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ABSTRACT: BACKGROUND: Pregnant women have been identified as high users of complementary and alternative medicine (CAM). However, no research to date has provided a detailed analysis of the prevalence and determinants of CAM consumption amongst pregnant women. AIM: To examine the prevalence and determinants of CAM use by pregnant women, utilising a national representative sample. METHODS: The study sample was obtained via the Australian Longitudinal Study on Women's Health. This paper is based on a sub-study of 1,835 pregnant women, administered in 2010. The women answered questions about CAM use, demographics, pregnancy-related health concerns and health service utilisation. RESULTS: Complementary and alternative medicine use was found to be high with 48.1% (n = 623) of pregnant women consulting a CAM practitioner and 52.0% (n = 842) of women using CAM products (excluding vitamins and minerals) during pregnancy. CAM practitioner visits were more likely for selected pregnancy-related health concerns, namely back pain or back ache, neck pain and labour preparation. Women were less likely to consult a CAM practitioner if they suffered with headaches/migraines. Employment was also found to be predictive of pregnant women's visits to a CAM practitioner. Significant health history and demographic predictors of CAM product use were tiredness and fatigue, embarking on preparation for labour and having a university education. CONCLUSION: Most pregnant women are utilising CAM products and/or services as part of their maternity care and obstetricians, general practitioners and midwives need to enquire with women in their care about possible CAM use to help promote safe, effective coordinated maternity care.
Australian and New Zealand Journal of Obstetrics and Gynaecology 03/2013; · 1.24 Impact Factor
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ABSTRACT: 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.
BMC Pregnancy and Childbirth 12/2012; 12(1):146. · 2.83 Impact Factor
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ABSTRACT: A higher percentage of referrals to complementary and alternative medicine (CAM) by midwives can be linked to their affinity with CAM. However, midwifery education does not commonly include CAM as part of the curriculum leaving potential for misinformation and unsafe practice. An approach to CAM education which encourages collaboration between all care providers is needed to ensure safe, woman-centred maternity care. Whilst a number of models have been considered in health education they are not without their limitations when aiming to promote interprofessional collaboration. It is proposed through this paper that improved communication between midwives and qualified CAM practitioners may be developed through employing the interprofessional education model. This model develops attributes for collaborative practice and improves the delivery of interprofessional care. Achieving this collaboration is vital for safe, woman-centred care for the many pregnant women accessing CAM and conventional care for their pregnancy and birth.
Complementary therapies in clinical practice 11/2012; 18(4):261-4.
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Complementary therapies in clinical practice 05/2012; 18(2):73-4.
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ABSTRACT: In line with increasing complementary medicine (CAM) use, the Australian government has committed considerable resources to the training of CAM practitioners. However, it has generally failed to complement this support with regulation or accountability measures. This is particularly true in Australia's largest CAM profession (naturopaths), which remains entirely unregulated but attracts approximately AUD$40 million each year in government funding for its education sector. This article explores the consequences of such unfettered support on professional outcomes.
Data on Australian government funding for naturopathic student places were collated and compared with various outcome measures including research and professional outcomes.
Lack of accountability measures attached to government support has enabled the proliferation of commercial education providers in the sector. This is often at the expense of the university sector, which is financially disadvantaged in naturopathic education delivery through extra academic and research obligations not shared by private for-profit providers. The major beneficiaries of government funding have facilitated few formal contributions to naturopathic research or professional development, whereas those with the highest research, professional, and academic output attracted the least government funding. Course content has declined in the previous 5 years, and government funding is still directed to courses that do not meet the minimum education levels for the prescribed government definition of naturopath. Unfettered support has also resulted in a significant increase in student numbers growth, which significantly outstrips growth in utilization, potentially affecting the profession's sustainability.
Lack of regulation in naturopathic education has resulted in significant risks to patients (through reduced standards) as well as the naturopathic profession itself. Although CAM advocates often focus on pushing for government support for the development CAM, support without the development of appropriate regulatory and accountability measures can ultimately be detrimental to the development of CAM.
