Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: an integrative review

Utilisation of supplementary prenatal screening and diagnostics in Germany: cross-sectional study using data from the KUNO Kids Health Study

BACKGROUND

Appropriate health system utilisation during pregnancy is fundamental for maintaining maternal and child's health. To study the use and determinants of supplementary prenatal screening and diagnostics in Germany this study provides comprehensive data.

METHODS

We obtained data from a recently established prospective German birth cohort study, the KUNO Kids Health Study. Analyses are based on Andersen's Behavioural Model of health system use, which distinguishes between predisposing (e.g. country of birth), enabling (e.g. health insurance) and need factors (e.g. at-risk pregnancy). We examined bi- and multivariate association with the use of supplementary prenatal screening and diagnostics using logistic regression.

RESULTS

The study has a sample size of 1886 participating mothers. One fifth of the mothers investigated did not use any supplementary prenatal screening or diagnostics. Notably, the chance of using supplementary prenatal screening and diagnostics more than doubled if the pregnant woman had a private health insurance (OR 2.336; 95% CI 1.527-3.573). Higher maternal age (OR 1.038; 95% CI 1.006-1.071) and environmental tobacco smoke exposure (OR 1.465 95% CI 1.071-2.004) increased the use of supplementary prenatal screening and diagnostics. However, regarding need factors only having an at-risk-pregnancy (OR 1.688; 95% CI 1.271-2.241) showed an independent association.

CONCLUSION

The important role of the type of health insurance and the relatively small influence of need factors was surprising. Especially with respect to equity in accessing health care, this needs further attention.

Complementary medicines and therapies in clinical guidelines on pregnancy care: A systematic review

BACKGROUND

There is a need for evidence-based guidance on complementary medicines and therapies (CMT) use during pregnancy due to high prevalence of use and lack of guidance on the balance of benefit and harms.

AIM

Evaluate the extent to which current clinical practice guidelines relevant to Australian healthcare professionals make clear and unambiguous recommendations about CMT use in pregnancy, and synthesise these recommendations.

METHODS

The search included EMBASE, PubMed, the National Health and Medical Research Council's Clinical Practice Guidelines Portal, and websites of Australian maternity hospitals and professional/not-for-profit organisations for published guidelines on pregnancy care. Data were synthesised narratively. Guidelines were appraised by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

FINDINGS

A total of 48 guidelines were found, of which 41% provided recommendations that were not limited to routine vitamin and mineral supplementation. There were wide variations in recommendations, particularly for vitamin D and calcium. There was some consensus on recommending ginger and vitamin B6 for nausea and vomiting, and additional supplementation for women with obesity. Guidelines generally scored poorly in the domains of editorial independence and rigour of development.

DISCUSSION

There is a lack of guidance with regard to appropriate CMT use during pregnancy, which may result in less-than-optimal care. Inconsistency between guidelines may lead to variations in care.

CONCLUSION

Guidelines should include clear and unambiguous guidance on appropriate CMT use during pregnancy, be based on a structured search of the evidence and informed by stakeholder engagement.

Midwives knowledge and education/training in complementary and alternative medicine (CAM): A national survey

Despite the proliferation of research exploring complementary and alternative medicine (CAM) use in maternity care and midwifery practice, there is a gap on midwives' level of CAM knowledge and education/training. This national survey investigated Australian midwives' knowledge and education/training in CAM. A total of 571 midwives completed the survey (16%). Over half (54.3%) had some level of CAM education/training (self-learning to diploma) and with multiple CAM modalities. The top four modalities that midwives had received education/training were acupressure (66.5%), aromatherapy (60.3%), massage (45.5%), and reflexology (37.7%). There was a significant correlation between midwives attending a CAM workshop with competency-assessment (p < 0.000) and confidence to discuss CAM options with pregnant women compared with participants who have not. There are no other health-related therapies used by women consumers with such frequency where clinicians are not expected to have baseline knowledge and understanding. Midwifery education programs need to include evidence-based information on CAM modalities.

