Review highlights need for more education and guidance on CAM use in midwifery

There is also need for greater respect and cooperation between conventional and alternative practitioners and improved communication with patients about the growing use of CAM.

University-based members of the Network of Researchers in the Public Health of Complementary and Alternative Medicine (NORPHCAM) reviewed 19 studies covering the views of more than 3,000 maternity professionals from Australia, Canada, the USA, UK, Germany, New Zealand and Israel.

The studies, which were all based on interviews or surveys, were published between 1999 and 2009, 13 in the last five years.

"There is no doubt that the popularity of CAM – including acupuncture, chiropractic, naturopathy, herbal medicine and yoga – has grown in recent years" says lead author Dr Jon Adams, Associate Professor at the University of Queensland, Australia, and Executive Director of NORPHCAM.

"The use of CAM during pregnancy has been debated by practitioners and policy makers around the world and it is clear that there is a real need to develop an integrated approach to maternity care. However this has been hampered by a lack of understanding of the attitudes and practice of mainstream maternity care professionals towards CAM. Our review aimed to provide a clearer picture by pulling together a wide range of published studies based on interviews and surveys."

Key findings from the most recent 2008 and 2009 studies include:

• A survey of 343 midwives from Canada and New Zealand found that 72% had recommended or offered CAM. The most common referrals were to homeopaths (51%), acupuncturists (50%), naturopaths (48%), chiropractors (36%), massage therapists (31%) and osteopaths (20%).
  
• All but one of the 381 obstetric departments who took part in a German survey said they offered at least one CAM therapy, with acupuncture (97%), homeopathy (93%) and aromatherapy (77%) heading the list.
  
• 78% of the 227 midwives who took part in an American study reported using CAM and 89% would refer a patient to CAM providers. The three most commonly used treatments were herbal preparations (85%), pharmacologic/biologic treatments (82%) and mind-body interventions (80%).
  
• A study of 401 American obstetricians found that 98% routinely endorsed, provided or referred patients for at least one CAM treatment. Movement therapies topped the list at 86%, followed by biofeedback and acupuncture (both 80%).

"For example, our study suggests that, in general, midwives have a more positive view of CAM than obstetricians and that understandings and perceptions of CAM appear to be closely linked with wider notions of professionalism and professional identity.

"In particular, the holistic nature of CAM has a close affinity with the philosophy, professional goals and care perspectives of many midwives."

The authors raise concerns that their research review showed that most medical professionals have no CAM training and little understanding of the pharmacological nature of alternative therapies and their possible risks to pregnant women.

"There have recently been calls for nursing and midwifery education to include CAM training" says Dr Adams. "In addition, a number of medical organisations and registration boards, including the Royal College of Midwives and Australian Nursing Federation, have issued position statements endorsing the linking of care standards to education and knowledge of CAM.

"We hope that our research review will provide a first step in developing an evidence base on this important topic and provide vital insights for those managing, practising and receiving maternity care."

More information: Attitudes and referral practices of maternity care professionals with regard to complementary and alternative medicine: an integrative review. Adams et al. Journal of Advanced Nursing. 67.3, pp472-483. (March 2011). DOI: 10.1111/j.1365-2648.2010.05510.x

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