Fundamentals of Midwifery: A Textbook for Students (130 page)

understand the broad characteristics of the group of healing systems known as complementary and alternative medicines (CAM)

identify the different categories of complementary and alternative medicines

understand the philosophy which underpins complementary and alternative medicines

identify some of the issues in relation to research and evidence of the safety and efficacy ofcomplementary and alternative medicines

discuss the role of the midwife in the context of complementary and alternative medicines.

Complementary and alternative medicines (CAM) have been reportedly popular among child-

bearing women for many years, and yet many CAM treatments reside in the margins of main- stream maternity provision, and do not form any part of routine National Health Service (NHS) care. This chapter attempts to define and categorise CAM, and to identify how it differs from Western medicine. CAM provision will be discussed, the growth of CAM will be explored, and finally this chapter will also address aspects relevant to respecting women’s rights to self- administer CAM products. The clinical effectiveness and safety, using the best available evi- dence to underpin practice, and working within, and being guided by, relevant policies, protocols and professional requirements, will also be examined.

, First Edition. Edited by Louise Lewis.

© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. Companion website: www.wileyfundamentalseries.com/midwifery

First, it is important to define CAM and to understand how it differs from other medicines. CAM

is a term used to describe a wide range of healing systems that are not considered part of mainstream or conventional Western medicine. Western medicine is the term used for the products and treatments that are provided predominantly within mainstream health care in the United Kingdom (UK). Western medicine is focused upon addressing and trying to prevent disease, through diet, exercise, prescription drugs and surgery.

A variety of definitions of CAM exist across the literature. For the purposes of this chapter the overarching term CAM is used to capture all of the complementary and alternative systems and processes which are associated with healing. Although the word medicine is used within the CAM acronym, the term CAM itself refers to treatments, therapies and products, as well as medicines.

It is helpful to be able to see some of the differences between the two approaches to healing (CAM and Westernised medicine). In Table 14.1, the Western and the Eastern approaches are identified.

Although the acronym CAM is used regularly, and the terms complementary and alternative are often used together;

and

have different meanings in the context of the role they play in healing. It is important to have a general understanding of the terms, and how they exist within a Western medicine framework. An

medicine or therapy

Western and Eastern approaches to healing (Adapted from ‘Eastern Medicine versus Western Medicine’ Vaxa [online] Available: http://www.vaxa.com/eastern-medicine-vs-western

-medicine.cfm)

303

Health is a balance between mind, body, and spirit

Health is the absence of pain, symptoms, and physical or mental defects

Being unhealthy is an imbalance or disharmony of the natural body energy

Being unhealthy means there is a defect of the bodily structure with a cause and symptoms

Symptoms are the body’s way of showing that it is healing

Symptoms are a sign of illness and must be eliminated or suppressed

The cause of an illness is any action that will cause disharmony of the

The cause of an illness is a foreign pathogen or force from outside the body

The patient’s responsibility is to prevent illness and live a healthy, harmonious lifestyle

Personal lifestyle and living conditions don’t play as much of a role, as more of an emphasis is put on healing vs. staying well

The role of the doctor is as an assistant, to help people stay well instead of fixing them once they become ill

The role of the physician is that of a mechanic, to fix what is broken and find things that are wrong

The goal of treatment is to restore balance through lifestyle changes and other natural means

The goal of treatment is to suppress symptoms, usually through drugs or surgery

The main strength of Eastern medicine is that it focuses on prevention and management of chronic illness, and the recognition of the importance of lifestyle and the mind/body connection

The main strength of Western medicine is that it is able to treat structural trauma and defects, as well as address

life-threatening illnesses that require medical or surgical intervention

304

would be one which is used as a separate and different approach to healing, different from one which is generally accepted in Western medicine as appropriate for relieving uncomfortable symptoms of a bodily defect (for example if acupuncture is used to alleviate or cure back pain instead of ‘routine’ analgesia). A

medicine or therapy is used in addition to or alongside a conventional approach (for example if acupuncture is used alongside analgesia to alleviate or cure back pain).

The field of CAM is very broad and constantly changing. The systems that exist within CAM are

diverse. For those who have an emerging understanding of CAM, it is perhaps easier to group CAM practices into categories, and whilst these categories may not always be formally defined, establishing and acknowledging CAM within three broad groups, may be a useful way of facili- tating the development of a knowledgebase for students and those new to CAM. In 2000, an enquiry into the regulation of, evidence for, accessibility of information about, the training of practitioners, and NHS provision of CAM, was undertaken by The Science and Technology Com- mittee of the House of Lords. At the time of the enquiry, the Committee identified a detailed list of CAM therapies which they admitted is

however, it does provides an indication and framework of the main types of therapies considered within the broad defini- tions of CAM. For someone with an emerging interest in CAM, this may be a helpful categorisa- tion of CAM and its associated practices. Table 14.2 outlines the House of Lords Scientific and Technology Categorisation of CAM.

