Use of Complementaries By Pregnant Women

Background: Complementary itoms (CI), Traditional therapies (TTs), and Alternative therapies (ATs) use is common. ATs and TTs are used singly or with modern medicare for prevention, treatment as complementary therapy (CT), even during pregnancy globally. Their use seems to have increased, even in developed countries, with little recorded evidence of reasons for use, efficacy, and side effects. Objectives: To know types of complementaries or CT used by pregnant women and reasons for use. Material Methods: Present study was carried out. by interviews of 1200 women with predesigned tool in postnatal wards a day after delivery. More rural women delivered, but were equalized, 600 rural, 600 urban. Results: Use of CI/CT was reported by 11.4% rural,11.2% urban women. Most frequently used item was Kesar (3%) during pregnancy, Coram seeds (2%) during labour, Aniseed (0.75%) and Coram seeds (0.75%) in postpartum. period with no difference weather rural or urban, less or more educated or of any, economic class. Those with physical symptoms were more likely to use CT/CI. Primigravida used for having natural birth. Six percent used CI postpartum for better lactation, elevated mood, prevent postpartum depression.


Background
Traditional modes of prevention and treatment have always played a role in health care. They are used globally, and their use seems to have increased, even in the developed countries [1][2][3][4][5].
It was believed that almost four billion people worldwide used such therapies [6], either because nothing else was available, or accessible or not affordable or due to dissatisfaction with the modern medicine or may be the faith on such modes. In the Indian culture, use of traditional therapies (TT) have always been there.
Am Fam Physician reported that in the present times women use TT with conventional modern medicine specially during pregnancy as complementary therapies (CTs). Some use kitchen itoms as complementary itoms (CI) While reviews have concentrated on the use of CI/CTs by pregnant women with recommendations for use by health professionals too during pregnancy, findings of relevant CTs-based studies have placed less emphasis on critically appraising the core elements of study designs and reporting.
Limited reviews of CTs recommendations made by healthcare professionals revealed that CTs, particularly Aayurvedic, Herbal

Results
When the details of the use of CIs/CTs, in the past pregnancy were asked it was revealed that it was mainly use of CIs. Massage was universal. Kesar was used by 0.92% urban and 0.83% rural women. Other items specially used were honey and dry fruits (Table 2).    and 3% respectively, Dry fruits by 0.8% and Coconut water by 7%. Chavanprash was used by 0.3% rural women and 0.3% urban women. Honey was also used Chavanprash and Honey were considered source of energy for the mother and baby (Table 3 & 4).          1   600  600  600  2  598  7  593  3  597  3  597  4  596  19  581   Total  1200  1200  3  1197  9  1191  5  1195  9  1191  4  CIs like. Honey, Jaggery water, Jira water, Glucose water and Sugar water were also given to the babies. Over all 4.3% women gave CIs to their babies. Mostly Honey and jira water. with no difference in rural or urban women. Over all 4% women gave CIs to babies, Honey or Sugar in water, by 1.8% followed by Jaggery. It was revealed that more urban women, 34 (5.6%) used CIs for baby compared to rural women 18 (3%). CTs for baby were considered a source of energy to the newborn as well as were believed to boost the immunity of the newborn in conjunction with breastfeeding ( Table 6). Tradition of massage was almost universal, legs and back during pregnancy and all over the body in postpartum, and to the baby too. This was irrespective of economic status or education.   Total  600  600  5  8  2  6  4  3  3  2  1  34  566   Total  1200  1200  11  11  5  8  6  4  3  3  1  52  Truijens et al. [13] reported that many women were habitual users of such items in daily life. So, they continued using them even in pregnancy and delivery with the belief that CTs/CIs prepared the body better for pregnancy and labor. It was found that CIs were used more often in labor by primigravidae. This could be due to anxiety about the birthing experience with a lower threshold for tolerance of minor ailments, pain and desire of better birthing experience. And also, women listened to whatever was told by the family. Most expectant women used CIs on advice of family and friends, and they did not disclose use of CIs to their care providers.
Skouteris [14] in his study, reported that half the Australian women surveyed consulted ATs practitioner for pregnancy related health conditions. It was quite common for women to consult multiple AT practitioners alongside their conventional maternity care providers.
If a woman consulted a AT practitioner and conventional care provider simultaneously for the management of the same condition, without disclosing use of ATs to either practitioner, this could creat risk for mother or baby or both through possible pharmacological interactions between treatments or broader conflicts between the treatment goals of the two (or more). Bridee [15] reported that Study by Hollyer [18] revealed a generalized lack of knowledge and poor understanding of the possible risks to women. and researcher reported that women's holistic needs may not be met within a medical model of maternity care So CTs have a place. Many pregnant women who used CTs did not know whether they did good or bad to the mother and/ or the baby. The lack of awareness could lead to serious hazards in the mother and /or the baby. Massage and Aromatherapy were used for treating anxiety, Acupressure for back and pelvic pain and Acupressure, and ginger for morning sickness is known.
In the present study in past pregnancy less women had taken traditional medicine and Low Dog [19] reported that they had lack of knowledge of these products and hesitated because the safety of these products was not known. The women felt that they could have better control of pregnancy and improved growth of the baby.
In general, CTs are increasingly being integrated into maternity care [20]. Use of Herbal and other natural treatments have been reported to be increasing in the United States and Canada, also as valid treatments [21]. Because Herbal and other natural remedies were not regulated to the same degree as traditional pharmaceutical products, use in pregnancy a potentially vulnerable time for both 253 mother and fetus, so monitoring such things was thought to be essential [22]. Kesar and Carom seed use in pregnancy as per their traditional belief, cleaned the stomach and helped in reducing vomiting and indigestion. During post-partum period it increased the energy in the body and prevented infection Health and Balanve Guife [23] reported that for Nausea; Acupuncture, Acupressure, Ginger root worked well and were considered safe for pregnant women, Exercise, hypnosis and on Herbs close to the skin have been stated to be beneficial in turning a breech baby. Relaxation techniques, patterned breathing, emotional support, and selfhypnosis are already widely used CT in labor. Robust research is needed to understand their utility, benefits and concern if any.
Pregnant women struggle with various health issues that can affect fetal development and normal delivery in the present study overall use was somewhat lower than expected. Conovar [24] from a single, urban hospital found that, 4.1% of women reported using an Herbal or other natural remedy, which was lower than our overall rate.
During labour Coram seeds were consumed by women with the beliefs that the conventional medications did not cover all the ailments and CI provided better and faster relief of symptoms.
Moreover, they prepared the uterus and cervix for a better birthing experience and increased the chances of natural birth.
Women reported CIs improved lactation and specially in prim para lowered the chances of postpartum depression, elevated mood and symptomatically treated minor ailments. For the baby honey was the commonest CI given. According to Pallivalappila et al. [25] the application of a consistent and useable CTs definition proved to be a major issue. However, what is used, why is used are not well known.
There are very few high-quality studies about the effectiveness CTs or ATs and more studies are needed. Studies should focus on the safety of specific with respect to wide range of pregnancy conditions and outcomes. Indeed, whether or not a particular therapy is deemed to be CTs may differ between countries, healthcare settings, and specialities. The lack of definitions and checklists may explain why the reported prevalence of CTS use appears to be highly variable, even within similar populations. However, what is used, why is used are not well known. Research is needed.

Conclusion
Community based research is needed to gain a greater understanding of the true use of AT, TT, CTs, CIs by pregnant women.
Health professionals should ask women about use. It is essential to know what they use during pregnancy, labour and after delivery.