Chapter 34: Complementary & Alternative Therapies in Care

Welcome to Last Minute Lecture.

This free chapter overview is designed to help students review and understand key concepts.

These summaries supplement not replaced the original textbook and may not be redistributed or resold.

For complete coverage, always consult the official text.

Welcome back to The Deep Dive.

Today, we are opening a door that usually stays pretty shut in the rigorous, sterile world of acute care nursing.

We are stepping into the space where ancient tradition collides head on with modern physiology.

Yeah, and it's a space that makes a lot of science -minded clinicians pretty uncomfortable.

We like our randomized control trials.

Right.

We like beta.

We like clear mechanisms of action.

But today, we're talking about energy fields, meridians, and herbs that probably haven't seen the lab since, I don't know, the Jurassic period.

And yet, we aren't just dismissing this.

We're digging into Chapter 34 of Introduction to Maternity and Pediatric Nursing, 8th edition.

The title is Complementary and Alternative Therapies.

And the reason we're doing this, it's really important to state this upfront.

It isn't to teach you how to align chakras or pick out the best crystals.

No, it's because if you don't understand this chapter, you might miss a life -threatening interaction in your patient.

That is the bottom line.

This deep dive is for the learner, you know, the nursing student prepping for the NCLEX or your OB -PEDS rotation.

Our mission is just to translate these dense tables and diagrams into a kind of survival guide.

So we're stripping away the stigma and really looking at the pharmacology and the anatomy that's hiding underneath.

Exactly.

We also need to draw a boundary here.

The National Center for Complementary and Integrative Health lists something like,

what is it, 1 ,800 different therapies.

It's a huge number, and we are not doing 1 ,800 today.

Definitely not.

So if it isn't in chapter 34, and if it doesn't directly relate to gynecology, obstetrics, or pediatrics, we are leaving it on the shelf for today.

Fair enough.

But before we get to any of the specific therapies, we really have to settle with the vocabulary.

The chapter throws around complementary, alternative, and integrative.

And people use those interchangeably all the time.

All the time.

But in a clinical setting, if you mix them up on a test, or, more importantly, in the patient's chart, you are just plain wrong.

Okay, so break it down for us.

What is the functional difference?

It all comes down to its relationship with, let's call it, Western medicine.

Complementary therapy is used alongside traditional medical care.

So think of the textbook example for hypertension.

You've got a patient taking their prescribed beta blockers, that's the Western medicine part, but they're also doing biofeedback or maybe guided imagery to lower their stress.

They work in tandem, one complements the other.

Precisely.

Like peanut butter and jelly, as you said.

Now, alternative therapy, that's an instead of situation.

It replaces the traditional treatment.

So using that same hypertension patient, if they flush their beta blockers down the toilet and decide to only use garlic supplements and meditation to treat their malignant hypertension, that is alternative therapy.

That distinction feels absolutely crucial.

The risk profile just changes completely, doesn't it?

Completely.

In the first scenario, the patient is still medically managed.

In the second, they are essentially, well, they're unmedicated according to the standard of care.

And that brings us to integrative or holistic healing.

Right.

That's the broader philosophy.

It's this understanding that you treat the whole person, not just the disease.

But the text frames all of this within a massive shift in the healthcare landscape.

We are seeing care migrate from the hospital to the home.

Which, on the surface, sounds great.

Patients want autonomy.

They want to be in their own beds.

It is positive, for the most part.

But for a nurse, it's a giant blind spot.

In the hospital, you have a totally controlled environment.

You verify every pill, every meal.

You know everything that's going in.

Everything.

But in the home, the patient has control.

They have access to the internet, advice from grandma, and the health food store right down the street.

So you're walking into a situation where you don't have all the hospital backup, and you don't necessarily even know what the patient is consuming.

Exactly.

If you are a home health nurse, or even just doing an admission history in labor and delivery, you have to assume the patient is doing something outside of your orders.

Which leads us right into section one.

