Acupressure for post-date pregnancy : a sequential mixed-methods feasibility study
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Around one-quarter of women experiencing their first full-term pregnancy continue past the due date, leading to an induced labour with potential negative sequelae. Acupressure may increase the likelihood of spontaneous labour onset in post-date pregnancy, but current evidence is very limited and of poor quality. There is also scarce information on complementary and alternative medicine (CAM) strategies that midwives in Australia discuss or recommend to women experiencing a post-date pregnancy. Aim: This project aimed to assess the feasibility of undertaking a randomised controlled trial (RCT) of acupressure for post-date pregnancy in the Australian maternity setting by addressing the eight components of ‘feasibility’: acceptability, demand, implementation, practicality, adaptation, integration, expansion and limited-efficacy testing. Methods: A sequential mixed-methods study was undertaken. Study 1: a feasibility RCT of acupressure to assist spontaneous labour onset for primigravid women experiencing a post-date pregnancy (n=44), together with a survey of trial participants (n=29) and five focus groups with health professionals (n=25). Study 2: a national survey of members of the Australian College of Midwives (n=571/3552) regarding their professional discussions, personal use, attitudes and knowledge of CAM, particularly acupressure, for post-date pregnancy. Quantitative analysis included descriptive and logistical regression modelling (SPSS v.23); thematic analysis was undertaken for qualitative data using generic qualitative description. Results: The RCT was feasible in this setting, where acupressure is an established part of clinical practice. Randomisation was well received, with 65.7% of eligible women willing to participate, and compliance with the acupressure protocol was high (81%). The representative national survey found that most midwife respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women experiencing a post-date pregnancy. Midwives were more likely to discuss strategies if they personally used CAM (p<0.001), were younger (p<0.001) or had worked fewer years as midwives (p=0.004). Australian midwives demonstrated interested in learning about CAM and 50% had completed some form of CAM education. Conclusion: While providing valid and important insights into the components of feasibility, the small number of women and staff participants in Study 1 limits generalisability of the findings. An acupressure RCT is feasible, but may need to be conducted in settings where acupressure is not an established part of clinical practice to ensure that the required sample size of 994 (80% power, α=0.05) can be met. Two implications arising from this study are the need for a CAM module in midwifery education curricula, and the publication of a national position statement on midwifery practice and CAM.
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