This article first published in Birth Matters 

The majority of women rely on health professionals such as midwives, general practitioners (GPs) and obstetricians during pregnancy and birth to ensure that both mother and baby are as healthy as possible. Are these the only practitioners providing care to women during this important time in their life? New research suggests there are ‘others’ involved. These other health professionals are broadly defined as complementary and alternative medicine (CAM) practitioners which is an umbrella term covering a diverse range of practitioner groups including acupuncturists, aromatherapists, chiropractors, doulas, massage therapists, naturopaths, osteopaths, and yoga and meditation teachers..

The research study

A study undertaken by researchers at the Australian Research Centre in Complementary and Integrative Medicine at the University of Technology Sydney has recently been published in BMC Pregnancy and Childbirth. The study involved a cross-sectional survey of 1835 Australian women who had recently given birth and examined their use of CAM during pregnancy, labour and birth. The cohort involved in the study were drawn from the Australian Longitudinal Study on Women’s Health which is the largest, nationally representative study in this field in Australia. The study reports that 1 in 2 Australian women consult with a CAM practitioner for pregnancy-related health conditions. This is the first time these figures from a nationally-representative data set have been reported at a national and international level.

Which practitioners are women consulting with?

Women most commonly consult with a massage therapist (34.1%), followed by a chiropractor (16.3%), yoga or meditation teacher (13.6%), acupuncturist (9.5%), naturopath (7.2%) and osteopath (6.2%). Less common is a doula (1.4%) or an aromatherapist (0.6%) (see Table 1). These findings highlight an additional and previously unexamined element in maternity care in Australia. It is also quite likely that women consult with multiple CAM practitioners alongside their (also often multiple) conventional maternity care providers (see Table 2). In fact, of the women who consulted with a CAM practitioner, half of them involved two or more CAM practitioners in their care team.

What conditions are women consulting with a CAM practitioner for?

The study also reported the pregnancy-related health conditions for which women were consulting with a CAM practitioner. The list of conditions examined was diverse, ranging from fatigue through to pre-eclampsia, and the CAM practitioner consulted varied significantly depending upon the health condition. Women were most likely to consult with a chiropractor, for example, if they experienced back pain but a massage therapist if they had neck pain or sciatica. Acupuncturists were also consulted for back pain but also to assist with preparation for labour. Naturopaths were consulted for conditions such as nausea, fatigue and indigestion.

An interesting finding that also came to light through this study was the co-treatment of many of these conditions between CAM and conventional care providers. For some conditions such as back pain and gestational diabetes a substantial number of women were consulting both conventional and CAM practitioners for their care. The majority of women were most likely to consult with a CAM practitioner without involving a conventional care provider in their treatment for other conditions such as neck pain, hip pain and sciatica. In fact, the only condition for which no women worked with a CAM practitioner without involving a conventional care provider was pre-eclampsia, and the only condition for which women did not engage with both a conventional and CAM practitioner for management was high blood pressure. This means women are not only consulting with CAM practitioners, some women are involving them in the management of health conditions which have a significant impact on the outcome of the pregnancy and birth for both mother and baby.

The woman’s health care team

What’s concerning is whether these practitioners are working together, or whether they are providing treatment and recommending interventions without knowledge and awareness of the other practitioners. This is something we still do not know. It may depend on the practice philosophy of the conventional care provider or the birth setting. One element which was identified through the study was a relationship between CAM practitioner consultations and visits with conventional maternity professionals. A trend was seen with doula care, as women who consulted more frequently with a midwife were also more likely to engage a doula in their maternity care. Women who consulted more frequently with an obstetrician, however, were less likely to also involve a doula in their care team. These relationships may reflect the attitudes of the maternity health professional, or they may be reflective of the birth setting, or the preferences of the women themselves.

What does this mean for women?

Women may be consulting with a CAM practitioner and conventional care provider simultaneously for the management of the same condition without disclosing this to either practitioner. This may create risk for mother and/or baby through possible pharmacological interactions between treatments, or broader conflicts between the treatment goals of the two (or more) practitioners. It is important for this reason that women ensure that all practitioners providing support during pregnancy or birth are clearly informed about the involvement of other care providers. This requires not only that practitioners are aware of the inclusion of others, but also that they are aware of the treatment interventions and recommendations being offered to the woman.

What does this mean for maternity health professionals?

All health professionals, whether providing conventional maternity care services, practising CAM or integrating both approaches need to be aware of some of the significant trends identified through this study. Primarily, it is important that health professionals caring for pregnant and birthing women are aware that they may not be the only practitioner involved in a woman’s maternity care team. In fact, with 1 in 2 women consulting with a CAM practitioner during pregnancy it is more likely than not that a CAM practitioner is involved! This also means that health professionals need to conscientiously enquire about women’s use of CAM and engagement with CAM practitioners as a standard element in their history taking. Likewise, should the involvement of a CAM practitioner be identified, it is vital that maternity care providers open the lines of communication and encourage clear disclosure of practice, treatments and interventions from both sides of the divide.