The nurse's role.

There is a specific quote in the text that I think kind of protects the nurse here.

It says the nurse's role is not to promote acceptance of these therapies.

You don't have to believe in them.

No, you don't.

Not at all.

But you have to recognize them.

You have to respect the patient's choice.

And most importantly, you have to assess them.

Assessment is the golden rule of chapter 34.

Because of polypharmacy.

Right.

Polypharmacy is just the concurrent use of multiple medications.

And if a patient is taking a prescription drug and then adds a potent herb, you have chemistry happening in their bloodstream that you did not plan for.

And if you don't ask, are you taking any supplements?

Any teas?

You're flying blind.

Totally blind.

And this spills over directly into cultural competence.

Maternity and pediatrics are, you could argue, the areas of medicine most steeped in tradition.

Oh, absolutely.

We aren't just treating a body.

We're entering a whole family structure.

The text lists some specific folk healers.

It does.

And this isn't just, you know, a matching exercise for a quiz.

It's about knowing who holds the real authority in your patient's life.

For a Mexican patient, it might be a curandero.

For an African -American family, a root doctor.

Right.

In many Asian cultures, an herbalist.

The text also mentions espiritistas for Puerto Rican culture and singers for the Navajo.

So the takeaway is that the doctor, the MD, might not be the only expert that the family is consulting.

And if you dismiss the root doctor or the singer, you break trust.

You lose that patient's compliance.

You have to respect that parallel authority, even if you don't understand it.

Speaking of culture, we need to visualize something from the book.

Figure 34 .2 shows quain rubbing.

Casual.

Right.

And to the untrained eye, I mean, looking at the photo in the book, this looks like physical trauma.

Oh, it really does.

It's a form of skin manipulation that's common in Southeast Asian cultures.

The practitioner uses a coin or maybe a spoon to rub the skin, usually on the back.

And what's the belief there?

The belief is that it draws out illness or aligns the body with gravity.

The result is these very distinct linear red welts.

They look exactly like the aftermath of a beating.

The text has a safety alert here that is, I mean, it's practically blinking in red neon.

It is.

It warns that Cougio is frequently mistaken for child abuse.

Imagine you're a pediatric nurse and you see a child with these welts all over their back.

Your first instinct is mandatory reporter.

You call security.

You call CPS.

But in this context, that reaction could destroy a family unit over a complete misunderstanding.

It's cultural tragedy.

It is.

You have to learn to distinguish between a therapeutic intent, even if you disagree with the method, and actual abuse.

You have to ask questions before you start making accusations.

Okay.

Let's pivot to section two, manual and physical therapies.

This is where we get into the, you know, the mechanics of touch.

Massage is the obvious one.

Sure.

And we all know massage manipulates soft tissue to improve circulation, muscle tone.

The text also mentions rolfing, which is a deeper form.

It focuses on fascia.

But in obstetrics, massage isn't just for relaxation.

It has some really functional applications.

It does.

You're thinking of perineal massage.

Exactly.

This is pre -delivery prep.

The idea is to stretch the perineal tissue to prevent tearing or, hopefully, the need for an episiotomy.

And then during labor, we have a flourish.

Which we covered back in chapter seven, that light circular stroking of the abdomen.

Yep.

It works on the gait control theory of pain.

It basically distracts the nerves.

But we have to slam the brakes on for a second.

We assume massage is totally benign.

It's just a back rub.

But the text says otherwise.

It does.

This is the contraindication list.

Specifically, foot massage in pregnancy.

This one surprises a lot of students.

Why on earth would a foot rub be dangerous?

Connect to reflectology, right?

That's the link.

That's the link.

There are reflex points on the feet that are believed to correspond to the uterus.

The theory is that vigorous stimulation of those points can trigger uterine contractions.

So a simple pedicure on a susceptible pregnant woman,

someone who is maybe at risk for preterm labor,

could theoretically tip them over the edge.

