Complementary medicine use by nurse midwives in the U.S

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Abstract

The purpose of this prospective descriptive study was to understand 1) the extent to which certified nurse midwives (CNMs) utilize complementary and alternative medicine (CAM), 2) how knowledge regarding CAM is gained, and 3) characteristics of these providers. A survey was designed to determine use of CAM treatment modalities: herbal preparations, pharmacologic/biologic treatments, manual healing/bioelectromagnetic applications, mind-body interventions, and diet and lifestyle. Random sampling was used to select participants (n = 500) who were members of the American College of Nurse Midwives. Of those CNMs responding (n = 227, 45%), 78% (n = 178) reported use of CAM. Herbal preparations were most commonly used (85%), followed by pharmacologic/biologic treatments (82%), mind-body interventions (80%), and manual healing/bioelectromagnetic therapies (47%). Virtually all CAM user respondents utilized at least one diet and lifestyle therapy.

Introduction

It has been estimated that upwards of 72 million Americans – nearly 62% – use at least one complementary or alternative (CAM) therapy each year with an estimated 425 million alternative provider visits annually.1, 2, 3 Over $27 billion is spent annually on alternative therapies.2 While data concerning patient CAM consulting patterns and outcomes are limited, the fact that most visits are non-reimbursed underscores public interest.2

While it is known that CAM is widely used, less is known about the extent to which health care providers utilize CAM therapies, how knowledge about CAM is gained, or the characteristics of those providers who use or recommend such use. It is widely assumed that Certified Nurse Midwives (CNMs) promote the use of more “natural” therapies, but little is known about their knowledge and practice patterns. Nor are there data regarding the extent to which CAM is included in nurse midwifery educational programs. The American College of Nurse Midwives (ACNM) core competencies detail content that must be taught in accredited programs. Complementary therapies were specifically included in the 1997 criteria4 but were deleted from subsequent competency updates.5, 6 The rationale for the deletion was unclear and the deletion is in contradiction to the Institute of Medicine's (IOM) suggestion that health professions incorporate sufficient information about CAM to allow competent advisement to patients.2

There have been limited studies regarding the use of CAM by nurse midwives and other maternity care providers. What studies are available are largely convenience samples at the state level7, 8 or are limited to specific practice areas such as labor induction.9 Though it is widely assumed that nurse midwives utilize many and varied alternative health strategies in practice, there have been no reported investigations examining the use of CAM strategies by CNMs across full-scope practice settings and across geographic regions. Further, information about practice patterns of nurse midwives is important to inform the debate about the place of CAM in health care, as well as the extent to which CNM education addresses consumer need.

CNMs provide care to women from menarche through the post-menopausal years with particular emphasis on maternity care. Substantial amounts of care are provided to vulnerable and disparate populations.10, 11 Population surveys have demonstrated factors predictive of CAM use and include women, better educated, poorer health status, higher income, and those middle-aged.3, 12, 13 Use in minority populations has also proven to be substantial14, 15, 16 though they are less likely to disclose use to their health care provider.17 There are no known national CAM prevalence studies of pregnant women in the U.S. though existing reports of use in pregnancy range from 7.1% to 73%.18, 19, 20, 21, 22

The aims of this study were to determine 1) the extent to which CNMs utilize CAM strategies, 2) how knowledge regarding therapies is gained, and 3) characteristics of CNMs using complementary and alternative health therapies.

Section snippets

Design

This prospective descriptive study surveyed CNMs practicing in the U.S. and territories and who were members of the American College of Nurse Midwives.

Survey development

A paper and pencil survey was developed to detail use of CAM therapies by CNMs. The survey was developed in three parts. Part I included 26 items related to demographic background and practice-related information, as well as 5 items designed to determine how knowledge about CAM therapies had been gained by the CNM. Part II listed CAM therapies in

Respondent characteristics

The final sample consisted of 227 responses for a response rate of 45%. Of those responding, 178 (78%) reported use of CAM in practice. For CAM users, over a quarter of the respondents were from Region 6 (west); response rates from the other five regions ranged from 8 to 19% (see Fig. 1). All respondents used CAM in some form or other. Respondents were largely middle-aged, married, and master's prepared. Practice sites were evenly distributed among rural, small town, city and metropolitan

Discussion

This study had several limitations. First, it is unknown how many CNMs actually received the survey materials. There was no follow-up of non-responders so there is potential responder bias and findings must be interpreted with caution. In addition, the study did not ascertain the rationale for using varied therapies nor were educational programs queried regarding the nature of the content provided in nurse midwifery programs. The structure of the survey questionnaire also may have limited

Conclusions

In summary, CAM therapies are widely used by U.S. CNMs. It is worrisome however, that nearly half of those using CAM in practice reported that they had not been taught how to critically read the literature. Given the paucity of research related to many CAM therapies, particularly botanicals, evaluation of the existing empirical evidence is critical for safe and judicious use in clinical practice. Nurse midwifery education programs need to ensure content that addresses commonly used CAM

Acknowledgments

This study was supported by an award from the Mayo Clinic Clinical Research Committee. Special thanks to Judith Franco for her assistance with this project.

References (45)

  • K.A. Hirschkorn et al.

    Actions speak louder than words: mainstream health providers' definitions and behaviour regarding complementary and alternative medicine

    Complement Ther Clin Pract

    (2007)
  • F.W. Anderson et al.

    Complementary and alternative medicine in obstetrics

    Int J Gynaecol Obstet

    (2005)
  • P.M. Barnes et al.

    Complementary and alternative medicine use among adults: United States, 2002

    Adv Data

    (2004)
  • Institute of Medicine [IOM]

    Committee on the use of complementary and alternative medicine by the American Public. Complementary and alternative medicine in the United States

    (2005)
  • H.A. Tindle et al.

    Trends in use of complementary and alternative medicine by US adults: 1997–2002

    Altern Ther Health Med

    (2005)
  • American College of Nurse Midwives [ACNM]

    ACNM core competencies in nurse-midwifery – May 1997

  • American College of Nurse Midwives [ACNM]

    ACNM core competencies for basic midwifery practice, May 2002

  • American College of Nurse Midwives [ACNM]

    ACNM core competencies for basic midwifery practice, June 2007

  • M. Hastings-Tolsma et al.

    A profile of Colorado nurse-midwives: implications for health care

    West J Nurs Res

    (2009)
  • J.G. Grzywacz et al.

    Age, race, and ethnicity in the use of complementary and alternative medicine for health self-management: evidence from the 2002 National Health Interview Survey

    J Aging Health

    (2005)
  • D.M. Upchurch et al.

    Complementary and alternative medicine use among American women: findings from the National Health Interview Survey, 2002

    J Womens Health

    (2007)
  • C.M. Brown et al.

    Patterns of complementary and alternative medicine use in African Americans

    J Altern Complement Med

    (2007)
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