Discussion From alternative, to complementary to integrative medicine: Supporting Australian midwives in an increasingly pluralistic maternity environment Helen G. Hall a, *, Lisa G. McKenna b , Debra L. Griffiths a a Monash University, School of Nursing & Midwifery, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia b Monash University, School of Nursing & Midwifery, Clayton Campus, Wellington Road, Victoria 3800, Australia 1. Introduction ‘Complementary and alternative medicine’ (CAM) describes a broad collection of therapies which are not generally considered part of conventional biomedicine. 1 Over the last decade the use of these therapies has become increasingly popular among expectant women living in Australia. 2 Research has found that women use CAM because they value a holistic, natural approach and want greater participation in their pregnancy care. 3 These ideals align well with midwifery discourse which promotes the normality of childbirth and respect for the woman’s autonomy. Furthermore, recent recommendations for reforms in Australian maternity care emphasise the benefits of expanding the role of the midwife and providing women centred care underpinned by a wellness paradigm. 4 Regardless of the constraints imposed by biomedicine, the consumer-led demand means that midwives often interact with women who are interested in CAM. Although many therapies lie beyond their scope of practice, the popularity of these therapies places an onus on midwives to develop the relevant knowledge and systems to respond appropriately. The following discussion paper explores midwifery educational and practice issues regard- ing CAM, and makes recommendations to be considered by the profession in Australia. 2. Supporting women’s informed choices Healthcare practitioners have a duty to disclose the possibility of therapies that demonstrate sufficient evidence of safety and efficacy. 5,6 Furthermore, midwives are ethically obliged to provide care within the principle of informed choice. 7 The fundamental principle of beneficence, doing what is in the best interests of the woman/child, compels midwives to have adequate knowledge of the risks and benefits of any proposed treatment and to canvas all safe options. If there is evidence that CAM may be beneficial, midwives should inform the woman and, if she is interested in pursuing the therapy, recommend she seek further professional advice from a qualified practitioner. For example, midwives should be aware that acupressure and ginger may be helpful to women suffering from pregnancy induced nausea. 8 In addition, they should appreciate that CAM therapies also carry risks. For example, Blue Cohosh (Caulophyllum thalictroides), once used traditionally to prepare for birth, is now contraindicated due to safety concerns. 9 Women and Birth 26 (2013) e90–e93 A R T I C L E I N F O Article history: Received 29 April 2012 Received in revised form 21 October 2012 Accepted 25 November 2012 Keywords: Complementary and alternative medicine Midwifery Education Policy Profession A B S T R A C T Background: The use of complementary and alternative medicine during pregnancy has become increasingly popular over the past decade in Australia. Aim: The purpose of this discussion paper to make recommendations and foster a constructive debate regarding the appropriate response by the midwifery profession. Discussion: Midwives should receive basic education regarding the use of complementary and alternative medicine. All women should be routinely question women about their use and this should be documented. While a few therapies could be safely integrated, in most situations interested women should be referred to a qualified practitioner. Referral frameworks and flexible clinical guidelines should be investigated. Conclusion: With the appropriate education and support, midwives are in an excellent position to engage women in open dialogue and raise awareness of the benefits and risks of CAM practices. The way forwards for midwifery profession is to focus on self-governance, education and flexible clinical guidelines. ß 2012 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. * Corresponding author at: Faculty of Medicine, Nursing and Health Sciences, School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankstonk, Victoria 3199, Australia. Tel.: +61 3 9904 4120; fax: +61 3 9904 4655. E-mail address: Helen.Hall@monash.edu (H.G. Hall). Contents lists available at SciVerse ScienceDirect Women and Birth jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/wo mb i 1871-5192/$ – see front matter ß 2012 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. http://dx.doi.org/10.1016/j.wombi.2012.11.004