Midwives’ support for Complementary and Alternative Medicine: A literature review

Effect of dance labor on the management of active phase labor pain & clients' satisfaction: a randomized controlled trial study

BACKGROUND

There are a wide variety of non- pharmacologic pain relief techniques for labor which include pelvic movement, upright position, back massage and partner support during the first stage of labor. The effectiveness of dance labor- which is a combination of these techniques- has not been evaluated.

AIM

This study aimed to evaluate the effectiveness of dance labor in pain reduction and woman's satisfaction during the first stage of labor.

METHODS

60 primiparous women aged 18-35 years old were randomly assigned to dance labor and control groups. In the dance labor group, women were instructed to do standing upright with pelvic tilt and rock their hips back and forth or around in a circle while their partner massaged their back and sacrum for a minimum of 30 minutes. In the control group, the participants received usual care during physiologic labor. Pain and satisfaction scores were measured by Visual Analogue Scale. Data were analyzed by using the t. test and Chi-square.

FINDINGS

Mean pain score in the dance labor group was significantly lower than the control group (P < 0.05). The mean satisfaction score in the dance labor group was significantly higher than in the control group (P < 0.05).

CONCLUSION

Dance labor which is a complementary treatment with low risk can reduce the intensity of pain and increase mothers, satisfaction with care during the active phase of labor.

The self-prescribed use of aromatherapy oils by pregnant women

BACKGROUND

While some studies have reported effectiveness of aromatherapy oils use during labour there is no reported evidence of efficacy or risks of aromatherapy oils use for pregnancy-related symptoms or conditions. A number of aromatherapy oils are unsafe for use by pregnant women yet there is currently no research examining the prevalence and characteristics of women who use aromatherapy oils during pregnancy.

AIM

To conduct an empirical study of the prevalence and characteristics of women who use aromatherapy oils during pregnancy.

METHODS

The research was conducted as part of the Australian Longitudinal Study on Women's Health (ALSWH), focusing on the nationally representative sample of Australian women aged 31-36 years. Data were collected via a cross-sectional questionnaire (n=8200) conducted in 2009.

RESULTS

Self-prescribed aromatherapy oils were used by 15.2% of pregnant women. Pregnant women were 1.57 (95% CI: 1.01, 2.43) times more likely to self-prescribe use of aromatherapy oils if they have allergies or hayfever, and 2.26 (95% CI: 1.34, 3.79) times more likely to self-prescribe use of aromatherapy oils if they have a urinary tract infection (UTI).

CONCLUSION

Our study highlights a considerable use of aromatherapy oils by pregnant women. There is a clear need for greater communication between practitioners and patients regarding the use of aromatherapy oils during pregnancy, as well a need for health care practitioners to be mindful that pregnant women in their care may be using aromatherapy oils, some of which may be unsafe.

Complementary and Alternative Medicines Use during Pregnancy: A Systematic Review of Pregnant Women and Healthcare Professional Views and Experiences

Aims. To undertake a systematic review of the recent (2008-2013) primary literature, describing views and experiences of CAM use during pregnancy by women and healthcare professionals. Method. Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Review Library and Allied, and Complementary Medicine Database were searched. Studies reporting systemic CAM products (homeopathic preparations, herbal medicines, Vitamins and minerals, homeopathy, and special diets) alone or in combination with other nonsystemic CAM modalities (e.g., acupuncture) were included. Results. Database searches retrieved 2,549 citations. Removal of duplicates followed by review of titles and abstracts yielded 32 relevant studies. Twenty-two reported the perspectives of women and their CAM use during pregnancy, while 10 focused on healthcare professionals. The majority of studies had significant flaws in study design and reporting, including a lack of appropriate definitions of CAM and associated modalities, absence of detailed checklists provided to participants, the use of convenience sampling, and a general lack of scientific robustness in terms of data validity and reliability. Conclusion. To permit generalisability of study findings, there is an urgent need to expand the evidence base assessing CAMs use during pregnancy using appropriately designed studies.

