided by a practitioner, was effective in easing labour pain and potentially reduced the length of the first stage and improved infant Apgar scores at birth.
The largest contemporary study into self-hypnosis in pregnancy, the SHIP trial (Downe et al. 2015), aimed to establish the impact of self-hypnosis, taught to groups of primigravidae, on their use of epidural anaesthesia. This randomised controlled study was undertaken across three maternity services in the UK and involved 680 women. Women were self-selected to enter the trial and randomised to either the self-hypnosis or control group in the third trimester. Two 90-minute sessions to teach self-hypnosis to women in the intervention group were undertaken between 32 and 35 weeks gestation and women were then expected to continue at home by listening to an audio self-hypnosis disc. The primary outcome was the use of epidural anaesthesia in labour; other outcome measures included the incidence of hypertension, labour onset, interventions and outcomes, duration of first and second stage labour, Apgar scores, admissions to the neonatal unit, infant feeding method at six weeks postpartum and stillbirths. The study also explored maternal satisfaction with the birth experience and early parenting. A cost analysis was undertaken as well but was not the focus of this paper (Finlayson et al. 2015). Although there was a slight reduction in epidural use in the trial group, this was not statistically significant, neither was there any real difference in secondary clinical outcomes. There was, however, a marked reporting of improved psychological factors, with women identifying a reduction in fear and anxiety in labour compared to that anticipated before labour.
Although the authors acknowledge that other factors could have impacted on this finding, the results are similar to a Danish study by Werner et al. (2013). One of the problems for the SHIP trial (Downe et al. 2015) was that around 10 per cent of the control group reported using self-hypnosis in labour, having been trained to use it outside the trial protocol, a problem encountered by other researchers (Cyna et al. 2013; Werner et al. 2013). Further, only two sessions were allocated to teach women how to trigger the self-hypnotic state, when it is more common to offer a longer course of preparatory sessions.
The Cochrane review (Madden et al. 2016) found no clear evidence that “hypnosis” is significantly better than standard childbirth preparation. It must however be concluded that, when taught antenatally, self-hypnosis is generally appreciated by women and can be effective when used in labour for pain relief (Finlayson et al. 2015). Certainly, there appears to be a greater satisfaction amongst women who use self-hypnosis, with increased relaxation and reduced stress and anxiety (Kenyon 2013). It is empowering for women who can harness a heightened state of relaxation, enabling them to distance themselves mentally from the physiological discomfort of uterine muscular contractions and to focus on the impending birth of the baby.
Mindfulness
Mindfulness training is also gaining in popularity and may be especially useful for women with tocophobia. Mindfulness is a way of processing thoughts so that individuals can see more clearly what is happening in their lives and learn to focus on ways to deal with their pressures. It is a psychological way of learning to live in the moment without regret for the past or worry about the future, and to develop a better understanding of themselves and the ways they cope with stress. It may incorporate breathing, meditation, visualisations and exercise such as yoga or tai chi. Although the neurological effects of mindfulness remains unclear, preliminary results suggest that it may impact on gene expression and reverse the physiological effects of chronic stress (Buric et al. 2017). When set in the context of the client group, mindfulness training can be more effective than applying general principles (Aslami et al. 2017).
It is known that fear of childbirth contributes to greater pain perception (Alehagen, Wijma and Wijma 2001) and increased intervention (Laursen, Johansen and Hedegaard 2009). The pilot Prenatal Education About Reducing Labour Stress (PEARLS) study (Duncan et al. 2017) offered a weekend workshop to primigravidae approaching term and compared the study participants to a control group that received a standard childbirth preparation course. Mindfulness training was designed to address fear and anxiety regarding labour. Women in the trial group required less intrapartum analgesia and improved mental wellbeing and reduced the impact of hormonal changes in the puerperium, with less postnatal depression. Mindfulness may also enhance women’s readiness for birth and motherhood (Korukcu and Kukulu 2017).
EMDR
A single-blinded study currently in progress in the Netherlands at the time of writing, the OptiMUM study (Baas et al. 2017), aims to address tocophobia amongst women with post-traumatic stress following a previous delivery, using eye movement desensitisation and reprocessing (EMDR). EMDR was developed in the 1980s by the psychologist Shapiro, who recognised that eye movements can reduce the intensity of traumatic thoughts. He began to treat victims of trauma with a system which appears to change the way the brain processes information. The therapy is designed to release the images, sounds and feelings from previous traumatic events so that normal brain processing is resumed and the person can view previous events in a less distressing way; this is similar in principle to mindfulness, although the practice differs. It is thought to be physiologically akin to brain activity during rapid eye movement (REM) sleep and dreaming and may involve changes in noradrenaline (Littel et al. 2017). Most research has focused on post-traumatic stress disorder (Boterhoven de Haan et al. 2017; Mevissen et al. 2017; Moreno-Alcázar et al. 2017; Schäfer et al. 2017), but there is sufficient evidence to apply the findings to fear of birth, especially in women with a previous poor obstetric experience.