That's the concern.

It's a wild connection, but it's one you have to be aware of.

So what about the more general contraindications for massage?

Well, just think about the mechanism.

Massage increases blood flow.

So if you have any condition where pumping more blood to an area is a bad idea, don't massage it.

Like cancer.

Right.

You don't want to help metastasize cells through the lymph system.

A localized infection.

You don't want to spread the bacteria systemically.

And cardiac disorders, it says.

Yeah.

If the heart is already struggling to pump, dumping a bunch of fluid back into the central circulation through massage can overload the whole system.

Okay.

Let's look at the pediatric side.

The NICU seems to be a huge proponent of touch.

Oh, huge.

For preterm infants,

gentle touch promotes bonding, physiological stability.

It's essential.

But again, the text throws a curve ball.

There is a specific population where you have to be extremely careful with any kind of manual manipulation.

And that is children with Down syndrome.

Right.

Why is that?

What's the physiological reason?

It's because of cervical spine anomalies.

Children with Down syndrome often have instability in the atlantic axial joint.

That's the connection between the top two vertebrae.

So if you manipulate the neck or spine too vigorously.

You risk a spinal cord injury.

It's a massive, massive safety point.

The text also mentions children with a history of sexual abuse.

Yes.

And this is a psychological contraindication, not a physical one.

For these children, touch can be triggering rather than soothing.

Okay.

Moving deeper into the skeleton, let's talk about osteopathy and chiropractic care.

So osteopaths or DOs are fully licensed physicians who combine manipulation with traditional medicine.

Chiropractors focus more specifically on the spinal column and its relationship to the nervous system.

But in pregnancy, the skeletal system undergoes a pretty major chemical change that, I guess, alters the rules of engagement.

It really does.

You're talking about the hormone relaxin.

Relaxin, right.

Its evolutionary purpose is brilliant.

It softens the connective tissue in the pelvis so the baby can actually fit through the birth canal.

But hormones aren't smart enough to target just one area.

So they affect every joint in the body.

The pregnant patient is just structurally looser.

Exactly.

Hypermobile.

And this makes them much more vulnerable to injury during manipulation.

The text issues a very specific warning.

Avoid vigorous manipulation between the 12th and 16th weeks of pregnancy.

That's a very specific window.

Why, then?

That's a period of significant hormonal shifts and structural settling.

The risk that's cited in the text is stimulating a miscarriage.

It's a fragility window where any manual therapy needs to be incredibly conservative.

Okay, let's finish this physical section with reflexology.

We touched on it with the foot massage, but figure 34 .4c actually gives us the map.

It does.

It shows the body divided into 10 vertical or longitudinal zones.

The whole premise is that the foot is a microcosm of the body.

The big toe might represent the head.

The arch could be the digestive tract.

So reflexologist isn't rubbing your foot because your foot hurts.

No.

They're rubbing your toe because you have a headache.

Exactly.

They believe they're clearing energy blockages along those longitudinal lines.

It's distinct from massage because the intent isn't local muscle relief.

It's remote organ therapy.

Which brings us seamlessly into section three, energy, light, and sensory therapies.

If reflexology is about lines on the foot,

acupuncture is about lines on the whole body.

And for this, we need to look at figures 34 .4a and b.

They contrast two very different concepts, meridians and dermatomes.

This is really the clash of east and west.

Okay, define them for us.

So meridians are the eastern concept.

They are these invisible channels through which chi or life energy is supposed to flow.

The text says there are 12 major meridians and about 150 specific points on them.

And acupuncture places needles on those points to unblock the chi.

That's the theory.

Now, dermatomes.

That's straight up western anatomy.

A dermatome is a specific area of skin that's innervated by a single spinal nerve root.

If I pinch your thigh at the L2 level, that signal travels directly to the L2 vertebrae.

So when we as nurses study acupuncture, are we validating the chi or are we looking at the nerve?

We're observing the effect.