Short and simplified descriptions of CAM disciplines: Science and Technology Committee of the House of Lords

Group 1: Professionally Organised Alternative Therapies
Therapy
Description
Acupuncture
Originating from China, acupuncture involves inserting small needles into various points in the body to stimulate nerve impulses. Traditional Chinese acupuncture is based on the idea of ‘qi’ (vital energy) which is said to travel around the body along ‘meridians’ which the acupuncture points affect. Western Acupuncture uses the same needling technique but is based on affecting nerve impulses and the central nervous system; acupuncture may be used in the West as an anaesthetic agent and also as an analgesic.
Chiropractic
Used almost entirely to treat musculoskeletal complaints through adjusting muscles, tendons and joints and using manipulation and massage techniques. Diagnostic procedures include case histories, conventional clinical examination and x-rays. Chiropractic was originally based on the idea that ‘reduced nerve flow’ led to disease.
Herbal medicine
A system of medicine which uses various remedies derived from plants and plant extracts to treat disorders and maintain good health. Another term for this type of treatment is phytotherapy.
Homeopathy
A therapy based on the theory of treating like with like. Homeopathic remedies use highly diluted substances that if given in higher doses to a healthy person would produce the symptoms that the dilutions are being given to treat. In assessing the patient homeopaths often take into account a range of physical, emotional and lifestyle factors which contribute to the diagnosis.
Table 14.2
(
Continued
)
(i) Group 1: Professionally Organised Alternative Therapies
Therapy
Description
Osteopathy
A system of diagnosis and treatment, usually by manipulation, that mainly focuses on musculo- skeletal problems, but a few schools claim benefits across a wider spectrum of disorders.Historically differs from chiropractic in its underlying theory that it is impairment of blood supply and not nerve supply that leads to problems. However in practice there is less difference than might be assumed. Mainstream osteopathy focuses on musculo-skeletal problems; but prior to osteopathy gaining statutory protection of title, other branches of this therapy purported to diagnose and treat a range of disorders. One such branch is now known ascranio-sacral therapy, which should be considered as a distinct therapy which would fall into Group 3.
(ii) Group 2: Complementary Therapies
Therapy
Description
Alexander technique
Based on a theory that the way a person uses their body affects their general health. This technique encourages people to optimise their health by teaching them to stand, sit and move according to the body’s ‘natural design and function’. This is, in essence, a taught technique, rather than a therapy.
Aromatherapy
Use of plant extract essential oils inhaled, used as a massage oil, or occasionally ingested. Common in France but practised there by medical doctors only. Can be used to alleviate specific symptoms or as a relaxant.
Bach and other flower remedies
The theory behind flower remedies is that flowers contain the life force of the plant and this is imprinted into water through sun infusion which is used to make the flower remedy. Flower remedies are often used to help patients let go of negative thoughts; usually flower remedies are ingested.
Body work therapies, including massage
Therapies that use rubbing, kneading and the application of pressure to address aches, pains and musculo-skeletal problems. Often used as a relaxant.
Counselling stress therapy
A series of psychical therapies that attempt to help patients to work through their thoughts and to reflect on their lives so as to maximise wellbeing.
Hypnotherapy
The use of hypnosis in treating behavioural disease and dysfunction, principally mental disorders.
Meditation
A series of techniques used to relax a patient to facilitate deep reflection and a clearing of the mind (see Maharishi Ayurvedic medicine below).
Reflexology
A system of massage of the feet based on the idea that there are invisible zones running vertically through the body, so that each organ has a corresponding location in the foot. It has also been claimed to stimulate blood supply and relieve tension.
Shiatsu
A type of massage originating from Japan which aims to stimulate the body’s healing ability by applying light pressure to points across the body. Relies on the meridian system of ‘qi’ in a similar way to traditional Chinese medicine and acupuncture.
Healing
A system of spiritual healing, sometimes based on prayer and religious beliefs, that attempts to tackle illness through non-physical means, usually by directing thoughts towards an individual. Often involves ‘the laying on of hands’.305(
Continued
)
Table 14.2
(
Continued
)
(iii) Group 2: Complementary Therapies (Continued)
Therapy
Description
Maharishi Ayurvedic medicine*
A system which promotes transcendental meditation, derived from the Vedic tradition in India. Recommends the use of herbal preparations similar to those used in Ayurvedic medicine (see below) and Traditional Chinese medicine (see below).
Nutritional medicine
A term used to cover the use of nutritional methods to address and prevent disease. Uses diets and nutritional supplements. Often used to address allergies and chronic digestive problems. The difference between nutritional medicine and dietetics is that nutritional therapists work independently in accordance with naturopathic principles and focus on disorders which they believe can be attributed to nutritional deficiency, food intolerance or toxic overload. They believe these three factors are involved in a wide range of health problems. Dieticians usually work under medical supervision, using diets to encourage healthy eating and tackle a narrower range of diseases. Nutritional therapists often use exclusion diets and herbal remedies to tackle patients’ problems.
