By Amie Steel, Jane Frawley
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 lives? New research suggests there are ‘others’ involved. These other health professionals are broadly defined as ‘complementary and alternative medicine (CAM) practitioners’, an umbrella term that covers a diverse range of practitioner groups including acupuncturists, aroma therapists, 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 was published recently in BMC Pregnancy and Childbirth. The study involved a cross-sectional survey of 1835 Australian women who had recently given birth. It examined their use of CAM during pregnancy, labour and birth. The cohort involved in the study was 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 half the Australian women surveyed consulted with a CAM practitioner for pregnancy-related health conditions. This is the first time that figures from a nationally representative data set have been reported at a national and international level.
Which Practitioners Did Women Consult?
The data shows that women most commonly consulted 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%). Doulas were less common (1.4%), as were aroma therapists (0.6%). (See Table 1.) These findings highlight an additional and previously unexamined element in maternity care in Australia. It is also quite common for women to consult with multiple CAM practitioners. This is 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 Did Women Consult a CAM Practitioner For?
The study includes information about pregnancy-related health conditions for which women consulted a CAM practitioner (Table 3, See Below). The list of conditions examined was diverse. It ranges from fatigue through to pre-eclampsia. Additionally, the CAM practitioner consulted varied significantly depending on the health condition. Women were most likely to consult with a chiropractor. For example, if they experienced back pain. But they were more likely to see a massage therapist if they had neck pain or sciatica. Women consulted acupuncturists for back pain and to assist with preparation for labour. Also, women can consult naturopaths for conditions such as nausea, fatigue and digestion.
Another interesting finding was evidence of the co-treatment of many of these conditions between both CAM and conventional care providers.
For some conditions, such as back pain and gestational diabetes, a substantial number of women consulted both conventional and CAM practitioners. Women were most likely to consult 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. The only condition for which women did not engage with both a conventional and CAM practitioner for management was high blood pressure. This means that some women are involving CAM practitioners in the management of health conditions that have a significant impact on the outcome of the pregnancy and birth for both mother and baby.
The Woman’s Health Care Team
An issue of concern is whether these practitioners are working together, or whether they are providing treatment and recommending interventions without the knowledge and awareness of the other practitioners. We do not currently have evidence about this and the situation may depend on the practice philosophy of the conventional care provider or the birth setting. One element identified through the study was a relationship between CAM practitioner consultations and visits with conventional maternity professionals. A trend was evident with doula care: 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?
If some women do consult a CAM practitioner and a conventional care provider simultaneously for the management of the same condition, without disclosing this to either practitioner, this may create risk for the mother and/or baby through possible pharmacological interactions between treatments, or broader conflicts between the treatment goals of the two (or more) practitioners.
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