Julie Williams

Bio: Julie Williams is an academic researcher from University of the West of England. The author has contributed to research in topics: Evidence-based medicine & Pregnancy. The author has an hindex of 3, co-authored 8 publications receiving 94 citations.

Midwifery managers' views about the use of complementary therapies in the maternity services.

Abstract: The burgeoning interest in complementary therapies (CTs) in the general population over the last decade has created a demand for CTs to be made available within the NHS. There are some excellent examples of midwives who have introduced CTs into clinical practice and who are providing an enhanced service to women as a result [Budd S. Moxibustion for breech presentation. Complement Therap Nurs Midwifery 2000; 6(4): 176-9; Tiran D. Complementary strategies in antenatal care. Complement Therap Nurs Midwifery 2001; 7: 19-24; Ager C. A complementary therapy clinic, making it work. RCM Midwives J 2002; 5(6): 198-200; Burns E, Blamey C, Ersser S, Lloyd AJ, Barnetsson L. The use of aromatherapy in intrapartum midwifery practice: an observational study. Oxford: OCHRAD; 1999]. Overall, however, service provision remains patchy and ad hoc with little evidence of a robust integration into the maternity services. This article presents the qualitative findings from a national survey of the heads of maternity services in England. They were asked to indicate their views and perceptions about the benefits, promoters and constrainers in relation to CT integration within the maternity services. Our findings show that overall, views are positive, with increasing consumer satisfaction, promotion of normal childbirth and a reduction in medical intervention being seen as the main benefits.

The use of complementary therapies in maternity services: A survey

Abstract: The aim of this study was to establish the extent of use of complementary therapies in the maternity services in England and to determine the views of heads of midwifery to the integration of these therapies into midwifery practice. The questionnaire was sent to 221 heads of midwifery in all NHS maternity units in England. A response rate of 75% was achieved. Sixty four percent of the maternity units who responded provided a complementary therapy service in a variety of combinations to mothers, babies and staff. However, only 9% provided a service to all three groups. The four therapies offered most widely were massage, aromatherapy, reflexology and acupuncture. Attitudes were positive with 70% of respondents convinced of the benefits and 94% believing it important for them to be available in the NHS. Respondents felt that complementary therapies had an important role, particularly in relation to increasing consumer satisfaction, promoting normal childbirth, decreasing medical intervention and increasing ...

Midwives’ support for Complementary and Alternative Medicine: A literature review

Abstract: Summary Objective There is evidence that the use of Complementary and Alternative Medicine by childbearing women is becoming increasingly popular in industrialised countries. The aim of this is paper is to review the research literature investigating the midwives’ support for the use of these therapies. Method A search for relevant research published from 2000 to 2009 was undertaken using a range of databases and by examining relevant bibliographies. A total of thirteen studies were selected for inclusion in this review. Results The findings indicate that the use of Complementary and Alternative Medicine is widespread in midwifery practice. Common indications for use include; labour induction and augmentation, nausea and vomiting, relaxation, back pain, anaemia, mal-presentation, perineal discomfort, postnatal depression and lactation problems. The most popular therapies recommended by midwives are massage therapy, herbal medicines, relaxation techniques, nutritional supplements, aromatherapy, homeopathy and acupuncture. Midwives support the use Complementary and Alternative Medicine because they believe it is philosophically congruent; it provides safe alternatives to medical interventions; it supports the woman's autonomy, and; incorporating Complementary and Alternative Medicine can enhance their own professional autonomy. Conclusions There is considerable support by midwives for the use of Complementary and Alternative Medicine by expectant women. Despite this enthusiasm, currently there are few educational opportunities and only limited research evidence regarding CAM use in midwifery practice. These shortfalls need to be addressed by the profession. Midwives are encouraged to have an open dialogue with childbearing women, to document use and to base any advice on the best available evidence.

Aromatherapy in childbirth: a pilot randomised controlled trial

Abstract: Objectives We aimed to determine the feasibility of conducting a randomised controlled trial (RCT) on the use of aromatherapy during labour as a care option that could improve maternal and neonatal outcomes. Design RCT comparing aromatherapy with standard care during labour. Setting District general maternity unit in Italy. Sample Two hundred and fifty-one women randomised to aromatherapy and 262 controls. Methods Participants randomly assigned to administration of selected essential oils during labour by midwives specifically trained in their use and modes of application. Main outcome measures Intrapartum outcomes were the following: operative delivery, spontaneous delivery, first- and second-stage augmentation, pharmacological pain relief, artificial rupture of membranes, vaginal examinations, episiotomy, labour length, neonatal wellbeing (Apgar scores) and transfer to neonatal intensive care unit (NICU). Results There were no significant differences for the following outcomes: caesarean section (relative risk [RR] 0.99, 95% CI: 0.70–1.41), ventouse (RR 1.5, 95% CI: 0.31–7.62), Kristeller manoeuvre (RR 0.97, 95% CI: 0.64–1.48), spontaneous vaginal delivery (RR 0.99, 95% CI: 0.75–1.3), first-stage augmentation (RR 1.01, 95% CI: 0.83–1.4) and second-stage augmentation (RR 1.18, 95% CI: 0.82–1.7). Significantly more babies born to control participants were transferred to NICU, 0 versus 6 (2%), P= 0.017. Pain perception was reduced in aromatherapy group for nulliparae. The study, however, was underpowered. Conclusion This study demonstrated that it is possible to undertake an RCT using aromatherapy as an intervention to examine a range of intrapartum outcomes, and it provides useful information for future sample size calculations.

Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

Abstract: Many women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women’s views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women’s views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women’s decisions and choices and to inform guidelines, policy, and practice. We searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women’s accounts of different pain relief methods. From 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural (n = 12), opioids (n = 3), relaxation (n = 8) and massage (n = 4) – all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. ‘Desires for pain relief’ illuminates different reasons for using pharmacological or non-pharmacological pain relief. ‘Impact on pain’ describes varying levels of effectiveness of the methods used. ‘Influence and experience of support’ highlights women’s positive or negative experiences of support from professionals and/or birth companions. ‘Influence on focus and capabilities’ illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, ‘impact on wellbeing and health’ reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes. Women report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.

Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: an integrative review

Abstract: Aim. This paper presents an integrative literature review examining the attitudes and referral practices of midwives and other maternity care professionals with regard to complementary and alternative treatment and its use by pregnant women.

Comparing the effects of ice massage and acupressure on labor pain reduction

Abstract: Background Childbirth is arguably one of the most painful experiences women undergo during their lives. This study aimed to compare the effects of ice massage, acupressure and placebo in reducing the intensity of labor pain in pregnant women from selected hospitals in Tehran, Iran. Methods A quasi-experimental study was conducted on 90 pregnant women referred from selected hospitals in Tehran. Mean age of the participants was 27.82 ± 6.20 years. Subjects were randomly divided into three groups ( n = 30) to receive ice massage, acupressure or placebo. The intervention was applied at the Hegu point and pain intensity assessed using a visual analogue scale (VAS) before the intervention, immediately 30 min and 1 h after the intervention. Results Comparing pain intensity immediately, 30 min and 1 h post-intervention across the three groups showed a significant difference between the groups. At 30 min post-intervention ( p Conclusion Ice massage and acupressure techniques reduced pain during labor. However, ice massage provided more persistent pain relief. Due to high levels of pain intensity and increased pain experienced by the women during the active phase of labor, it is suggested that repeating these techniques during the first stage of labor could be an effective, accessible, cost-effective and non-invasive technique to help reduce the intensity of labor pain.