Providing maternity care from outside the system: perspectives of complementary medicine practitioners

One in two women in Australia use complementary medicine (CM) during pregnancy including consulting with CM practitioners for pregnancy-related health concerns. Yet, very little is known about the everyday care and practice of this group of health professionals as it relates to the provision of care to childbearing women. As such, this study aims to examine the perceptions and experiences of CM practitioners who provide care to childbearing women. Semi-structured interviews were conducted with 23 practitioners from six CM professions (acupuncturists, doulas, chiropractors, massage therapists, naturopaths, and osteopaths) who identified as providing care to pregnant and birthing women in their clinical practice. The participants described professional issues affecting their provision of care to childbearing women including scope of practice, regulation and standards, and practice-specific issues, all of which they linked back to their profession and the reputation of their profession among other health professionals and the community. The study results draw attention to the importance of considering the perspectives of CM maternity care providers and place on interprofessional collaboration, as well as the barriers they face to achieving this collaboration. The insights afforded by this study have the capacity to inform new policy and practice initiatives to support improved interprofessional maternity care.

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Background

The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.

Methods

We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.

Results

Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Conclusion

TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.

Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour

OBJECTIVE

To assess whether the multitherapy antenatal education 'CTLB' (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings.

DESIGN

Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data.

METHODS

We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group.

RESULTS

If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group.

CONCLUSION

The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%.

TRIAL REGISTRATION NUMBER

ACTRN12611001126909.

Descriptive study of interprofessional collaboration between physicians and osteopaths for the pediatric population in Quebec, Canada

Background

Osteopathy is an increasingly popular healthcare approach that uses a wide variety of therapeutic manual techniques to address pain and somatic dysfunction. In Quebec, Canada, osteopathy is the complementary medicine most often recommended by family physicians. However, factors fostering the development of interprofessional collaboration (IPC) between physicians and osteopaths are unknown. This study aimed to describe the current situation in terms of IPC among practitioners working with pediatric patients.

Methods

A self-administered questionnaire was sent to osteopaths, family physicians, and pediatricians involved with pediatric patients in the province of Quebec. The postal questionnaire captured general knowledge about osteopathy and its practice parameters and role, sources of information, communication aspects including having a professional relationship and referrals, and influence of the upcoming government regulation. Quantitative data from the questionnaires were analyzed using descriptive statistics. Logistic regression model for factors associated with osteopathic referrals and multiple linear regression analyses for the number of correct answers about general osteopathic practice parameters were performed.

Results

A total of 274 physicians (155 family physicians (response rate 13%) and 119 pediatricians (17%)) and 297 osteopaths (42%) completed the survey. According to physicians, osteopathy was most appropriate for musculoskeletal pain (241; 91%) and plagiocephaly (235; 88%). Osteopathic referral was positively associated with having a professional relationship (odds ratio [OR] 4.10 (95% confidence interval [CI] 2.12; 7.95), p < 0.001), personal consultation (OR 2.58 (95% CI 1.35; 4.93), p = 0.004), community-based practice (OR 1.89 (95% CI 1.03; 3.47), p = 0.040), and belief in the active role of osteopathy for pediatric conditions (OR 1.22 (95% CI 1.01; 1.47), p = 0.042). The majority of physicians (72%) and osteopaths (62%) considered the upcoming government regulation of osteopathy a positive factor for collaboration.

Conclusion

Some collaboration already exists among these practitioners, including mutual referrals, but optimizing this collaboration still poses some challenges.

Substantial out-of-pocket expenditure on maternity care practitioner consultations and treatments during pregnancy: estimates from a nationally-representative sample of pregnant women in Australia

Background

A wide range of health care options are utilised by pregnant women in Australia. The out-of-pocket costs of maternity care in Australia vary depending on many factors including model of care utilised, health insurance coverage, and women’s decision to access health services outside of conventional maternity care provision.

Methods

Women from the 1973–78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) who identified as pregnant or as recently having given birth in 2009 were invited to complete a sub-study questionnaire investigating health service utilisation during their most recent pregnancy.

Results

A total of 1,835 women agreed to participate in the sub-study. The majority of women (99.8%) consulted with a conventional health care practitioner during pregnancy, 49.4% consulted with a complementary and alternative medicine practitioner at least once during pregnancy and 89.6% of the women used a complementary and alternative medicine product. Women reported an average of AUD$781.10 in out-of-pocket expenses for consultations with conventional health care practitioners, AUD$185.40 in out-of-pocket expenses for consultations with complementary and alternative medicine practitioners and AUD$179.60 in out-of-pocket expenses for complementary and alternative medicine products. From the study data we estimate Australian pregnant women spend over AUD$337 M on out-of-pocket health services.