Exercise classes
Exercise classes specifically designed for expectant mothers offer an alternative form of group activity with the intention of maintaining health and fitness in preparation for birth. They do not usually incorporate discussion on what actually happens in labour. Pilates and yoga are especially popular. However, the opportunity for women to learn postures, visualisation and breathing techniques in a safe, women-only group allowing for the sharing of worries and experiences can have a profound effect on those who attend (Campbell and Nolan 2016), especially when classes are facilitated by midwives.
Pilates
Pilates has been shown to improve flexibility, potentially aiding pelvic capacity at birth, to ease discomforts such as musculoskeletal issues and to increase maternal self-confidence in birthing and mothering abilities (Uppal et al. 2016). It can also help to strengthen the pelvic floor (Balogh 2005; Gomes et al. 2017; Hagen et al. 2017), although Bø and Herbert (2013) dispute this. Pregnant women who regularly practise Pilates are empowered to take control of their bodies, with reduced stress and increased mindfulness (Caldwell et al. 2013).
Yoga can be pleasurable, providing a supportive environment for women preparing for birth, especially when combined with discussion and storytelling (Doran and Hornibrook 2013). However, the style of yoga should be such that the activity is largely sedentary rather than the excessive exercise of some types, such as “hot” yoga which would raise the woman’s temperature excessively (Peters and Schlaff 2016), although Polis et al. (2015) found no adverse maternal or fetal effects in women who practised Bikram yoga. In general, yoga can have a positive physical and mental effect, reducing stress in pregnancy, which contributes to a positive approach to labour (Kusaka et al. 2016) and may reduce depression in some women (Battle et al. 2015; Davis et al. 2015). Yoga may contribute to decreased interventions, reduce first stage duration and alter women’s perception of pain in labour so that they require less pharmacological pain relief (Jahdi et al. 2017). This may result from a generalised impact on stress and biomarkers such as cortisol, salivary amylase and immunoglobulins (Kusaka et al. 2016).
Sophrology
Sophrology involves learning a combination of dynamic physical and mental exercises that help to relax the body and calm the mind. It is commonly offered to pregnant women in France and Italy and is gradually gaining popularity in the UK. In essence, sophrology is a combination of yoga and other gentle exercise methods, breathing exercises and hypnotic suggestions. Very few research papers could be accessed, although some abstracts of French studies were found postulating that sophrology can ease anxiety and regulate breathing (Besnier 2016; Diehr 2016). A Japanese study of 220 pregnant women who practised sophrology incorporating yoga exercise, deep inspiratory and expiratory breathing, music and guided imagery revealed a reduction in stress biomarkers compared with a control group (Suzuki et al. 2012).
Autogenic training
Autogenic training also focuses on relaxation through the use of suggestions. It is similar to hypnosis and sophrology in its overall concept, but autogenic training is less well known. Autogenic training involves the induction of an altered state of consciousness similar to hypnosis, often incorporating progressive muscle relaxation and guided imagery. Treatment leads to a marked reduction in cortisol levels (Kiba et al. 2017) and may be a mechanism for reducing pain perception (Kanji 2000).
Tai chi
Field et al. (2013) investigated the impact of a 12-week course of combined Tai chi and yoga on a group of women with antenatal depression and achieved good results, but the effect on labour was not specifically elucidated. Tai chi may also positively impact on glucose levels in diabetic women, offering an effective system of pregnancy relaxation (Yamamoto et al. 2016).
Guided imagery
Guided imagery, a form of relaxation that encourages a focus on positive images, has been shown to be effective in reducing antenatal stress in pregnant teenagers (Flynn, Jones and Ausderau 2016), African American women (Jallo et al. 2015) and women at risk of preterm birth (Chuang et al. 2015). A Cochrane review (Marc et al. 2011) found some evidence to demonstrate that mind-body interventions such as autogenic training, biofeedback, hypnotherapy, guided imagery, meditation, prayer, tai chi and yoga may relieve stress and anxiety in late pregnancy, contributing to a more relaxed approach to labour, but there was no significant body of evidence for any one modality.
Antenatal exercises in water
Antenatal exercises in water may improve quality of life during pregnancy (Vallim et al. 2011). Exercising in water reduces the impact on joints and ligaments that can occur during land-based exercise, easing backache and other skeletal problems, while the hydrostatic pressure may ease oedema and enhances respiratory and gastrointestinal functioning (ACPWH 2010). It is important that the water temperature remains between 28 and 32 degrees Celsius. Very little evidence on the use of water-based exercise could be found, but two studies appear to be currently in progress, one at the University of York (Bgeginski et al. 2016) and the other, a more general exercise study, at the University of Swansea (the Exercise in Pregnancy Evaluative Controlled Trial – EXPECT – headed by Professor Lewis1).
In the UK and other developed countries, red raspberry leaf (Rubus idaeus) is probably one of the most commonly used self-help remedies to prepare for childbirth. Some studies have shown that up to 58 per cent of pregnant women use it (Holst, Haavik and Nordeng 2009; Nordeng et al. 2011). However, clinical experience and discussions of this author with numerous midwives and mothers suggest that the number of women in the UK now taking raspberry leaf in pregnancy is considerably higher, although no definitive survey has been conducted in recent years. This prevalence may be due in part to dissemination of consumer information and experience via the Internet, although most of this is insufficient to ensure safe self-administration, and sometimes it is dangerously incorrect.