The scientific theory is that inserting those hair -thin needles stimulates the nerve cells to release endorphins, our body's natural opioids.

It's basically biochemical hacking.

And acupressure is just the same map, but no needles.

Or shiatsu, which uses deep thumb pressure instead.

In maternity, these are go -to therapies for things like nausea, back pain, and constipation.

But, and you knew there was a but coming.

Here it comes.

We have forbidden buttons again.

The text lists acupoints to avoid during pregnancy.

They are the bottom of the foot, the inner lower leg, and the base of the thumb.

That base of the thumb one is the surprising one for a lot of people.

It's the hegu point, or LI4.

In traditional Chinese medicine, stimulating this point is known to induce labor.

So if you press it effectively on a pregnant woman at, say, 30 weeks.

You are courting disaster.

Seriously.

Let's talk about machines.

We live in a tech world, and energy healing isn't just hands anymore.

Figure 34 .3 shows a device called the Primabella.

Yeah, it looks like a futuristic watch, doesn't it?

It's a 10NS unit transcutaneous electrical nerve stimulation.

We usually see 10NS units for, like, chronic back pain.

This one is very specific.

It targets the median nerve at the wrist.

And it's actually FDA cleared for nausea and vomiting.

So for hyperemesis in pregnancy.

Or chemo nausea.

Both.

It's a perfect example of an energy therapy crossing that bridge into standard recognized medical equipment.

What about magnets?

The text is pretty brief on those.

Super brief.

The rule is, do not put magnets over a pregnant abdomen.

We just have no data on how strong magnetic fields affect fetal development.

So the default answer is a hard no.

Okay, moving to light and heat.

Light therapy seems pretty mainstream now.

Oh, it is.

If you walk into any nursery and see a baby with jaundice under those blue lights, that's phototherapy.

It's using light to break down bilirubin in the skin.

We also use light boxes for seasonal affective disorder, or SAD.

But heat gets a really bad rap in this chapter.

Specifically, saunas and hot tubs.

This is all about maternal hyperthermia.

Overheating.

Right.

When a pregnant woman's core body temperature rises significantly, it can cause tachycardia and fetal distress.

Also, some medical conditions inhibit sweating.

If a patient can't sweat efficiently, a sauna just becomes a convection oven.

It's really dangerous.

Let's gauge the mind -body connection now.

Aromatherapy.

It's everywhere.

You can buy essential oils at the gas station now.

Which is actually part of the problem.

Essential oils are incredibly potent.

They are distilled plant concentrates.

One single drop can be the equivalent of pounds of plant material.

So the text gives us a safe list and a dangerous list for our moms and kids.

The safe list includes things like jasmine, citrus, and peppermint for nausea and labor anxiety.

And then lavender and chamomile for pediatric pain and just general soothing.

But the dangerous list.

Yeah.

This is where the NCLEX questions are probably hiding.

Probably.

A void.

Anise, juniper, thyme, wintergreen, nutmeg, pennyroyal, and mugwort.

Wait, wait.

Nutmeg and thyme.

Those are in my spice rack.

In your spice rack, they're spices.

Used in tiny amounts.

As a concentrated essential oil, the dose is much, much higher and potentially toxic.

Pennyroyal and mugwort, in particular, are historically known as abortifacients.

Substances that induce miscarriage.

Yes.

So if a pregnant patient says, oh, I'm just using natural oils to relax, the nurse absolutely needs to ask which ones specifically.

Because natural does not mean safe for baby.

Not even close.

This leads us to the absolute behemoth of this chapter, section four, herbal medicine.

This is the deep dive within the deep dive.

This is the wild west of pharmacology.

And we have to start with the law.

Why are these things on the shelf right next to the pharmacy, but they're not regulated by the pharmacy?

It all goes back to 1994 and the DSHEA Act, the Dietary Supplement Health and Education Act.

It created a legal category for herbs as dietary supplements, not drugs.

What's the practical implication of that classification?