Conclusion

While the majority of pregnant women in Australia may obtain health services via the publically-funded health care system and/or private health insurance coverage, our analysis identifies substantial out-of-pocket expenditure for health care by pregnant women – a trend in public spending for maternity care of importance to policy makers, health administrators, and health professionals.

"We make choices we think are going to save us": Debate and stance identification for online breast cancer CAM discussions

Patients discuss complementary and alternative medicine (CAM) in online health communities. Sometimes, patients' conflicting opinions toward CAM-related issues trigger debates in the community. The objectives of this paper are to identify such debates, identify controversial CAM therapies in a popular online breast cancer community, as well as patients' stances towards them. To scale our analysis, we trained a set of classifiers. We first constructed a supervised classifier based on a long short-term memory neural network (LSTM) stacked over a convolutional neural network (CNN) to detect automatically CAM-related debates from a popular breast cancer forum. Members' stances in these debates were also identified by a CNN-based classifier. Finally, posts automatically flagged as debates by the classifier were analyzed to explore which specific CAM therapies trigger debates more often than others. Our methods are able to detect CAM debates with F score of 77%, and identify stances with F score of 70%. The debate classifier identified about 1/6 of all CAM-related posts as debate. About 60% of CAM-related debate posts represent the supportive stance toward CAM usage. Qualitative analysis shows that some specific therapies, such as Gerson therapy and usage of laetrile, trigger debates frequently among members of the breast cancer community. This study demonstrates that neural networks can effectively locate debates on usage and effectiveness of controversial CAM therapies, and can help make sense of patients' opinions on such issues under dispute. As to CAM for breast cancer, perceptions of their effectiveness vary among patients. Many of the specific therapies trigger debates frequently and are worth more exploration in future work.

A critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness

Background

Despite the expansion of conventional medical treatments for headache, many sufferers of common recurrent headache disorders seek help outside of medical settings. The aim of this paper is to evaluate research studies on the prevalence of patient use of manual therapies for the treatment of headache and the key factors associated with this patient population.

Methods

This critical review of the peer-reviewed literature identified 35 papers reporting findings from new empirical research regarding the prevalence, profiles, motivations, communication and self-reported effectiveness of manual therapy use amongst those with headache disorders.

Results

While available data was limited and studies had considerable methodological limitations, the use of manual therapy appears to be the most common non-medical treatment utilized for the management of common recurrent headaches. The most common reason for choosing this type of treatment was seeking pain relief. While a high percentage of these patients likely continue with concurrent medical care, around half may not be disclosing the use of this treatment to their medical doctor.

Conclusions

There is a need for more rigorous public health and health services research in order to assess the role, safety, utilization and financial costs associated with manual therapy treatment for headache. Primary healthcare providers should be mindful of the use of this highly popular approach to headache management in order to help facilitate safe, effective and coordinated care.

Integrating acupuncture: are there positive health outcomes for women?

The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence.

A methodological review of qualitative case study methodology in midwifery research

AIM

To explore the use and application of case study research in midwifery.

BACKGROUND

Case study research provides rich data for the analysis of complex issues and interventions in the healthcare disciplines; however, a gap in the midwifery research literature was identified.

DESIGN

A methodological review of midwifery case study research using recognized templates, frameworks and reporting guidelines facilitated comprehensive analysis.

DATA SOURCES

An electronic database search using the date range January 2005-December 2014: Maternal and Infant Care, CINAHL Plus, Academic Search Complete, Web of Knowledge, SCOPUS, Medline, Health Collection (Informit), Cochrane Library Health Source: Nursing/Academic Edition, Wiley online and ProQuest Central.

REVIEW METHODS

Narrative evaluation was undertaken. Clearly worded questions reflected the problem and purpose. The application, strengths and limitations of case study methods were identified through a quality appraisal process.

RESULTS

The review identified both case study research's applicability to midwifery and its low uptake, especially in clinical studies. Many papers included the necessary criteria to achieve rigour. The included measures of authenticity and methodology were varied. A high standard of authenticity was observed, suggesting authors considered these elements to be routine inclusions. Technical aspects were lacking in many papers, namely a lack of reflexivity and incomplete transparency of processes.

