Foundation Degree Complementary Therapiesfootstepsreflexologyschool.com/docs/CTH405... · Gestational diabetes 1 March 2010 . Foundation Degree Complementary Therapies CTH405 Reflexology

Foundation Degree Complementary Therapies

CTH405 Reflexology

Sharon Young

Introduction

This study will research pregnancy. The study will look at some of the physical,

physiological and psychological effects involved. The study will compare the

traditional treatment available on the NHS (National Health Service) with an

appropriate reflexology treatment, observing how it can be used before, during and

after pregnancy. The study will include relevant current research and look at the

limitations of the reflexology treatment.

The study begins by looking at some of the symptoms experienced by women during

pregnancy. Symptoms are displayed below. (Mackereth, Tiran 2002) (nhs.uk, 2010).

The psychological factors, according to Deutsch (1947) cited in Rankin (2002, p.9)

states that “pregnancy is a calm dream like period that fulfils a woman’s deepest

yearnings”. However Bibring (1959) cited in Rankin (2002, p.9) states that

Possible Symptoms suffered during pregnancy

❖ Stress

❖ Lower backache

❖ Oedema

❖ Nausea and vomiting

❖ Headaches and migraine

❖ Carpal tunnel syndrome

❖ Varicose veins

❖ Thrush

❖ Incontinence

❖ Heartburn

❖ Indigestion

❖ Constipation

❖ Haemorrhoids

❖ Pelvic joint pain.

❖ Gestational diabetes

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pregnancy is more of an emotional stress period and that anxiety increases as the

pregnancy progresses. Although every woman is unique; emotional stress and

anxiety are quite common. (Rankin 2002). Levels of anxiety were increased in

pregnant women compared to the non-pregnant state. (Condon1987 cited in Rankin

2002). Anxiety has been related to the different trimesters of pregnancy and

research suggests that women become more emotional, such as crying, worry and

nervousness being more common in the 2nd and early 3rd trimesters. These feelings

have been found to be at the peak in the 3rd trimester. (Rankin 2002). Some women

have however, not experienced these negative emotions and have actually as stated

by Rankin (2002, p.9) “increased levels of psychological well-being”.

Many physiological changes occur during pregnancy states Rankin (2002, p.11),

“Adjustments are necessary to provide an optimal environment for the developing

foetus”.

The cardiovascular system is affected and blood pressure may become high due to

hormonal influences and cardiovascular changes. These changes are necessary as

extra oxygen is needed by the body’s tissues and for the needs of the growing foetus

as pregnancy progresses. The respiratory system is also affected, especially in the

3rd trimester of pregnancy. This is because the uterus can force the diaphragm up as

much as 4cm and can result in a reduction in the respiratory reserve. (Rankin 2002).

According to Rankin (2002) Profound changes occur in the endocrine system during

pregnancy. Extra body tissue is needed to support the pregnancy and the hormone

oestrogen aids this. Progesterone has a relaxing effect and so aids the

cardiovascular system to cope with the demands of the pregnancy.

Hormonal changes can also cause constipation. (NHS 2010)

Rankin (2002, p.14) observes “Pregnancy is a diabetogenic event especially through

the action of the hormones cortisol, progesterone and chorionic

sommatomammotrophin”. The body can become more resistant to insulin.

According to Lefers (2004), chorionic sommatomammotrophin is “A hormone that

promotes maternal breast development during pregnancy”.

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Relaxin helps to relax the ligaments, as a result, becoming more flexible. Relaxin is

produced from the early weeks of pregnancy. The pelvis-sacroiliac joints and pubis

symphysis joint are mainly affected, according to Romen et al (1991) cited by Rankin

(2002). Although this may be desirable, especially for accommodating the foetus

and delivery of baby, the hormones can affect all joints making them as stated by

Rankin (2002, p.14) “Potentially unstable” [and this is also more prone in] “weight

bearing areas”. [authors words in brackets].

