The drivers and impact of complementary and alternative medicine use in the provision of care for women during pregnancy, labour and birth : a health services research study

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Background: There is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focused upon the factors which drive women’s use of CAM during pregnancy, labour and birth (PLB) and the patterns of CAM use which impacts on labour and birth outcomes. Methods: A cross-sectional sub-study of women from the ‘younger’ cohort of the Australian Longitudinal Study on Women’s Health (aged 31-36 years) (n=8012) who identified as pregnant or recently given birth (n=2445) were recruited for the study. Alongside the women’s demographics and health history, the survey explored women’s consultations with conventional maternity health professionals and CAM practitioners, use of pharmacological pain management techniques (PPMT) and non-pharmacological pain management techniques (NPMT), and incidence of birth outcomes. The statistical analysis included Pearson chi-square tests, and analysis of variance or t-tests to examine bivariate relationships. Multiple logistic regression and backwards stepwise regression was undertaken as needed to more closely examine the relationship between variables. Results: The survey was completed by 1835 women. A substantial number of respondents consulted with a CAM practitioner (49.4%) or used CAM products commonly associated with CAM practice (52.0%) for pregnancy-related health conditions. Differences were seen in the influence of demographics, health service utilisation, health status, use of CAM, and attitudes and beliefs upon consultation with a CAM practitioner and use of intrapartum pain management techniques across all categories of practitioners. Higher educational attainment was strongly associated with consultations with an acupuncturist (RR=4.17-4.53). More than two thirds of women (66.7%) who used NPMT utilised CAM during pregnancy. Women were significantly more likely to use NPMT during birth if they were married (OR=6.90), consulted with massage therapist (OR=1.58), or attended yoga/meditation class (OR=2.87). Women who consulted with a chiropractor were less likely to have a premature delivery (OR=0.29) or caesarean section after onset of labour (OR=0.10) but more likely to have emotional distress associated with the labour (OR=3.27). Conclusions: This thesis presents novel findings and further develops our understanding of CAM use in PLB. This thesis highlights a need for future research to examine this topic more closely, and to develop policy and encourage health literacy in relation to CAM use in PLB. The results of this study requires the attention of policy makers, maternity health professionals and women.
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