Clinical Abstracts-With Comments by Adriane Fugh-Berman, MD
June 2000; Volume 2; 48
Alternative Medicine Popular with Midwives
Source: Allaire AD, et al. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000;95:19-23.
Objective: To assess the recommendations of nurse midwives concerning the use of complementary and alternative medicine for their pregnant or postpartum patients.
Setting/Method/Subjects: Surveys were sent to all 120 licensed certified nurse midwives in North Carolina. Complementary and alternative medicine was defined as therapeutic interventions that are not currently part of the conventional medical system, not taught widely in U.S. medical schools, or not available at U.S. hospitals.
Results: The survey yielded 82 responses (68.3%). Of these, 77 (93.9%) had recommended alternative treatments to their pregnant patients within the past year. Forty-seven (57.3%) recommended alternative treatments to more than 10% of their patients. Seventy-three (89%) reported that their patients used alternative therapies within the past year.
Thirty-four certified nurse midwives (41.5%) had received formal training in different alternative therapies: most commonly herbal therapies (19), massage (10), acupressure (4), homeopathy (4), and therapeutic touch (4). Twenty-nine nurse midwives (35.4%) had received some training in alternative therapies during nurse-midwife training, the most common being herbal therapy (10), massage (6), acupressure (5), and mind-body interventions, including hypnosis, bio-feedback, and relaxation techniques (3). The most popular recommendations were herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%) and mind-body interventions (48.8%.) In addition, 32.9% recommended aromatherapy, 30.5% recommended homeopathy, 23.2% recommended spiritual healing, 19.5% recommended acupuncture, and 14.6% recommended bioelectric or magnetic applications. Herbal therapy was most commonly recommended for nausea or vomiting, cervical ripening, and lactation disorders. Mind-body interventions were most commonly recommended for anxiety, stress, and fatigue. Chiropractic, acupuncture, massage therapy, and bioelectric or magnetic applications were most commonly recommended for musculoskeletal and back pain. Acupressure was most commonly recommended for nausea and vomiting. Forty-six (76.7%) of those who used herbal therapy reported use for labor stimulation (including labor induction, labor augmentation, or post-term prevention).
Of the 60 nurse midwives who used herbal therapy, 71.7% reported that herbs were used concurrently with conventional medicine; 36.7% used herbs before conventional medication. Also, 58.3% cited patient preference; 31.7% cited personal preference. In addition, 31.7% indicated that herbs were safer than conventional medicine; 30% noted that herbs were less expensive; and only 10% indicated that herbs were more effective then conventional medicine. Herbs most commonly used for nausea and vomiting were ginger, peppermint, raspberry leaf, and chamomile. For post-term pregnancy, herbs included evening primrose oil, black cohosh, blue cohosh, raspberry leaf, and castor oil; for dysfunctional labor, blue cohosh, black cohosh, and raspberry leaf were cited. For perineal healing or postpartum discomfort, arnica and comfrey were most commonly prescribed, and for postpartum depression, St. John’s wort was most popular.
Funding: Not mentioned.
Comments: There is very little literature on the use of alternative therapies among midwives and none on the use of alternative therapies by obstetricians. This survey has a number of interesting findings, including the fact that herbs were most commonly used with, rather than instead of, conventional therapies, and that only a small minority of surveyed midwives felt that herbs were more effective than conventional therapies.
The recommendation of acupressure for nausea and vomiting is evidence-based (see Alternative Therapies in Women’s Health, January 1999, pp. 9-11) and the use of chiropractic, massage, or acupuncture for musculoskeletal or back pain seems reasonable. The herbs commonly recommended for nausea and vomiting—ginger, peppermint, raspberry leaf, and chamomile—are common ingredients in herbal tea and there is no evidence that they cause any harm during pregnancy.
The same cannot be said for black cohosh (Cimicifuga racemosa) or the unrelated blue cohosh (Caulophyllum thalictroides); in another survey of nurse midwives, the use of black or blue cohosh was associated with transient fetal tachycardia and meconium passage (see Alternative Therapies in Women’s Health, October 1999, pp. 81-83). Blue cohosh contains oxytocic compounds and has been associated with several adverse events, including case reports of congestive heart failure and myocardial infarction in an infant exposed to a high dose in utero, infant stroke, and aplastic anemia.1-3 I assume that the recommendations of arnica and comfrey for perineal discomfort are for external use; this would be most common, as neither of these herbs should be consumed internally. It is a weakness of this report that no distinction is made between oral use and topical application; evening primrose oil, for example, may be used internally or applied to the cervix in an effort to speed cervical ripening. Besides a possible but not well-delineated risk of therapies used for dysfunctional labor, other therapies used by midwives in this survey would not be expected to result in adverse effects. It bears noting that this survey was limited to one state and may not represent a cross-section of midwives nationally.
References
1. Jones TK, Lawson BM. Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication. J Pediatr 1998;132:550-552.
2. Wright IM. Neonatal effects of maternal consumption of blue cohosh. J Pediatr 1999;134:384.
3. FDA/CFSAN resources page. Food and Drug Administration Web site. Available at: http://vm.cfsan.fda.gov/~dms/aems.html. Accessed May 3, 2000.
June 2000; Volume 2; 48
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