Pain Management in Pregnancy: Multimodal Approaches

Table 3

Complementary medicine.

Therapy	1st trimester	2nd trimester	3rd trimester	Labor	Postpartum
CAM (acupuncture, acupressure, massage) [52, 53]	Do not use (may stimulate uterine contractions)	Use with caution; (experienced therapist; not a high risk pregnancy)	Use with caution; (experienced therapist; not a high risk pregnancy)	Use with caution; (experienced therapist; not a high risk pregnancy)	Safe
Physical therapy (TENS unit) [52]	Safe	Safe	Safe	N/A	Safe
Hydrotherapy/aqua therapy [54]	Use with caution (avoid hot tubs)	Use with caution (avoid hot tubs)	Use with caution (avoid hot tubs)	Use with caution (birthing pool)	Safe (avoid if C-section)
Cognitive behavioral therapy, biofeedback [52]	Safe	Safe	Safe	Safe	Safe
Chiropractic care [54]	Use with caution (pressure off abdomen)	Safe	Use with caution; (avoid lying on back)	N/A	Safe

The use of complementary and alternative medicine (CAM) is on the rise in Western countries as the research focusing on its use has intensified over the last decade [55]. The World Health Organization (WHO) defined CAM as “a broad set of health practices that are not part of a country’s own tradition, or not integrated into its dominant health care system [52].” CAM is utilized in various treatment populations including parturient. There have been several large-scale surveys, which indicate that 48% of all women of childbearing age currently use at least one CAM therapy for health-related problems [52]. Studies have shown that women, who are older, have higher education and income and are more likely to use CAM therapies for their physical symptoms during pregnancy. Other associations such as previous use of CAM, primiparity, nonsmoking, and planning a natural birth were also directly correlated with consumption of CAM [53]. A common belief amongst users of CAM is that it is considered natural, safe, and/or having equal efficacy when compared to medical treatments for pregnancy and its related symptoms. However, the research to support the common beliefs and perceptions is limited and the potential risks to mother and fetus are unknown [55].