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Complementary and Alternative Medicine News: Taking the Pain out of Pregnancy

Pain Management, March 2011, Volume 4, Issue 2

Integrating CAM therapies during pregnancy provides the pain management specialist with an opportunity to become a leading voice in maternal care.

Integrating CAM therapies during pregnancy provides the pain management specialist with an opportunity to become a leading voice in maternal care.

According to a literature review published in the March 2011 issue of the Journal of Advanced Nursing, maternity care providers are using complementary and alternative medicine (CAM) to soothe a variety of pregnancy-related complaints including nausea, vomiting, back pain, depression, and perineal and general discomfort.

The willingness of both health care providers and expectant mothers to integrate CAM therapies into maternal care plans has implications for pain management practitioners because though “recent discussion has identified the need to develop an integrated approach to maternity care … there is a lack of understanding of attitudes and behaviours of maternity care professionals towards these treatments.”

Pain management specialists are already well-positioned to manage a majority of these complications, and by inculcating respect and understanding of CAM therapies and their use during pregnancy, pain practitioners can establish themselves as an integral and leading voice within the maternal care team.

Recommendations and referrals

The authors focused on 21 research papers published between 1999 and 2009 that highlight CAM practices in maternity care in Australia, Canada, Germany, Israel, New Zealand, the UK, and US. Of the 21 papers, 14 examined recommendation or referral for CAM and “showed that most of their respondents reported practising, recommending or referring pregnant women for complementary therapies or products.” Not only are they practicing, recommending, and referring, “many of these service providers employed or endorsed more than one type of alternative therapy for their clients.” The three German studies revealed “an average of four alternative therapies practiced in each gynaecology and obstetrics clinic/hospital.”

These therapies include herbal and massage therapy, chiropractic, acupressure, homeopathy, physiotherapy, biofeedback, aromatherapy, bioelectromagnetic therapies, yoga, reflexology, phytotherapy, and hydrotherapy.

A wrinkle to consider: “The most commonly used alternative interventions by pregnant women did not necessarily correspond to those considered most effective or useful by physicians. This incongruity was explained by the fact that many pregnant women had initiated complementary treatment without first consulting their physicians.”

Provider point of view

The authors noted “geographical variations in the incidence of practice or referral for CAM,” that must “be considered alongside the wider social and cultural contexts of healthcare provision and policy and the training available to providers in different countries.” For example, Canadian midwives referred “more often to naturopaths, massage therapists, and chiropractors,” whereas midwives in New Zealand more often turned to homeopaths, osteopaths, and herbalists.

Additionally, a documented “divergence between prescriptions of alternative therapies by obstetricians and midwives” must also be taken into account. Multiple studies suggest that “midwives have a more positive view of complementary medicine than obstetricians [who] ... are not fully convinced of the efficacy of CAM methods.” Obstetricians are more likely to attribute benefits from CAM therapy to the placebo effect and insist “on the need for an evidence base for alternative treatment.”

One study found that 88% of midwives “considered available training of CAM inadequate,” while “many providers identify gaining knowledge about CAM as an important and pressing professional issue and support the idea that CAM teaching should be integrated into conventional medical and healthcare curricula.” It should be no surprise then that many “receive no formal training” and learn about CAM through “self-study, discussions with colleagues or participation in workshops.”

A need for collaboration

This lack of formal training could be an opportunity for pain management specialists to lend their expertise to other maternal care providers in order to enhance patient care, satisfaction, and well-being. And vice versa.

Such developments will be highly important going forward, because without both respect and cooperation, the past, fraught with “users of CAM” hiding it from their doctors and physicians discussing CAM only with great difficulty, will surely repeat itself. “Encouraging constructive debate and discussion on the relative roles of conventional and alternative providers would improve communication between all practitioners and their patients.”

This, the authors write, “will help reduce the risk of adverse effects and maximize the potential usefulness of therapies.”