As the pregnancy progresses the musculo-skeletal system is affected, due to the

increased laxity at the pelvis and loss of tone in the abdominal muscles. This may

cause an exaggerated curvature of the lower spine. (Lumbar lordosis). Low back

pain is a common complaint during pregnancy. (Rankin 2002).

Carpal Tunnel Syndrome can occur in late pregnancy this is due to oedema around

the nerves in the wrists. (Mackereth, Tiran 2002).

Reflexology is beneficial to this system as it can help to balance the endocrine

system and insulin production (Enzer n.d.).

The NHS offer help for common problems during pregnancy. All pregnant women

are appointed a midwife to oversee their care and well being during their pregnancy.

[Author].

Drugs may be prescribed during pregnancy for some symptoms like constipation,

haemorrhoids, lack of iron. However it is stated in the BNF (Sept 2009) “Drugs

should be prescribed in pregnancy only if the expected benefit to the mother is

thought to be greater than the risk to the foetus”.

As observed by Mackereth and Tiran (2002, p.124) it has been suggested that

reflexology “Could be an ideal non-pharmalogical way of managing difficult

symptoms”. For example nausea, pain relief, emotional stress and anxiety. In a

case study documented by Mackereth and Tiran (2002, p.141). A pregnant woman

complaining of constipation had not had a bowel movement for 3 weeks. The

midwife performed zone therapy on 2 occasions thus the pregnant client reported

bowel movement twice weekly from this intervention.

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Regular health checks and antenatal screening are very important during pregnancy

both for mother and baby. The NHS offer antenatal classes to help prepare for

arrival of baby. They're informative classes ranging from coping with labour pain,

pregnancy emotions, and exercise and relaxation classes during pregnancy. (NHS,

2010).

In a study and book written by Rankin (2002). Rankin’s study investigated the

effects of regular exercise during and following pregnancy in psychological well

being and birth outcomes. The findings of the study found no difference between the

control group and intervention group in relation to pregnancy birth outcomes

including length of labour, labour duration and mode of delivery. It was not possible

to conclude whether maternal exercise influenced pregnancy and birth outcomes.

Regular exercise did, however, show benefits for the pregnant mothers’

psychological well being.

Lower backache is common and studies, as observed by Mackereth and Tiran

(2002) have shown that if reflexology is required too early then the treatment may

not be as effective.

Pain relief in labour is usually given in the form of an epidural or pethidine. [Author].

Sometimes if labour is slow, to make contractions more effective a Syntocinon drip

which contains an artificial form of the labour hormone, oxytocin can help speed up

the contractions. (NCCWCH 2007).

Reflexology may be a better alternative. According to Mackereth and Tiran (p.144,

2002), reflexology during labour can be very relaxing and pain relieving stating that

“Simple pressure applied to the heels can be very effective during contractions”.

Studies in the UK and Denmark have shown to speed up labour and reduce pain.

Flanagan (2004) Cited in McCulloch (2009) states that

“In a Danish study at the Gentofte Hospital in Copenhagen, 68 women tried

reflexology instead of drugs in labour. An impressive 61 % said they experienced

outstanding pain relief”.

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Liisberg G. (1989) Cited by Cheryl Cole (n.d.) observed that of 593 women giving

birth at the Danish hospital, 89.7% of those choosing reflexology and no analgesic

drugs felt it reduced pain, only 4 of them required additional pain medications. The

study also demonstrated that in about half the cases it helped bring about labour

without further intervention. This is backed by a study by Dr. Gowri Motha.

Dr. Gowri Motha is the pioneer for the use of reflexology in pregnant women. Her

book The Gentle Birth Method has become very popular due to celebrities such as

Gwyneth Paltrow, Elle Macpherson and Kate moss promoting its benefits. (Cole

n.d.). Dr. Motha has researched reflexology in pregnancy and the results are

illustrated below.