CONCLUSION

This review raises the profile of case study research in midwifery. Midwives will be encouraged to explore if case study research is suitable for their investigation. The raised profile will demonstrate further applicability; encourage support and wider adoption in the midwifery setting.

Complementary and Alternative Medicine Use among Women of Reproductive Age in the United States

BACKGROUND

The purpose of this study was to examine the prevalence of complementary and alternative medicine (CAM) use, types of CAM used, and reasons for CAM use among reproductive-age women in the United States.

METHODS

Data are from the 2007 National Health Interview Survey. We examined a nationally representative sample of U.S. women ages 18 to 44 (n = 5,764 respondents). Primary outcomes were past year CAM use, reasons for CAM use, and conditions treated with CAM by pregnancy status (currently pregnant, gave birth in past year, neither). Multivariate logistic regression was used to estimate the odds of CAM use by pregnancy status.

FINDINGS

Overall, 67% of reproductive-age U.S. women reported using any CAM in the past year. Excluding vitamins, 42% reported using CAM. Significant differences in use of biologically based (p = .03) and mind-body therapies (p = .012) by pregnancy status were found. Back pain (17.1%), neck pain (7.7%), and anxiety (3.7%) were the most commonly reported conditions treated with CAM among reproductive-age women. However, 20% of pregnant and postpartum women used CAM for pregnancy-related reasons, making pregnancy the most common reason for CAM use among pregnant and postpartum women.

CONCLUSIONS

CAM use during the childbearing year is prevalent, with one-fifth of currently or recently pregnant women reporting CAM use for pregnancy-related reasons. Policymakers should consider how public resources may be used to support appropriate, effective use of alternative approaches to managing health during pregnancy and postpartum. Providers should be aware of the changing needs and personal health practices of reproductive age women.

Characteristics of women who practice yoga in different locations during pregnancy

OBJECTIVES

Yoga practice during pregnancy is gaining increasing popularity. This study examined the characteristics of pregnant women who practiced yoga in regard to the different locations (at home, in yoga classes, or both).

DESIGN

The study sample was drawn from the Australian Longitudinal Study on Women's Health (ALSWH), a national longitudinal study of women to investigate multiple factors affecting health and well-being of women over a 20-year period.

SETTING

Postal survey.

PARTICIPANTS

Women born between 1973 and 1978, who were randomly selected from the national Medicare database and identified as being pregnant or having recently given birth (n=2316).

OUTCOME MEASURES

Relationships between yoga use (attending yoga classes and/or practising yoga at home) and women's characteristics (demographic measures, pregnancy-related health concerns, health service utilisation, attitudes to complementary and alternative medicine).

RESULTS

Practising yoga both at home and in classes was associated with perceiving complementary and alternative medicine (CAM) as preventative (odds ratio (OR)=1.62); perceiving CAM as affording health control (OR=1.50); experiencing sadness (OR=1.72); preparing for labour (OR=2.31); birthing in a birth centre (OR=7.97); and experiencing less vomiting (OR=0.38). Practising at home only was associated with perceiving CAM as affording health control (OR=1.76); perceiving CAM as promoting a holistic health approach (OR=1.65); and birthing in a birth centre (OR=3.54). Practising in classes only was associated with experiencing stress (OR=1.97); and birthing in a birth centre (OR=4.85) (all p<0.05).

CONCLUSIONS

The findings suggest that the location in which a woman practices yoga is associated with attitudinal, health-related and birth environmental factors.

Trained or professional doulas in the support and care of pregnant and birthing women: a critical integrative review

The professionalisation of doula care and research interest in this area of maternity care/support have both grown internationally in recent years highlighting important broader issues around the access, continuity and delivery of maternity care services. However, no work to date has provided a critical appraisal of the international literature on this topic. In response, this paper presents the first critical review of international empirical literature examining professional doula care for pregnant and birthing women. A database search of AMED, CINAHL, Maternity and Infant Care, and MEDLINE using the search term, "doula" was undertaken. A total of 48 papers published between 1980 and March 2013 involving trained or professional doulas were extracted. Four descriptive categories were identified from the review: 'workforce and professional issues in doula care'; 'trained or professional doula's role and skill'; 'physical outcomes of trained or professional doula care'; and 'social outcomes of trained or professional doula care'. Of the studies evaluating outcomes of doula care, there were a number with design and methodology weaknesses. The review highlights a number of gaps in the research literature including a lack of research examining doula workforce issues; focus upon the experience and perspective of significant stakeholders such as expectant fathers with regard to trained or professional doula care; clinical trials measuring both subjective experiences and physical outcomes of trained or professional doula support; synergy between the design of clinical trials research examining trained or professional doula care and the clinical reality of professional doula practice. It is imperative that key aspects of trained doula care be subject to further rigorous, empirical investigation to help establish an evidence base to guide policy and practice relating to this area of support and care for pregnant and birthing women.