What does that mean on the ground?

It completely flips the burden of proof.

For a drug like, say, Tylenol, the manufacturer has to prove to the FDA that it's safe and effective before they can sell it.

OK.

For an herbal supplement, the manufacturer can just put it on the shelf.

The FDA has to prove it's dangerous after it's already on the market in order to pull it.

So there is absolutely no guarantee of strength, purity or consistency?

None.

A bottle of Ginkgo from brand A might be 10 times stronger than the one from brand B.

Or it could be contaminated with pesticides, lead or mercury because the oversight is just minimal.

And yet our patients are taking them every day.

So let's look at table 34 .1, herbs and surgery.

This is a list every single nurse should basically memorize.

The general rule is simple.

Stop all herbal supplements two weeks before any surgery.

No exceptions.

Because of three main risks.

Let's break them down.

Risk number one, bleeding.

The G -herbs.

Garlic, ginger, ginkgo biloba ginseng, also feverfew.

These herbs all inhibit platelet aggregation.

They thin the blood.

They do.

So if you're going in for a C -section and you've been loading up on garlic supplements, your blood won't clot effectively.

You are at a huge risk of hemorrhage.

OK.

Risk number two.

Sedation.

Valerian, St.

John's wort, kava kava.

These are all natural relaxants.

If you mix them with anesthesia, you get potentiation.

The anesthesia works too well.

Meaning the patient might not wake up or their blood pressure bottoms out on the table.

And risk number three.

Cardiac instability.

Ephedra, also called mahwam, and ginseng again.

Right.

They can cause hypertension and arrhythmias.

You do not want a chaotic heart rhythm while a surgeon is operating.

It's terrifying.

It really is.

That something you buy at a health food store can complicate a major surgery this much.

OK.

Let's look at pregnancy.

Table 34 .2.

The assumption patients make is it's a plant, nature made it, it must be good for the baby.

The reality is most of these herbs cross the placenta.

The text mentions aloe vera.

Yeah.

We use it topically for sunburns.

But if you take it internally, the text says it engorges the pelvic vessels.

It fills the uterus with blood, which increases the risk of abortion.

What about St.

John's wort?

It increases uterine tone.

It basically makes the uterus clamp down, not what you want during pregnancy.

OK.

This next one has shocked me.

Chamomile.

It's just tea, right?

In medicinal doses, chamomile has been linked to teratogenic effects, meaning birth defects, and potential miscarriage.

A weak cup of tea now and then is probably fine, but a concentrated supplement is a definite risk.

Then there is box 34 .2, which lists herbs that promote menstruation.

I mean, just think about the logic here.

If an herb promotes menstruation, it triggers the shedding of the uterine lining.

And if you're pregnant, that means you lose the pregnancy.

You do.

The list includes cascara, cohosh, goldenseal, pennyroyal, sage, and senna.

Senna is the big one to watch there, I think.

It's a super common over -the -counter laxative.

It is.

Pregnant women get constipated all the time.

They might grab a natural senna tea to stay regular, not having any idea they are taking something that promotes menstruation.

Kids are not small adults.

Their metabolic rates are faster.

Their immune systems are immature.

Their livers process things differently.

It's popular, but it's totally unproven.

And the risk is contamination.

If that algae came from a polluted water source, it can cause liver failure or even cholera.

What about melatonin?

I feel like every parent I know uses melatonin gummies for their kids.

The text really advises caution here.

We have serious concerns about how long -term use affects puberty and hormonal development.

We also worry about seizure thresholds in some children.

We just don't have the long -term data yet.

And a feature rears its head again.

This is a tragedy waiting to happen with teenagers.

They use it for weight loss or as an energy booster for sports.

It's a powerful stimulant.

An overdose can lead to cardiac arrest.

It's basically legal speed.

Are there any herbs the text actually seems to be okay with?

A few.

Probiotics are pretty standard now for antibiotic -associated diarrhea.