Research on Reflexology in Pregnancy and on labour outcomes

Dr. Gowri Motha, Ms Zia Rowji and Dr. Jane McGrath (2004)

For this research study reflexology was given free of charge to 64 pregnant women

from 20 weeks of pregnancy to term. The study was done in 1992-93, in Forest

Gate, London. 37 women completed the course of 10 treatments.

It was shown that reflexology helped with the following problems.

The effects on labour outcomes were outstanding. Labour times ranged from only

2-3 hours. First time mothers and 20-25 year olds had an average first stage labour

of 5-6 hours. (Text book average is 16-24 hours). Second time mothers and 26-30

year olds had longer labours. (It is suggested that these may have fallen in to the

Musculo-skeletal 24.3% Cystitis 5.4%

Heartburn 18.9% Insomnia 5.4%

Oedema 16.2% Irritable Uterus 5.4%

Hypertension 13.5% Migraine 5.4%

Social Stress 10.8% No Problems 5.4%

Immunological Stress 8.1% Nose Bleeds 2.7%

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category experiencing more social stress). The second stage of labour averaged at

16 minutes, textbook expectancy is 1-2 hours. (Motha et al 2004)

Feder et al (1993) cited in (Mackereth and Tiran 2002) has also stated that

reflexology can reduce the length of first stage of labour.

The study also illustrated that normal deliveries were high in mothers receiving

reflexology.

Outcomes for mothers receiving reflexology in the study

Dr. Motha in a different study found that reflexology normalised hypertension.

Dr Motha's study shows good results with reflexology used in pregnancy. A

comparison is shown below between Gentle birth method and the national average

on delivery.

O’Brien (2004) cited in (Motha et al 2004) states that Dr. Motha has solid medical training. She has seen 50000 expectant mothers and that she claims she is able to tell within moments of meeting them those who will have problems.

Normal Deliveries 89.0%

Inductions 5.4%

Forceps 2.7%

Selective C Section 2.7%

Emergency C Section 5.4%

Immunological Stress 8.1% (13% in Newham District)

Gentle Birth Method National Average

Vaginal Delivery 90% 79%

Episiotomies 34% 15%

Epidural 17% 38%

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Dr. Motha does state however that women should not endure more than 8 hours strong labour without an epidural “There is always going to be a need for intervention and why suffer”. (Motha 2004).

Dr Gowri Motha writes in her book, that Reflexology is one of the most powerful tools

in her programme, and describes the benefits of Reflexology treatments throughout

pregnancy which include:

• Reducing and normalising high blood pressure

• Elimination of oedema and reduced swelling in feet and ankles

• Prevention of heartburn

• Improved sleep quality

• Clearing headaches

• Relieving varicose veins

• Clearing pelvic congestion

• Improved lymphatic drainage

• Helping to aid digestion

• Oxygenating the baby by improving the blood flow within the whole body,

helping the uterus and the baby’s placenta.

• Helping to carry the baby to term

• Can be used to prime labour if you are overdue, thereby reducing the need for

medical induction at hospital

• Intensifying contractions during labour and shortening labour as a result

(Cole n.d.)

An article by John Rhind in the Journal of Association of Reflexologists (2009) also

suggests that reflexology can be beneficial in pregnancy and aid labour. He

describes a mother whom he was treating. She had been receiving reflexology

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treatments from John and on the day she returned for priming the mother had her

baby 4 hours later, the birth process took just 12 minutes from first push to birth.

Rhind (2009) states that there are “3 acupressure points that should be avoided for

pregnant feet”. The 3 points in question are used by trained maternity reflexologists

to encourage labour.

“The 3 points are

Spleen 6 located 4 fingers width above the medial ankle bones.

Bladder 60 located on the posterior of each ankle between Achilles tendon and

ankle.

Bladder 67 located on lateral base corner of number 5 toenail.

Spleen 6 produces huge blood flow expelling contents of uterus and bladder 60 and

67 expedite labour by expelling contents of the bladder.”