Journal of alternative and complementary medicine (New York, N.Y.) 04/2012; 18(4):363-70. · 1.69 Impact Factor
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ABSTRACT: It is known that women are high users of complementary and alternative medicine (CAM) including naturopathy and that CAM is frequently used by pregnant women. However, we still know little about the consumption, practice and role of naturopathy in pregnancy, labour and post-natal care. With this in mind, this paper proposes a possible framework for advancing further research on this topic. The framework is divided into issues associated with three core stakeholder groups - pregnant women, naturopaths/herbalists and other maternity health professionals including obstetricians, midwives and general practitioners. The development of a rigorous health services research agenda around this topic has much to offer maternity-care users, practitioners and policy makers and the framework outlined here is offered with the hope of inspiring further inquiry into this significant issue in women's health.
Complementary therapies in clinical practice 11/2011; 17(4):189-92.
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ABSTRACT: Although there has been much international commentary, little is known about the interface between traditional knowledge and scientific research in modern naturopathic practice. This study aimed to explore this interface from the perspective of naturopaths.
Semistructured interviews were conducted with naturopaths in current practice. The participants were selected using purposive sampling, and the data from the interviews were interpreted using thematic analysis.
Interviews were conducted in a place suitable to each participant.
Twelve (12) naturopaths in current clinical practice were interviewed. The participants represented a diversity of characteristics including gender, time in practice, level of qualification, and clinical contact hours per week.
Thematic analysis was used to identify common themes from the interviews.
Analysis identified a disparity in practitioner definition of what constitutes traditional information. However, it also identified that traditional knowledge is considered a valid source of information, whereas the validity and value of modern research is questioned. There is also tension between these two information sources, with science being argued to both support traditional knowledge, while also undermining its value. This tension seems to be overcome by practitioners' use of traditional knowledge to direct their own research, as well as drawing upon their knowledge of science to explain traditional knowledge as yet not researched.
The findings of this qualitative study reveal tensions and ambiguities around the interface between tradition and science with regard to naturopathic clinical practice. Understanding these findings may assist individuals and groups within the naturopathic profession, as well as those outside the profession engaging and collaborating with naturopaths.
Journal of alternative and complementary medicine (New York, N.Y.) 10/2011; 17(10):967-72. · 1.69 Impact Factor
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ABSTRACT: The approach of evidence-based medicine (EBM), providing a paradigm to validate information sources and a process for critiquing their value, is an important platform for guiding practice. Researchers have explored the application and value of information sources in clinical practice with regard to a range of health professions; however, naturopathic practice has been overlooked.
An exploratory study of naturopaths' perspectives of the application and value of information sources has been undertaken.
Semi-structured interviews with 12 naturopaths in current clinical practice, concerning the information sources used in clinical practice and their perceptions of these sources.
Thematic analysis identified differences in the application of the variety of information sources used, depending upon the perceived validity. Internet databases were viewed as highly valid. Textbooks, formal education and interpersonal interactions were judged based upon a variety of factors, whilst validation of general internet sites and manufacturers information was required prior to use.
The findings of this study will provide preliminary aid to those responsible for supporting naturopaths' information use and access. In particular, it may assist publishers, medical librarians and professional associations in developing strategies to expand the clinically useful information sources available to naturopaths.
Health Information & Libraries Journal 06/2011; 28(2):110-8. · 0.89 Impact Factor
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ABSTRACT: The type of information used and its application in clinical practice has generated interest due to its relationship to evidence-based medicine (EBM). However, it is also acknowledged that the principles of EBM place less value on practitioners' experience and intuitive insights when making clinical decisions. Research in this area has been conducted with conventional health professionals, meanwhile complementary and alternative medicine practitioners such as naturopaths have received little attention. In response interviews were undertaken with naturopaths to explore their approach to information-seeking and application in clinical settings. Thematic analysis identified how naturopaths incorporate deductive reasoning alongside intuition and clinical experience to overcome difficulties in applying information to relevant clinical situations. This research provides an understanding of the approach taken by naturopaths to improve the relevance of available data when making clinical decisions and is of significance for health policy and health service delivery in this area.
Complementary therapies in clinical practice 05/2011; 17(2):81-4.