Yoga
A system of adopting postures with related exercises designed to promote spiritual and physical well-being.
(iv) Group 3 (a): Alternative Disciplines: Long Established and Traditional Systems of Healthcare
Therapy
Description
Anthroposophical medicine
‘Anthroposophy’ describes people in terms of their physicality, their soul and their spirit. Anthroposophical medicine aims to stimulate a person’s natural healing forces through studying the influence of their soul and spirit on their physical body.
Ayurvedic medicine
An ancient discipline, originating in India, based upon the principle of mind-spirit-body interaction and employing natural herbs, usually mixtures, in treatment.
Chinese herbal medicine*
(See Traditional Chinese medicine below). A tradition of medicine used for thousands of years in China, which has its own system of diagnosis. Uses combinations of herbs to address a wide range of health problems.
Eastern medicine (Tibb)*
Tibb is a tradition which synthesises elements of health philosophy from Egypt, India, China and classical Greece. It literally means ‘nature’. The concept of wholeness and balance permeates the principle of Tibb. Imbalance is thought to cause disease. It is thought to occur on four levels: physical, emotional, mental and spiritual. Tibb uses a range of treatments including massage, manipulation, dietary advice and herbal medicine, and a psychotherapeutic approach to restore imbalances which are considered the cause of disease.
Naturopathy
A method of treatment based on the principle that the natural laws of life apply inside the body as well as outside. Uses a range of natural approaches including diet and herbs and encourages exposure to sun and fresh air to maximise the body’s natural responses.
Traditional Chinese medicine
The theory behind Traditional Chinese medicine is that the body is a dynamic energy system. There are two types of energy - Yin qi and Yang qi – and it is thought if there is an imbalance in Yin and Yang qi then symptoms occur. Traditional Chinese medicine uses a number of treatment methods to restore the balance of Yin and Yang qi; these include acupuncture, herbal medicine, massage and the exercise technique Qigong.306
Table 14.2
(
Continued
)
(v) Group 3 (b): Other Alternative Disciplines
Therapy
Description
Crystal therapy
Based on the idea that crystals can absorb and transmit energy and that the body has a continuing fluctuating energy which the crystal helps to tune. Crystals are often placed in patterns around the patient’s body to produce an energy network to adjust the patient’s energy field or ‘aura’.
Dowsing
Traditionally used as a way to identify water sources underground. Is not itself a therapy but is used by a range of other disciplines to answer questions through intuitive skills. Often used in conjunction with Radionics.
Iridology
A method of diagnosing problems and assessing health status that relies on studying the iris of the eye and noting marks and changes.
Kinesiology
A manipulative therapy by which a patient’s physical, chemical, emotional and nutritional imbalances are assessed by a system of muscle testing. The measurement of variation in stress resistance of groups of muscles is said to identify deficiencies and imbalances, thus enabling diagnosis and treatments by techniques which usually involve strengthening the body’s energy through acupressure points.
Radionics
A type of instrument-assisted healing which attempts to detect disease before it has physically manifested itself. It is based on the belief that everyone is surrounded by an invisible energy field which the practitioner tunes into and then attempts to correct problems which have been identified. Practitioners believe it can be done over long distances. Instruments are a focus of the healer’s intent and include sugar tablets which carry the healing ‘idea’.307*We received evidence about these therapies, although they were not included in our original Call for Evidence.Alternatively, for the purposes of discussing CAM, the United States Department of Health and Human Services, suggest the useful categorisations outlined in Table 14.3.
Why is CAM important to know about?
Reports of increasing consumer demand for CAM by pregnant women and new mothers arewell-documented in studies and discussion papers (Jones 2012). Anecdotal evidence suggests that childbearing women reportedly pursue and use CAM before, during and after birth (Tiran 1996; Tiran 2003; Tiran and Chummun 2004; Tiran 2006a; Mitchell et al. 2006; Mitchell and Wil- liams 2007; Evans 2009; Kenyon 2009; Mousley 2010; Cant et al. 2011; Tiran 2006b; Tiran 2006c; Mitchell and Williams 2006). It is not entirely clear if large numbers of childbearing women are actually engaging with CAM as the literature would suggest, as there have been very few primary studies which involve data collection directly from women in the UK (Jones 2012).A recent report on the frequency of CAM use by a population of pregnant women in the former county of Avon in South West England, revealed that 26.7% (n = 3774) had used CAM at least once in pregnancy, the use rising from 6% in the first trimester to 12.4% in the second trimester, to 26.3% in the third trimester, with herbal teas being the most commonly reported CAM at any time (Bishop et al. 2011). Surveys undertaken in the United States by Gibson et al. (2001) and Ranzini et al. (2001) suggest that approximately one in three people have used CAM, two-thirds of them being women, and a recent study in Australia reported that almost 50% of a large nationally representative sample of Australian women consult a CAM practitioner during