(Rhind 2009, p.18)

Mackereth and Tiran (2002) have also stated that when labour is slow the

reflexologist may stimulate the pituitary gland and this can increase the strength and

frequency of contractions. They also agree that labour can be initiated using reflex

zone therapy. Tiran the author of Clinical reflexology is a practising midwife and has

with consenting agreement between parties involved encouraged the onset of labour

using reflexology. Tiran estimated if labour was imminent by “Palpating foot zones,

for the anterior and posterior pituitary gland and applying the findings to knowledge

of hormonal changes in late pregnancy”. (Mackereth and Tiran 2002, p.143)

This is perhaps worth further research.

The safety of reflexology in pregnancy has been somewhat debated. Mackereth and

Tiran (p.143, 2002) state that “It is professionally irresponsible for independent

therapists to agree to stimulate uterine contractions [without] adequate consultation”

between therapist, mother and midwife. An article by Flanagan (2004) also states

that although there is no evidence to suggest reflexology would cause a miscarriage,

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unless the reflexologist has been trained to work with pregnant women, e.g. midwife,

then treatment prior to 13 weeks is not recommended.

Dr. Motha also advises that only a gentle foot massage working on upper areas of

foot is advisable before 12 weeks gestation. Although reflexology has been found to

be safe during pregnancy , some midwives have advised against it, stating that it

may cause miscarriage or provoke early labour.

Dr Laurence, an obstetrician asked Dr. Motha to research whether reflexology was

safe in pregnancy. The findings were presented at the Clinical Governance in

Maternity Services in 2001. The graph below illustrates the findings. The 1.7% born

at 36 weeks was twins.

Safety of Reflexology in Pregnancy Graph [Internet] Available at http://

www.gentlebirthmethod.com/birth_prep/body_reflexology.html

Mackereth and Tiran (p.133,2002) emphasise that “Therapeutically appropriate

reflexology will not cause pregnancy complications”.

There is no research evidence to support or deny this.

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There are however some contraindications to reflexology in pregnancy these include

pre-term labour and placenta praevia (Flanagan, 2004). DVT and a risk of pre-

eclampsia. (Enzer, n.d). If a women complains of headaches particularly in later

pregnancy a medical examination would be appropriate to exclude pre-eclampsia or

impending eclampsia (Yongshen & Xiaolian 1995) cited in (Mackereth and Tiran

2002).

What research there is on reflexology is shown to be beneficial and could be

considered an option for pregnant mothers to have reflexology available on the NHS,

for treating specific disorders such as constipation, carpal tunnel syndrome, lumbar

lordosis to name a few, as well as treating symptoms of labour and to accelerate

labour.

Looking at the research available it would perhaps be more beneficial and especially

in these days of litigation for reflexologists to be trained in maternity reflexology and

have specialist knowledge of physiological changes and possible complications in

pregnancy.

As stated by Mackereth and Tiran (2002, p.144) “Reflexology for this client group is

complementary to any orthodox maternity care provided”.

Further investigation and more clinical research are needed to prove the benefits of

reflexology in pregnancy. A larger randomised controlled trial providing strong

evidence, would give the medical science world some answers, however quality

approaches to patients experience of reflexology should be taken into consideration,

when assessing the value of reflexology.

How and why associated areas, cross reflexes and the spinal chart would be used in planning treatments for pregnancy symptoms.

SYMPTOM ASSOCIATED

AREA

CROSS REFLEXES SPINAL CHART

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Heartburn Stomach Solar plexus, adrenals,

liver, gall bladder,

intestines

6T

Thrush Uterus Fallopian tubes,

thymus, urethra, anus.

6T

Nausea Morning

sickness

Stomach Ovaries, uterus, thyroid,

oesophagus.

6T

Vomiting morning

sickness

Stomach Ovaries, uterus, thyroid,

oesophagus.