Homeopathy in rural Australian primary health care: a survey of general practitioner referral and practice in rural and regional New South Wales, Australia

INTRODUCTION

Homeopathy has attracted considerable recent attention from the Australian conventional medical community. However, despite such increased attention there has been little exploration of the interface between homeopathy and Australian conventional medical practice. This article addresses this research gap by exploring homeopathic practice and referral by rural and regional Australian general practitioners (GPs).

MATERIALS AND METHODS

A 27-item questionnaire was sent to all 1486 GPs currently practising in rural and regional New South Wales, Australia (response rate 40.7%).

RESULTS

Few GPs in this study utilised homeopathy in their personal practice, with only 0.5% of GPs prescribing homeopathy in the past 12 months, and 8.5% referring patients for homeopathic treatment at least a few times over the past 12 months. Nearly two-thirds of GPs (63.9%) reported that they would not refer for homeopathy under any circumstances. Being in a remote location, receiving patient requests for homeopathy, observing positive responses from homeopathy previously, using complementary and alternative medicine (CAM) practitioners as information sources, higher levels of knowledge of homeopathy, and being interested in increasing CAM knowledge were all independently predictive of increased referral to homeopathy amongst GPs in this study. GPs in this study were less likely to refer to homeopathy if they used peer-reviewed literature as the major source of their information on CAM.

CONCLUSIONS

Homeopathy is not integrated significantly in rural general practice either via GP utilisation or referral. There is significant opposition to homeopathy referral amongst rural and regional GPs, though some level of interaction with homeopathic providers exists.

Physical and psychologic effects of aromatherapy inhalation on pregnant women: a randomized controlled trial

OBJECTIVES

Stress reduction care is important for pregnant women to decrease obstetric complications and children's health problems after birth. The aim of this study is to clarify the physical and psychologic effects of inhalation aromatherapy on pregnant women. Essential oils with high linalool and linalyl acetate content that may be used during pregnancy were selected and among these, and the one preferred by the participant was used.

DESIGN

This was a prospective, randomized, controlled trial.

SETTINGS/LOCATION

This trial was performed at a gynecology outpatient department in a hospital in Kyoto, Japan.

PARTICIPANTS

The study included pregnant women in week 28 of a single pregnancy with a normal course.

INTERVENTIONS

Participants were randomly assigned into an aromatherapy group and a control group. They were seated in the resting, seated position for 10 minutes. During the latter 5 minutes of each 10-minute session, aromatherapy inhalation was performed for the aromatherapy group.

OUTCOME MEASURES

Before and after the intervention, the Profile of Mood States (POMS) was measured. During the trial, the heart-rate fluctuations were measured for the autonomic nervous system regulation.

RESULTS

A total of 13 pregnant women participated in the trial. Seven (7) participants were assigned to the aromatherapy group and 6 participants to the control group. The results of the POMS were such that based on an intragroup comparison, significant differences were observed in the Tension-Anxiety score (p<0.05) and the Anger-Hostility score (p<0.05), and the respective improvements observed were due to aromatherapy. The results of the autonomic nervous system regulation were such that based on an intragroup comparison within the aromatherapy group, the parasympathetic nerve activity increased significantly (p<0.05).

CONCLUSIONS

Aromatherapy inhalation using essential oils containing linalyl acetate and linalool was found to be effective for the POMS and parasympathetic nerve activity, based on an intragroup comparison. However, based on a comparison between the groups, no substantial difference was observed; hence, further study is necessary in the future.

Holistic Pregnancy Care: Aligning Complementary and Alternative Medicine With Midwifery Practice

BACKGROUND:The use of complementary and alternative medicine (CAM) to manage pregnancy-related conditions is becoming increasingly popular. This article draws on a qualitative study that aimed to explain the processes midwives engaged when determining the role of these therapies for pregnancy care.