And ginger is generally recognized as effective for nausea, though you have to watch out for heartburn in large doses.

Finally, menopause.

Table 34 .4.

Women who are trying to avoid hormone replacement therapy often turn to herbs.

Right.

And black cohosh is the standard for hot flashes.

It seems to work by lowering luteinizing hormone.

Sage can help with night sweats.

But there is a big catch with Dong Quai.

A huge catch.

Dong Quai contains phytoestrogens.

It mimics estrogen in the body.

So if one has uterine fibroids or heavy bleeding, adding more estrogen is like throwing gasoline on a fire.

It can make the problem much, much worse.

We are in the home stretch.

Section 5.

Specialized in chemical therapies.

Let's distinguish homeopathy from herbalism.

Totally different philosophies.

Herbalism uses material doses of plants you can measure.

Homeopathy is based on the law of similars.

The idea is if a substance causes a symptom in a healthy person, a microdose of it will cure that symptom in a sick person.

And when we say microdose.

We mean microscopic.

Often, there is no detectable molecule the original substance left.

It's been diluted over and over again.

So is it safe?

Generally, yes, just because the dose is so incredibly low.

But the text does warn that some of the base preparations or the carriers can use things like alcohol, mercury, or arsenic.

So it's not zero risk.

Then there's Ayurveda.

That's an ancient Hindu system.

It's really a whole lifestyle regimen.

Diet, herbs, massage, all based on your body type and biological rhythms.

It's very comprehensive.

And finally, we're back to high tech again.

Hyperbaric oxygen therapy or HBO key.

This is where you go into a pressurized chamber and you breathe 100 % oxygen.

It forces oxygen deep into the tissues.

We use it for carbon monoxide poisoning and diabetic wound healing.

But there is a massive critical contraindication for pregnancy here.

Yeah.

And this involves the fetal heart.

This is pure physiology.

It is pure physiology.

In the womb, the baby isn't using its lungs.

The blood bypasses the lungs through a little shunt called the ductus arteriosus.

There's a shortcut.

It's a shortcut.

And the signal for that shortcut to close is a high level of oxygen in the blood, which usually happens when the baby takes its first breath of air outside the mom.

So if you put a pregnant woman in a hyperbaric chamber.

You saturate her blood with 100 % oxygen.

That super high oxygen level crosses the placenta to the baby.

And it tricks the ductus arteriosus into closing while the baby is still inside.

Which cuts off their entire circulation.

It leads to fetal death.

It is a stark, stark reminder that you are always treating two patients with two very different physiologies.

We have covered a massive amount of ground.

From coin rubbing to essential oils to the ductus arteriosus.

What is the synthesis here?

What's the big takeaway?

For me, it all circles back to the assessment.

You cannot protect your patient if you are judgmental.

If you roll your eyes when they mention their herbalist, they will stop talking to you.

And then you won't know about the ginseng before the C -section.

Exactly.

You have to build that bridge.

You don't have to agree with the therapy to keep your patients safe.

And you have to respect the physiology.

These aren't just vibes or energy fields.

Herbs act on receptors.

Massage moves fluid.

Oxygen changes heart structures.

It's all real.

It's all real.

Here's a final thought for you, our listeners, to chew on.

We often critique these camp therapies for being unregulated or unproven.

But Western medicine is hyper -focused on the disease, on the pathology.

Many of these alternative therapies focus on the person, the energy, the feeling of being cared for.

That's a valid gap in our system, for sure.

So as we move into a future where patients have infinite information at their fingertips, they are increasingly becoming their own doctors.

They are mixing ancient wisdom with Amazon Prime delivery.

The question is, how do you, as a nurse, navigate a world where the patient holds the control, but you still hold the responsibility for the outcome?

That is the challenge of modern nursing.

Thank you for joining us on this deep dive.

Good luck with your studies, and watch out for that senatee.

See you next time.

This has been the Last Minute Lecture Team, signing off.