6T

Headache Head, neck Face, sinuses, eyes,

solar plexus, stomach,

small and large

intestine, liver, gall

bladder, pituitary,

thyroid, adrenals,

ovaries.

1C

Migraine Head, neck Same as headache 1C

Carpal tunnel

syndrome

Area affected Neck, lymphatic,

circulatory

1T

Constipation Large intestine Solar plexus, small

intestine, liver, gall

bladder, adrenals,

pancreas.

1L

Lumbar lordosis

Lower backache

Lower back Sacro-iliac, sciatic

nerve, knees, hip and

pelvis, solar plexus,

adrenals.

4L

Sciatica Primary and

secondary

sciatic nerve

4L

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(Tucker 2008) (Hartman 1995) (Rhind 2009) (Mackereth and Tiran 2002) (Cross

Reflexes, Areas of assistance – J O’Hanlon, reflexology notes, Newcastle College)

(Parsons 2003)

Cross reflexes may be used in the event of contraindicated parts, for example,

working the hands instead of the feet, if client is an amputee or has a skin disease

on the foot.

Cross reflexes are also used as areas of assistance or helper areas. The therapist

can work away from the contact points for a specific problem. For example:

Haemorrhoids Rectum Large intestine,

adrenals, solar plexus

Coccyx

Induce labour Spleen 6, bladder 60

and 67, pituitary

Anaemia 5T, 9T

High blood

pressure

Heart Solar plexus, adrenals,

kidneys, head, brain

1C, 7C

Respiratory Lung Digestive 1T

Labour pain Pelvis Hip

Stress Whole treatment Adrenals 1C

Varicose veins Heart and reflex

area associated.

Intestines, liver,

adrenals

2L

Hip Hip Solar plexus, sciatic

nerve, adrenals, pelvic

muscles

Lumbar, sciatic

and cervical

Gestational

diabetes

Pancreas Adrenals, pituitary, liver,

kidneys, eyes

9T, 7T

Incontinence Bladder, kidneys,

urethra

Adrenals 3L

Oedema Lymphatic Spleen, kidneys, heart,

adrenals.

5L, 12T

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Bad shoulders – located in zone 5, we need to think what else is in zone 5 – so the

knees, hip and pelvis. Working these areas will help the shoulder as it will clear the

zone (O’Hanlon, verbal, Gillanders 2000).

Our body systems work in unison with one another, therefore a full reflexology

treatment should be carried out, paying particular attention to the areas directly

associated with the problem as well as the cross reflexes, this will ensure harmony of

the body and relief of stress (Parsons 2003)

Another example could be constipation. This is a symptom of pregnancy. Working

the direct reflex would be the large intestine as it is responsible for the removal of the

waste products from digestion.

The cross reflexes as demonstrated in the table would be the small intestine,

stomach, liver, gall bladder, pancreas. These are accessory organs, which the

digestive system relies upon. They have a function in the overall effect of the body’s

wellbeing, including ingestion, digestion, absorption and elimination, so working

these areas aids the healthy function of the digestive system (Parsons 2003).

Working the spinal reflexes affects the whole body. It is the area where all the

nerves are and therefore it is the communication network of the body (Tucker 2008).

For example: Hip pain, which can be associated with pregnancy. The cross reflexes

on the spine would be the lumbar, sacral and coccyx area. The sacral plexus area of

the nerves contains the 4th and 5th lumbar nerve, the 1st 4 sacral nerves, which

supply the pelvis, buttocks and part of the legs and the sciatic nerve branches from

this area. Sciatic is also a common problem during pregnancy, so all this area could

be worked during a reflexology treatment for the hip symptoms.

In relation to constipation 1L would be worked this is where the lumbar plexus is and

this supplies the abdomen and groin. (Parsons 2003).