The Outcomes of Complementary and Alternative Medicine Use among Pregnant and Birthing Women: Current Trends and Future Directions

Complementary and alternative medicine is used by a substantial number of pregnant women and maternity care providers are often faced with the task of ensuring women are using safe and effective treatments while respecting a woman's right to autonomous decision-making. In the era of evidence-based medicine maternity health professionals are expected to draw upon the best available evidence when making clinical decisions and providing health advice. This review will outline the current trends in research evidence associated with the outcomes of complementary and alternative medicine use amongst pregnant and birthing women as well as highlight some potential directions for future development in this important yet largely unknown topic in contemporary maternity care.

Women's Use and Self-Prescription of Herbal Medicine during Pregnancy: An Examination of 1,835 Pregnant Women

BACKGROUND

Recent research points to high levels of herbal medicine use during pregnancy. The objectives of this study were to elucidate the prevalence and understand the determinants of both the use and self-prescription of herbal medicine during pregnancy.

METHODS

The study sample was obtained via the Australian Longitudinal Study on Women's Health. Women who were pregnant or who had recently given were invited to complete a subsurvey in 2010 about pregnancy, and complementary and alternative medicine use.

FINDINGS

A response rate of 79.2% (n=1,835) was attained and 34.4% (n=588 of 1,835) of the sample were utilizing herbal medicine during pregnancy, of which 77.9% (n=458 of 588) were self-prescribing these products. The women in our study (aged 33-38) were more likely to use herbal medicine if they had anxiety (odds ratio [OR], 1.30; 95% CI, 1.02-1.64; p=.031), sleeping problems (OR, 1.55; 95% CI, 1.15-2.11; p=.005), or fatigue (OR, 1.32; 95% CI, 1.04-1.68; p=.025), but less likely to use herbal medicine if they had nausea (OR, 0.71; 95% CI, 0.56-0.91; p=.007). Women were more likely to self-prescribe herbal medicine if they suffered from varicose veins (OR, 2.46; 95% CI, 1.04-5.84; p=.041) and less likely to self-prescribe herbal medicine if they suffered from preeclampsia (OR, 0.23; 95% CI, 0.81-0.63; p=.005). Women who self-prescribed herbal medicine during pregnancy were also more likely to live in a rural environment (OR, 2.22; 95% CI, 1.32-3.73; p=.003).

CONCLUSIONS

Many Australian women are consuming herbal medicine during pregnancy. The self-prescription of herbal medicine by pregnant women is of particular concern owing to potential safety issues, and it is important that maternity health care providers have an open and nonjudgmental conversation with women about herbal medicine use during pregnancy.

The characteristics, experiences and perceptions of naturopathic and herbal medicine practitioners: results from a national survey in New Zealand

Background

Despite the popularity of naturopathic and herbal medicine in New Zealand there remains limited data on New Zealand-based naturopathic and herbal medicine practice.

In response, this paper reports findings from the first national survey examining the characteristics, perceptions and experiences of New Zealand-based naturopaths and herbal medicine practitioners across multiple domains relating to their role and practice.

Methods

An online survey (covering 6 domains: demographics; practice characteristics; research; integrative practice; regulation and funding; contribution to national health objectives) was administered to naturopaths and herbal medicine practitioners. From a total of 338 naturopaths and herbal medicine practitioners, 107 responded providing a response rate of 32%. Data were statistically analysed using STATA.

Results

A majority of the naturopaths and herbal medicine practitioners surveyed were female (91%), and aged between 45 and 54 years. Most practiced part-time (64%), with practitioner caseloads averaging 8 new clients and over 20 follow-up clients per month.

