Viewpoint--midwives' enthusiasm for complementary therapies: a cause for concern?

Abstract

The demand for complementary therapies and natural remedies during pregnancy and childbirth, originally consumer-driven, has fuelled a tremendous interest and enthusiasm amongst midwives, with over 34% having used one of more therapies in their practice. The majority of pre-registration education programmes now include an introduction to the subject, midwives who are especially interested can undertake further study and, in many areas, maternity service re-evaluation includes complementary therapies as an adjunct to the development of women-centred, midwife-led birthing centres. The last 10 years has seen the subject of complementary and alternative medicine (CAM) evolve from a ‘‘fringe’’ element, disregarded by the sceptics, to a significant aspect of healthcare. The work of organisations such as the Prince of Wales’ Foundation for Integrated Health has done much to bring CAM ‘‘in from the cold’’ and the House of Lords has acknowledged its value in enhancing the care of people with a range of health problems. The Complementary Maternity Forum has over 200 members, most of whom are midwives, and there are numerous projects around the country where midwives are implementing one or more therapies into their practice. However, midwifery is no longer a single generic profession. Whilst most midwives provide care for women with normal pregnancies from conception to the end of the puerperium, areas of specialist expertise have developed, including care of mothers suffering domestic violence or abusing drugs, teenage mothers or intensive labour ward care for women with medical complications. Some midwives have learnt new skills such as ultrasound scanning, ventouse delivery or assisting the surgeon in the operating theatre. So too should the use of CAM therapies for pregnant, labouring and newly delivered mothers be considered a specialism, in which certain midwives acquire new knowledge and develop new skills to become experts to which other midwives refer as an appropriate resource. Indeed, the need for each maternity service to employ at least one CAM midwife has long been advocated. However, whilst CAM awareness amongst midwives is currently at an all-time high, this has brought with it such enthusiasm that they are in danger of over-stepping the boundaries of their professional accountability. In an attempt to be seen to act as the mothers’ advocate, there appears to have been an injudicious sense of urgency to offer yet another element of womenfocused care, without due regard for the professional, legal, ethical and inter-disciplinary issues to be considered as part of the implementation process. Midwives have ‘‘jumped on the bandwagon’’ but are at risk of the momentum carrying them over the precipice into fatal waters. The incorporation of CAM therapies, as with any other component of advanced midwifery practice, requires a slow but persistent approach, rather than careering ahead regardless. Even midwives who are not actively involved in CAM are jeopardising their registration status by giving women incomplete or inaccurate information on natural remedies without complying with the Nursing and Midwifery Council’s requirement for ‘‘adequate and appropriate’’ preparatory education. The commonest example of this is the ARTICLE IN PRESS