Denise Tiran

The use of herbs by pregnant and childbearing women: a risk-benefit assessment.

This paper reviews some of the evidence in relation to herbal remedies, and considers both their efficacy and safety for pregnant and childbearing women. It concludes with some suggested guidelines for midwifery and obstetric practice.

The use of fenugreek for breast feeding women

Fenugreek is widely used as a culinary spice and is frequently used in Indian Ayurvedic and in Traditional Chinese Medicine, particularly as a galactogogue to encourage lactation. Little research appears to have been undertaken on the effectiveness of this spice and the majority of evidence for side-effects has arisen from case reports of complications. Skin test patching appears to suggest a significant proportion of patients susceptible to fenugreek allergy. For example, allergic reaction to inhalation of fenugreek seed powder has resulted in wheezing, rhinitis and fainting, while dermal application of fenugreek paste for dandruff of the scalp in an asthmatic woman caused facial oedema, numbness of the head and wheezing. Mild gastrointestinal symptoms have also been reported. This may be due to allergenic chemicals occurring naturally within the plant, or to the presence of substances such as nitrates from the soil in which the plant is grown, as has occurred in certain areas of Jordan. Research on the use of fenugreek by non-insulin diabetic patients has shown a small reduction in fasting and post-prandial blood sugar levels, but a more statistically significant decrease in total cholesterol and triglyceride levels of patients with coronary artery disease. Of more concern is the potential for fenugreek to interact with prescribed pharmacological medications, notably warfarin. It is also possible that fenugreek may potentiate antihypertensive and antidiabetic medication and increase the risk of bleeding in women requiring non-steroidal antiinfammatories, especially aspirin. With reference to women who are breast feeding, the following recommendations can be extrapolated from these findings:

Ginger to reduce nausea and vomiting during pregnancy: evidence of effectiveness is not the same as proof of safety.

Ginger is a common traditional remedy taken by numerous women experiencing nausea and vomiting in pregnancy (NVP). There is considerable evidence to support its effectiveness as an anti-emetic, but also increasing concern over its safety. Ginger is a powerful herbal medicine which acts pharmacologically and thus has specific indications, contraindications, precautions and side-effects, the most notable of which is an anticoagulant action. Midwives and other professionals advising women in early pregnancy about strategies for coping with NVP should be aware of the risks and benefits of ginger in order to provide comprehensive and safe information to expectant mothers. This paper reviews some of the contemporary research evidence which demonstrates that ginger is not a universally appropriate or safe choice for women with NVP and offers a checklist for professionals advising expectant mothers.

The use of complementary therapies in midwifery practice: a focus on reflexology

This paper introduces the use of complementary therapies within midwifery practice, and particularly focuses on reflexology. Case reports illustrate instances in which reflexology has been successful for childbearing women. Some of the issues pertinent to midwives are explored.

Increasing research evidence in practice: a possible role for the consultant nurse

AIMS To determine the extent to which clinical nursing practice has adopted research evidence. To identify barriers to the application of research findings in practice and to propose ways of overcoming these barriers. BACKGROUND Way back in 1976, nursing and midwifery practice started adopting research evidence. By 1990s, there was some transparency of research evidence in practice, but more could have been done to widen its adoption. Many barriers were identified which could hinder implementation of the evidence in practice, and the effort to remove these remains weak. EVALUATION 25 research articles from across Europe and America were selected, and scrutinized, and recommendations analysed. FINDINGS Many clinical practitioners report a lack of time, ability and motivation to appraise research reports and adopt findings in practice. The clinical environment was not seen as research friendly as there were a general lack of research activities and facilities locally. There was a clear lack of research leadership in practice. IMPLICATION FOR NURSING MANAGEMENT This paper reviewed the research evidence from several published research papers and provides consultant nurses with practical suggestions on how to enhance research evidence application in their practice. It recommends how consultant nurses can make their practice more research transparent by providing the required leadership, creating a research-friendly organization, developing a clear research agenda and facilitating staff develop a local research framework for reading research and implementing research evidence in their practice.

Implementing complementary therapies into midwifery practice

This paper discusses ways in which midwives can incorporate complementary therapies into their practice and describes some of the innovative services established by midwives in the UK to date.

Viewpoint—midwives’ enthusiasm for complementary therapies: a cause for concern?

The demand for complementary therapies and natural remedies during pregnancy and childbirth, originally consumer-driven, has fuelled a tremendous interest and enthusiasm amongst midwives, with over 34% having used one of more therapies in their practice. The majority of pre-registration education programmes now include an introduction to the subject, midwives who are especially interested can undertake further study and, in many areas, maternity service re-evaluation includes complementary therapies as an adjunct to the development of women-centred, midwife-led birthing centres. The last 10 years has seen the subject of complementary and alternative medicine (CAM) evolve from a ‘‘fringe’’ element, disregarded by the sceptics, to a significant aspect of healthcare. The work of organisations such as the Prince of Wales’ Foundation for Integrated Health has done much to bring CAM ‘‘in from the cold’’ and the House of Lords has acknowledged its value in enhancing the care of people with a range of health problems. The Complementary Maternity Forum has over 200 members, most of whom are midwives, and there are numerous projects around the country where midwives are implementing one or more therapies into their practice. However, midwifery is no longer a single generic profession. Whilst most midwives provide care for women with normal pregnancies from conception to the end of the puerperium, areas of specialist expertise have developed, including care of mothers suffering domestic violence or abusing drugs, teenage mothers or intensive labour ward care for women with medical complications. Some midwives have learnt new skills such as ultrasound scanning, ventouse delivery or assisting the surgeon in the operating theatre. So too should the use of CAM therapies for pregnant, labouring and newly delivered mothers be considered a specialism, in which certain midwives acquire new knowledge and develop new skills to become experts to which other midwives refer as an appropriate resource. Indeed, the need for each maternity service to employ at least one CAM midwife has long been advocated. However, whilst CAM awareness amongst midwives is currently at an all-time high, this has brought with it such enthusiasm that they are in danger of over-stepping the boundaries of their professional accountability. In an attempt to be seen to act as the mothers’ advocate, there appears to have been an injudicious sense of urgency to offer yet another element of womenfocused care, without due regard for the professional, legal, ethical and inter-disciplinary issues to be considered as part of the implementation process. Midwives have ‘‘jumped on the bandwagon’’ but are at risk of the momentum carrying them over the precipice into fatal waters. The incorporation of CAM therapies, as with any other component of advanced midwifery practice, requires a slow but persistent approach, rather than careering ahead regardless. Even midwives who are not actively involved in CAM are jeopardising their registration status by giving women incomplete or inaccurate information on natural remedies without complying with the Nursing and Midwifery Council’s requirement for ‘‘adequate and appropriate’’ preparatory education. The commonest example of this is the ARTICLE IN PRESS

Aromatherapy in midwifery: benefits and risks

This paper examines the potential dangers for pregnant, labouring, and newly delivered women of using essential oils without adequate knowledge of the actions of the chemical constituents of the oils. Although the discussion focuses specifically on the use of essential oils by midwives, the principles could equally apply to other health professionals.

A holistic framework for maternity care

This paper explores the concept of holism and its implications for maternity care. The integration of all aspects which affect the care of an individual mother and her baby is considered a holistic framework for maternity care is proposed.

Complementary therapies education in midwifery

Midwives and their clients are becoming increasingly interested in the use of complementary and alternative therapies which offer a variety of different strategies for dealing with the effects of pregnancy and childbirth. This paper explores the current provision of complementary therapy education for midwives, and suggests the establishment of a new clinical specialism of complementary therapies in midwifery.