In reflexology a spinal chart is used. It can be used 2 ways. If the client has a

problem i.e. a headache, then the reflexologist would work 1C or for constipation 1L

as the nerves in the spine relate to these areas. Another way to use the chart is

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when the reflexologist is working the spine, they may come across a painful spot.

The spinal chart can be consulted to see if the client has that particular problem that

the sore spot relates to, i.e. 2L painful = appendicitis, cramp. (O’Hanlon, verbal

2010).

Appendix A demonstrates the spinal chart. Appendix B demonstrates the

spinal nerves.

How drugs would affect the feeling in the feet when carrying out a treatment

and examples of this.

Areas in the body can become congested because of the medications clients are

taking. (Gillanders 2000).

A client of mine [author] who suffers with high blood pressure and arthritis always

has sensitivity in the kidney and ear reflex, this is a side effect of her blood pressure

tablets.

Anti-histamines create inflammation in the kidney reflex. Aspirin can cause stomach

ulceration. (Gillanders 2000).

Alcohol anaesthetises the foot. (O’Hanlon 2010, verbal). Steroids create sensitivity

in the foot, therefore client would be unable to tell the therapists if areas were

sensitive. (Gillanders 2000).

Antacids have chalk content and this has an effect on the kidney, painkillers may

cause constipation. People taking amphetamines, usually have sensitivity in the

adrenal glands and the brain. Sleeping pills and anti depressant tablets cause

sensitivity in the brain reflex. Antibiotics upset the balance of the body, destroying

the natural flora content in the intestines. (Gillanders 2000).

It would be advisable therefore for the therapist to work all areas of elimination to

replace the natural bacteria or flora of the stomach once the medication has finished.

The study will discuss the role of the practitioner in educating clients about

holistic approaches to improving and maintain their health.

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The word holistic comes from the Greek word holos meaning whole. (Tucker 2008,

Parsons 2003.)

The client’s lifestyle will have determining factors in their overall health and

wellbeing. They will be required to self help to de-stress, and the therapist can

advise on things to help with this, for example yoga. The client will also need to look

at their diet and perhaps incorporate healthy eating, with plenty of fresh fruit and

vegetable. Exercise would also be beneficial, even just walking outside in the fresh

air.

Working on improving this will bring body, mind and spirit into equilibrium, otherwise

known as homeostasis, all the body working in harmony (Parsons 2003).

If healing is to take place then the client needs to be aware of what their body

requires, and respond accordingly. Parsons (2003, p.114) states “The old saying,

you can take a horse to water but cannot make it drink.” is somewhat appropriate.

Clients need to understand that if the condition that caused the problem in the first

place is still there, then the problem will continue (Tucker 2008).

Things such as poor posture could be addressed. The therapist could recommend

things like, getting plenty of sleep and fresh air, eating organic veg, addressing their

stress issues, drinking plenty of water, taking regular exercise, watching their alcohol

intake, avoiding smoking and smoky atmospheres, reduce or cut out caffeine intake.

Try to live as healthy a lifestyle as possible. All these factors should be taken into

account to enable a holistic approach to health and wellbeing.

The study closes with some recent developments regarding the NHS and

reflexology.

After a recent debate in the House of Lords, it concluded that all major forms of

complementary health are integrated into mainstream healthcare, as such an NHS

directory of reflexologists has been compiled, this enables GP’s access to

practitioners during consultation.

Some maternity units have their own reflexologist or have access to one.

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The NHSTA cited in (Babyworld, n.d.) says “Many NHS practitioners now endorse its

use, some recommending that patient consult a reflexologist privately, with a growing

number prepared to fund treatment via the NHS”.

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APPENDIX A

SPINAL CHART

(Hartman RL Dr. 1995)

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APPENDIX B

(Fox and Pritchard 2003, p194)

March 2010 18

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Foundation Degree Complementary Therapiesfootstepsreflexologyschool.com/docs/CTH405... · Gestational diabetes 1 March 2010 . Foundation Degree Complementary Therapies CTH405 Reflexology