Raspberry leaf is a traditional herbal remedy that was first recorded as a therapeutic agent in 1597 (Bamford, Percival and Tothill 1970), although some authorities believe it to have been used as early as the 6th century (Nordeng, Saboni and Samuelsen 2014). Raspberry leaf has long been a popular remedy for gynaecological issues such as dysmenorrhoea and menorrhagia and it has a reputation as a versatile herbal medicine for preventing miscarriage or easing pregnancy sickness (under the direction of a qualified medical herbalist) and for facilitating labour and birth. It is said to aid diuresis, enhance the immune system, stimulate bile production and purify the blood, act as an anti-ageing agent (Tito et al. 2015) and, due to its effect on lipid metabolism, may also aid weight loss (Morimoto et al. 2005).
There are several misconceptions about raspberry leaf which need clarifying. This raises the issue of whether midwives and doulas should initiate discussions with women about the use of such a popular herbal remedy. Indeed, the NMC (2009) states that midwives, at the point of registration, should be able to advise on over-the-counter herbal remedies such as raspberry leaf, yet very few students receive adequate information during training to enable them to do this. Lack of professional knowledge thus leads midwives either to decline to advise women on the subject, or to attempt to offer what they believe is correct information, but which is often wrong or, more frequently, incomplete. Given that so many women now choose to take raspberry leaf in the UK, there is an urgent need to ensure that midwives and doulas have sufficient knowledge to help them appropriately.
Many women and maternity caregivers erroneously believe that raspberry leaf is a remedy for starting labour (see Chapter 7), and it is of grave concern that over 50 per cent of midwives may be advising women to use raspberry leaf at term to avoid induction of labour (Mollart et al. 2017). However, it is intended as a preparation for birth to be taken during the third trimester. It is thought to tone smooth muscle, thus having an effect on the myometrium, ostensibly shortening pregnancy and enhancing uterine efficiency so that labour starts spontaneously and progresses normally. However, there is no direct research to support this claim, or the belief that it may also reduce pain in labour. Unless prescribed by a qualified medical herbalist, raspberry leaf should not be self-administered prior to the third trimester, nor should it be delayed until term with the intention of initiating contractions.
Raspberry leaf is oestrogenic (Eagon et al. 2000), rich in iron, antioxidants and antithrombotic agents (Han et al. 2012). However, studies on the uterine-contracting effects of raspberry leaf are inconclusive (Parsons, Simpson and Ponton 1999). Holst et al. (2009) elicited conflicting results and questioned its routine use by women. Reviews of animal studies by Johnson et al. (2009) and Zheng et al. (2010) suggest a dose-dependent effect, with increased duration of pregnancy and first stage labour with ingestion of larger doses, and at least two chemical constituents have been shown to have muscle relaxation effects (Rojas-Vera, Patel and Dacke 2002). Further, a study on rats by Makaji et al. (2011) found long-term alterations in cytochrome activity in female offspring, suggesting a possible lifelong effect on the individual’s ability to metabolise toxic substances.
The question of whether raspberry leaf should be professionally promoted as a birth preparation is contentious. Women’s bodies are physiologically designed to be pregnant and to labour spontaneously, but stresses of modern daily life conspire to convince women that they should try everything they can to encourage labour. This psychological pressure adds to the physical stresses of pregnancy, contributing to higher cortisol levels and adversely affecting the natural process of labour. However, as with any pharmacologically active remedy, there are certain women who should refrain from taking raspberry leaf, and women who choose to take it should be assessed to ensure that there are no contraindications or precautions. Box 8.1 summarises the contraindications and precautions.
Contraindications to the use of raspberry leaf in pregnancy
• avoid in early pregnancy unless prescribed by a qualified medical herbalist
• not to be used as a means of labour induction at term/post-term
• previous Caesarean section, or other uterine surgery; elective Caesarean section planned
• excessive or painful Braxton Hicks contractions (reduce dose)
• multiple pregnancy
• abnormal presentation or lie – breech, transverse, oblique, unstable lie
• placenta praevia or low-lying placenta
• antepartum haemorrhage, whether placenta praevia, abruption or incidental causes
• epilepsy, irrespective of need for medication
• hypertension, pre-eclampsia, history in previous pregnancy
• current or previous varicosities, thrombophlebitis, deep vein thrombosis
• threatened preterm labour, or history of preterm labour in previous pregnancy
• history of precipitate labour in previous pregnancy
• on anticoagulants/other drugs with anticoagulant action, or history of coagulation disorder
• any pre-existing or gestational medical condition requiring medication
• irritable bowel syndrome, Crohn’s disease
• hormone-sensitive cancer – ovarian, uterine, cervical
• endometriosis, fibroids
• anaemia (dependent on cause, may affect absorption)
• diabetes mellitus.
Copyright © Expectancy® 2017. All rights reserved
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