Our analysis shows that researched information impacts upon and is useful for naturopaths and herbal medicine practitioners to validate their practices.

However, the sources of researched information utilised by New Zealand naturopaths and herbal medicine practitioners remain variable, with many sources beyond publications in peer-reviewed journals being utilised. Most naturopathic and herbal medicine practitioners (82%) supported registration, with statutory registration being favoured (75%). Integration with conventional care was considered desirable by the majority of naturopaths and herbal medicine practitioners surveyed (83%).

Naturopaths and herbal medicine practitioners feel that they contribute to several key national health objectives, including: improved nutrition (93%); increased physical activity (85%); reducing incidence and impact of CVD (79%); reducing incidence and impact of cancer (68%).

Conclusions

There is a need for greater understanding and communication between practitioners of conventional care and naturopathic and herbal medicine which could support informed, coordinated and effective health provision within the New Zealand health care system. There is a need for further in-depth research examining naturopaths and herbal medicine practitioners’ perceptions and practices, to provide insights of benefit to all those practising and managing health services as well as those directing health policy in New Zealand.

A review of nurses' knowledge, attitudes, and ability to communicate the risks and benefits of complementary and alternative medicine

AIMS AND OBJECTIVES

This study reviewed existing literature to investigate how frequently nurses include complementary and alternative forms of medicine in their clinical practice. In so doing, we investigated nurses' knowledge of and attitudes towards complementary and alternative medicine as well as their ability to communicate the risks and benefits of these therapies with patients.

BACKGROUND

Little information is available concerning nurses' knowledge and attitudes towards complementary and alternative medicine or how they incorporate these therapies into their practice. In addition, little is known about the ability of nurses to communicate the risks and benefits of complementary and alternative medicine to their patients.

STUDY DESIGN

This study used a scoping review method to map and synthesise existing literature.

DATA SOURCES

Both electronic and manual searches were used to identify relevant studies published between January 2007 and January 2014.

REVIEW METHODS

The review was conducted in five stages: (1) identification of research question(s), (2) locate studies, (3) selection of studies, (4) charting of data, and (5) collating, summarising, and reporting of results.

RESULTS

Fifteen papers met the inclusion criteria for this review, among which 53·7% referenced how frequently nurses include complementary and alternative medicine in their practice. We found that 66·4% of nurses had positive attitudes towards complementary and alternative medicine; however, 77·4% did not possess a comprehensive understanding of the associated risks and benefits. In addition, nearly half of the respondents (47·3-67·7%) reported feeling uncomfortable discussing complementary and alternative medicine therapies with their patients.

CONCLUSION

The lack of knowledge about complementary and alternative medicine among nurses is a cause for concern, particularly in light of its widespread application.

RELEVANCE TO CLINICAL PRACTICE

Findings from this study suggest that health care professionals need to promote evidence informed decision-making in complementary and alternative medicine practice and be knowledgeable enough to discuss complementary and alternative medicine therapies. Without involvement of complementary and alternative medicine communication on the part of our profession, we may put our patients at risk of uninformed and without medical guidance.

Complementary medicine as a path toward empowerment of Arab-Palestinian women in Israel

Arab-Palestinians in Israel compose a traditional minority population that previously relied on traditional folk medicine and religious healing. Today some among this minority population are adopting imported complementary medicine. We interviewed Arab-Palestinians of the first generation of complementary medicine practitioners. Their decision to study complementary medicine constitutes a path toward empowerment, providing healers with an aura of modernity, enabling integration into the predominantly Jewish Israeli medical establishment to gain professional recognition as experts, and to acquire a sense of belonging. Practicing complementary medicine provides financial independence, liberation, and self-fulfillment and an opportunity to help female patients break through constraining barriers.

Managing the pain of labour: factors associated with the use of labour pain management for pregnant Australian women

BACKGROUND

Despite high rates of women's use of intrapartum pain management techniques, little is known about the factors that influence such use.

OBJECTIVE

Examine the determinants associated with women's use of labour pain management.

DESIGN

Cross-sectional survey of a substudy of women from the 'young' cohort of the Australian Longitudinal Study of Women's Health (ALSWH).

SETTING AND PARTICIPANTS

Women aged 31-35 years who identified as being pregnant or recently given birth in the 2009 ALSWH survey (n = 2445) were recruited for the substudy. The substudy survey was completed by 1835 women (RR = 79.2%).