METHODOLOGY:Our study used grounded theory methodology. Twenty-five midwives, who were employed in metropolitan hospitals situated in Victoria, Australia, participated in the study. Data was collected from semistructured interviews and nonparticipant observation of a subgroup over an 18-month period.

RESULTS:Midwives’ attitudes and behavior toward the CAM was influenced by their professional ideology and knowledge. When participants considered the role of these therapies, they employed various strategies including aligning CAM with midwifery philosophy, using the therapies to increase women’s options, valuing diverse ways of understanding and seeking out professional knowledge.

CONCLUSIONS:Although midwives do not reject conventional medicine, many value the opportunity CAM offers to individualize care and promote natural childbearing.

The use of complementary and alternative medicine by nurses

BACKGROUND

Complementary and alternative medicine (CAM) use is common among patients attending the department of the authors of this article. With expanding roles of nurses in various clinics, the nurses are often asked for their advice on CAM use by their patients. CAM education is not part of the nursing curriculum in various parts of the world. The aim of this study was to establish the use of CAM by nurses along with their knowledge base and attitudes towards it.

METHODS

A questionnaire-based study based on the published literature was used among qualified nurses. The data were collected and analysed using SPSS for Windows.

RESULTS

The response rate was 86% (531/621; females were 91% and the mean age was 32 years (range 20-63). Eighty percent of the responders admitted to use of CAM and 41% were using CAM at the time. The most commonly mentioned CAM were massage, cod liver oil and cranberry juice. CAM was mostly used for relaxation, joint pain and urinary tract infection. Only five nurses believed CAM was not effective and 74% would recommend CAM use to others. Ninety-three percent of nurses did not have any formal education on CAM. Most nurses would consider some education on CAM to enable them to counsel their patients.

CONCLUSIONS

The use of CAM is high among nurses. As patients are increasingly relying on nurses for advice on its use, it is important for nurses to be educated about CAM in order to guide their patients.

Moxibustion for cephalic version: a feasibility randomised controlled trial

Background

Moxibustion (a type of Chinese medicine which involves burning a herb close to the skin) has been used to correct a breech presentation. Evidence of effectiveness and safety from systematic reviews is encouraging although significant heterogeneity has been found among trials. We assessed the feasibility of conducting a randomised controlled trial of moxibustion plus usual care compared with usual care to promote cephalic version in women with a breech presentation, and examined the views of women and health care providers towards implementing a trial within an Australian context.

Methods

The study was undertaken at a public hospital in Newcastle, New South Wales, Australia. Women at 34-36.5 weeks of gestation with a singleton breech presentation (confirmed by ultrasound), were randomised to moxibustion plus usual care or usual care alone. The intervention was administered over 10 days. Clinical outcomes included cephalic presentation at birth, the need for ECV, mode of birth; perinatal morbidity and mortality, and maternal complications. Feasibility outcomes included: recruitment rate, acceptability, compliance and a sample size for a future study. Interviews were conducted with 19 midwives and obstetricians to examine the acceptability of moxibustion, and views on the trial.

Results

Twenty women were randomised to the trial. Fifty one percent of women approached accepted randomisation to the trial. A trend towards an increase in cephalic version at delivery (RR 5.0; 95% CI 0.7-35.5) was found for women receiving moxibustion compared with usual care. There was also a trend towards greater success with version following ECV. Two babies were admitted to the neonatal unit from the moxibustion group. Compliance with the moxibustion protocol was acceptable with no reported side effects. Clinicians expressed the need for research to establish the safety and efficacy of moxibustion, and support for the intervention was given to increase women's choices, and explore opportunities to normalise birth. The sample size for a future trial is estimated to be 381 women.

Conclusion

Our findings should be interpreted with caution as the study was underpowered to detect statistical differences between groups. Acceptance by women and health professionals towards moxibustion suggest further research is warranted.

Trial Registration

Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000985280