Denise and her blog

Published : 31/10/2024

Diagnosis and Professionalism in Reflexology

I recently saw a Facebook post on a reflexologists’ page, in which an obviously inexperienced therapist was querying why expectant mothers should not lie flat on their backs at 39 weeks’ gestation. Whilst it is worrying that she did not understand and possibly had not undertaken specific training on working with pregnant clients, the responses from her colleagues were even more worrying. Many (although not all) did not seem to appreciate the impact of supine hypotension on maternal and fetal oxygenation, nor did they fully understand safe positioning to avoid not only resulting dizziness and fainting but also how to avoid excess strain on the spinal muscles and ligaments and the symphysis pubis. Another post, a few days earlier, - of a type which I see frequently – was the group’s attempt to make a diagnosis from a photograph of a client’s feet. There were some extremely worrying comments, with therapists jumping to conclusions about possible medical conditions which they had “recognised” from the picture, with no other history available. Even more concerning were the comments about how reflexologists might actually treat this person, based on their so-called diagnosis.

 

As a midwife for over 40 years, a clinical reflex zone therapist for 35 years and having treated almost 6000 pregnant clients, I am alarmed by the attitudes of these practitioners, which showed little knowledge and understanding of the physiology and possible pathology of the client in question. I have no doubt at all that it is possible to examine the feet visually and via palpation, as well as taking into account the reactions of the client in terms of areas of tenderness and pain in relevant reflex zones on the feet. I have, myself, often seen or felt variations on the foot reflex zones that indicate changes in physiology or impending pathology, and my main interest in the therapy is its diagnostic potential. For example, I have undertaken formal research whilst at the University of Greenwich in the 1990s, to show that it is possible to predict stages of the menstrual cycle from an examination of the feet zones relating to the pituitary gland, ovaries, fallopian tubes and uterus – I have around a 70-75% success rate in so doing. I teach this in my courses for midwives and lead on to teaching how they can estimate the onset of labour, using the same theories.

 

However, a clinical diagnosis is achieved from a complete assessment of the client, including taking a comprehensive medical (and obstetric) history, ascertaining the current signs and symptoms, then a visual examination and thorough palpatory examination of the feet. Having drawn some conclusions, it is then essential to understand the physiopathology behind the assumed condition and to work out whether or not reflexology is an appropriate treatment to reduce the severity of symptoms, rather than resolving the condition. More often than not, medical conditions are a contraindication, even for a statutorily regulated health profession, and certainly for a reflexologist who is not a clinician.   I am sure the injudicious attempt to work out what is happening and how reflexology may be able to help people with specific medical conditions arises from a compassionate but misplaced enthusiasm to help people.

 

If we want reflexology to be seen as a credible therapy with underpinning theory and evidence-based practice, practitioners MUST acknowledge the boundaries of their personal practice. These parameters may be different in different therapists due to their training and experience, but it is fundamental to professionalism to know when not to treat as much as it is essential to understand how to treat someone. This certainly applies to working with pregnant clients – and it is usually a post-registration training and qualification to be eligible to treat pregnant and newly-birthed women. For someone working with a client at 39 weeks of pregnancy and not to understand the most basic principle of positioning is obviously due to lack of, or poor, training and the fact that she was still about to treat the client is bordering on negligence. Further, I would assume that if she did not know this, she would certainly not be prepared to deal with any emergencies that might arise such as the woman having a rapid labour resulting in a precipitate birth whilst in the consulting room, or her waters breaking and the umbilical cord prolapsing.


Published : 21/10/2024

Guidelines On Herbal Remedies In Pregnancy 

The term “natural remedies” refers to herbal remedies, herbal teas, aromatherapy essential oils, homeopathic medicines, plus traditional (indigenous) medicines, whether sourced from plants, minerals or animals.

  • All natural remedies should be treated with the same respect as pharmaceutical drugs.
  • “Natural” does not mean that all remedies are safe, or safe for everyone, particularly during pregnancy and childbirth.
  • Natural remedies should not be used as a replacement for proven medical treatment, especially in the event of an emergency. 
  • Expectancy parents should be advised to avoid ALL natural remedies, including aromatherapy oils, before and during pregnancy, labour and breastfeeding unless under the supervision of an appropriately qualified, insured professional.
  • Women should be asked at their first antenatal appointment if they are using any remedies, especially herbal medicines and aromatherapy oils and again as they prepare for the birth, especially if they are desperate to avoid induction of labour. 
  • Advise parents that not all remedies are approved, regulated or evidence based. Remedies obtained from the Internet may be falsely labelled, contaminated with chemical impurities or contain banned or toxic ingredients.
  • Women should be informed about the possible risks of taking pharmacologically active remedies, including adverse effects such as allergies and interactions with prescribed medications, foods or other remedies.
  • Advise women against combining several different NRs / complementary therapies: take only one remedy at a time, particularly at term when trying to avoid induction.
  • Natural remedies are completely contraindicated for pregnant women with major hepatic, renal, cardiac and neurological conditions and cancers of any type, irrespective of whether they currently require pharmaceutical medications. 
  • Anyone taking medically prescribed drugs, by whatever route of administration, should be strongly advised against using NRs at any time.
  • Midwives should be alert to the possibility that deviations from physiological progress in pregnancy or labour may be linked with undisclosed use of natural remedies.
  • Women admitted to the antenatal ward have, by definition, pathological complications requiring medical attention and should avoid self-administering all natural remedies. It is not appropriate for midwives and doulas to advocate natural remedies for these women or to use essential oils for aromatherapy in the antenatal ward area.
  • Women should be advised to discontinue all pharmacologically active herbal and traditional medicines at least two weeks prior to elective surgery or dental extraction to reduce the risk of excessive bleeding. Anaesthetists and dental surgeons should check whether women have continued to use remedies immediately prior to surgery, many of which may have an adverse effect on blood clotting. 
  • Medical, midwifery and health visitor pre-registration education and doula and antenatal teacher preparation should include an appropriate introduction to the safe use of natural remedies in pregnancy and childbirth that balances benefits and risks. 
  • There is an urgent need for more research on natural remedy safety, although not all modalities can be studied using a randomised, controlled, blinded approach.

 


Published : 17/10/2024

Midwives, did you know? 🌿

If a pregnant woman needs to change from her pre-pregnancy antidepressant, the popular alternative remedy, St. John's Wort may not be a safe alternative.

This herbal remedy works in a similar way to some antidepressants and can carry similar risks during pregnancy.

Always advise your clients to consult with their midwife or a qualified herbalist before considering St. John's Wort. (NB always midwife before doctor!!)

Keeping both mother and baby safe is always the top priority!


Previous articles

Diagnosis and Professionalism in Reflexology

Guidelines On Herbal Remedies In Pregnancy 

Midwives, did you know? 🌿

This week is World Reflexology Week!

Complementary Therapies and The M25 

Today is Expectancy’s 20th Birthday! 🎉

Pass The Baton - Where Is The Next Generation Of Leaders In The Specialism Of Midwifery Complementary Therapy?

Our Woman In Tokyo

Safe Care Cannot - And Should Not - Be Done On The Cheap

Guest Blog : Annual Networking Day