New Zealand and Canadian midwives’ use of complementary and alternative medicine

Background: Complementary and alternative medicine (CAM) is widely used by women and midwives in maternity care despite the lack of strong evidence for safety or efficacy. The purpose of this research was to investigate how midwives in primary midwifery care practice in two countries use CAM. Methods: A pre-tested survey was administered to all registered midwives (265) in two provinces of Canada (British Columbia and Ontario) and a sample (383) of midwives in primary care practice in New Zealand. The two part survey consisted of 40 items including Likert scale, yes/no and open ended questions. Part one collected midwives’ demographics and information regarding the use of CAM by midwives and women, the types of CAM therapies, referral patterns and midwives’ opinions regarding the role of CAM in midwifery practice. Part two examined the use of evening primrose oil, chosen as an exemplar to explore typical patterns of CAM use by midwives, and is reported elsewhere. Results: A total of 343 midwives responded (53%) with results indicating that CAM is widespread in both countries. The most commonly used therapy was homeopathy, followed by herbs, aromatherapy and acupuncture. CAM was perceived as an essential part of midwifery practice by 71.5% of respondents. A similar number agreed that CAM enhances midwifery care and supports normal birth. However, 74.4% of respondents perceived CAM use as an intervention. Although 77.4% concurred that CAM is a traditional part of midwifery practice, 63.3% felt that the long history of CAM use is not evidence for safety in practice. There was strong support (81.4%) by midwives for the statement that CAM is used to avoid medical interventions. Midwives who may not discuss CAM with every client indicated they would discuss CAM options in circumstances such as breech presentation or postdates pregnancy. A qualitative analysis interpreted four main reasons for the use of CAM, identified in this study as ‘Resistance’ to the dominant medical paradigm, ‘Efficacy’ since CAM is perceived to make a difference, supporting ‘Women’s Choice’ and as a way of ‘Keeping Birth Normal’. Conclusions: This study demonstrates that midwives regard CAM as an essential and traditional part of midwifery practice, supporting normal birth. However, midwives also regard the traditional and empirical basis of CAM as problematic since contemporary midwifery care requires midwives to base their practice on robust evidence of efficacy.