MAIN VARIABLES STUDIED

Determinants examined included pregnancy health and maternity care [including complementary and alternative medicine (CAM)] for their most recent pregnancy and any previous pregnancies. Participants' attitudes and beliefs related to both CAM and maternity care were also included in the analysis.

MAIN OUTCOME MEASURES

The outcome measures examined were the use of both pharmacological and non-pharmacological pain management techniques (NPMT).

RESULTS

Differences were seen in the effects of demographics, health service utilization, health status, use of CAM, and attitudes and beliefs upon use of intrapartum pain management techniques across all categories. The only variable that was identified as a determinant for use of all types of pain management techniques was a previous caesarean section (CS).

DISCUSSION AND CONCLUSIONS

The effect of key determinants on women's use of pain management techniques differs significantly, and, other than CS, no one determinant is clearly influential in the use of all pain management options.

Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives' training in Catalan hospitals accredited as centers for normal birth

BACKGROUND

The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards.

METHODS

A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers.

RESULTS

Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center.

CONCLUSIONS

Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

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.

Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women

BACKGROUND

There is little known about women's concurrent use of conventional and complementary health care during pregnancy, particularly consultation patterns with complementary and alternative medicine (CAM). This study examines health service utilisation among pregnant women including consultations with obstetricians, midwives, general practitioners (GPs) and CAM practitioners.

METHODS

A sub-study of pregnant women (n=2445) was undertaken from the nationally-representative Australian Longitudinal Study on Women's Health (ALSWH). Women's consultations with conventional practitioners (obstetricians, GPs and midwives) and CAM practitioners for pregnancy-related health conditions were analysed. The analysis included Pearson chi-square tests to compare categorical variables.

RESULTS

The survey was completed by 1835 women (response rate = 79.2%). A substantial number (49.4%) of respondents consulted with a CAM practitioner for pregnancy-related health conditions. Many participants consulted only with a CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Meanwhile, women consulted both CAM practitioners and conventional maternity health professionals (obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a general practitioner (GP) 3-4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often (p=<0.001, x2=20.5). Women who had more frequent visits to a midwife were more likely to have consulted with an acupuncturist (p=<0.001, x2=18.9) or a doula (p=<0.001, x2=23.2) than those visiting midwives less frequently for their pregnancy care.

CONCLUSIONS

The results emphasise the necessity for a considered and collaborative approach to interactions between pregnant women, conventional maternity health providers and CAM practitioners to accommodate appropriate information transferral and co-ordinated maternity care. The absence of sufficient clinical evidence regarding many commonly used CAM practices during pregnancy also requires urgent attention.

Midwives' use of complementary/alternative treatments

BACKGROUND

in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.

OBJECTIVE

to systematically review all surveys of CAT use by midwives.

SEARCH STRATEGY

six electronic databases were searched using text terms and MeSH for CAT and midwifery.

SELECTION CRITERIA

surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.

DATA COLLECTION AND ANALYSIS

full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.

MAIN RESULTS

19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.

CONCLUSION

most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.

The use of complementary and alternative medicine during pregnancy: a longitudinal study of Australian women

BACKGROUND

The use of complementary and alternative medicine is increasingly prevalent in contemporary Western societies. The objective of this study was to explore trends and patterns in complementary and alternative medicine practitioner consultations and the use of complementary and alternative medicine consumption before, during, and after pregnancy and between pregnancies.

METHODS

Analysis focused on data from 13,961 women from the younger cohort of the Australian Longitudinal Study on Women's Health collected between 1996 and 2006. Chi-square tests were employed for the cross-sectional analysis of categorical variables and t tests for continuous variables. Generalized estimating equations were used to conduct multivariate longitudinal analysis.

RESULTS

Complementary and alternative medicine use among pregnant and nonpregnant women continued to increase over the 10-year period. Although pregnancy status was not predictive of the use of alternative treatments, pregnant women employed these therapies or modalities for the relief of pregnancy-related complaints and symptoms. Analysis also revealed that women used complementary and alternative treatments selectively during pregnancy.

CONCLUSIONS

This study highlights the need for further research that is sensitive to the consumption of specific complementary and alternative therapies or modalities and to the wider contexts within which women perceive risk associated with their use of complementary and alternative treatments.