So what?

The involvement of CAM practitioners in the care of women during pregnancy and birth is clear. For the sake of the health of the mother and baby these practitioners need to move away from their place outside of the conventional maternity care system and be more effectively included in the woman’s chosen maternity care team. This is the safest option and the most woman-centred approach. There may be some barriers to overcome to achieve this but it is a goal deserving of the attention, energy and commitment of women using CAM during pregnancy and any health professional providing maternity care.

References

(1)   Steel, A., J. Adams, D. Sibbritt, A. Broom, C. Gallois and J. Frawley (2012). “Utilisation of complementary and alternative medicine (CAM) practitioners within maternity care provision: results from a nationally representative cohort study of 1,835 pregnant women.” BMC pregnancy childbirth 12(1): 146.

To read more about this study please access the full article (free to all) at: http://www.biomedcentral.com/1471-2393/12/146

Author Biographies: Amie Steel and Jane Frawley are research scholars based at the Australian Research Centre in Complementary and Integrative Medicine at the University of Technology Sydney (http://www.nmh.uts.edu.au/arccim/). Amie is a naturopath practicing at Herbs on the Hill at South Brisbane in QLD (www.herbsonthehill.com.au) and mother to her 4 year old boy. Amie is also an associate of Embrace Holistic Services, a company focused on promoting collaborative maternity practice through education (www.embraceholistic.com), and the Maternity Coaltion consumer representative on the Mater’s Maternity Clinical Governance Advisory Committee (MCGAC) in Brisbane. Jane is an herbalist living in the Blue Mountains in NSW and mother to her 3 year old boy.

 

 

Table 1: Women’s consultations with complementary and alternative medicine (CAM) practitioners for pregnancy-related health conditions (1)

Professional Group	Total
	%
Acupuncturist (n=1714)	9.5
Aromatherapist (n=1670)	0.6
Chiropractor (n=1709)	16.3
Naturopath/Herbalist (n=1684)	7.2
Doula (n=1667)	1.4
Massage (n=1743)	34.1
Meditation/Yoga (n=1690)	13.6
Osteopath (n=1690)	6.2
Any CAM practitioner	49.4

 

 

Table 2: Different CAM practitioner professional groups consulted by women for pregnancy-related health conditions (1)

Practitioners	Complementary medicine† (n=1629)
	%
0	54
1	25.7
2	13.1
3	4.8
4	1.8
5	0.5
6	0.1

† Complementary medicine practitioners includes acupuncturists, aromatherapists, chiropractors, naturopaths/herbalists, doulas, massage therapists, meditation/yoga classes, and osteopaths

 

 

 

Table 3: Patterns of consultations with health professionals based on pregnancy-related health conditions (1)

Condition		All women				Only women with pregnancy-related condition
		CAM practitioners				Level of integration between CAM and conventional care
		Chiropractor	Acupuncturist	Naturopath	Massage	CAM practitioner only†	Both CAM and conventional practitionersǂ	Conventional  practitioner only§
	%	%	%	%	%	%	%	%
Back pain	39.5	11.3	4.1	1.7	0.5	2.2	61.8	32.1
Tiredness	35.4	0.4	1.0	1.2	1.0	6.0	2.3	26.0
Reflux/Indigestion	34.7	0.2	0.3	1.0	0.1	6.0	1.9	51.3
Nausea	32.9	0.4	1.3	1.6	0.2	5.0	4.6	48.2
Sciatica	22.1	5.3	1.3	0.2	6.6	40.4	16.3	22.7
Preparing for labour	21.9	1.0	2.4	0.9	0.9	11.0	13.7	72.1
Hip pain	20.9	5.0	1.1	0.1	4.5	35.4	17.5	25.3
Neck pain	12.4	5.7	0.4	0.2	5.9	74.6	5.3	5.3
High Blood Pressure	6.6	0.1	0.2	0.0	0.0	0.8	0.0	93.4
Gestational diabetes	4.9	0.0	0.1	0.1	0.0	6.7	22.2	64.4
Pre-eclampsia	3.2	0.1	0.1	0.2	0.0	0.0	5.2	93.1

†Women who only consulted with a CAM practitioner for the designated pregnancy-related condition. This includes chiropractors, acupuncturists, naturopaths and massage therapists

‡Women who consulted with both a conventional and CAM practitioner for the designated pregnancy-related condition

§ Women who only consulted with a conventional practitioner for the designated pregnancy-related condition