The issues surrounding the use of complementary therapies in modern, Western society are terribly complex. First of all, there are lengthy debates about language, where some people either love or hate the terms complementary, alternative, holistic or integrative, depending on their core beliefs about creating, maintaining and rebuilding health and the usefulness of different approaches to this. Some people, for instance, find the term alternative therapies offensive, as it suggests that Western medicine is the norm (which, on a global scale, is certainly not the case), while others positively revel in using this term as a way of demonstrating that they set themselves apart from the crowd in the choices they make about their health.
Then there are myriad political issues, which again involve language and the question of whether “West is best”, but also the fact that, although complementary medicine is used more widely around the world than Western medicine, it is Western medicine that is currently deemed the ‘conventional’ approach, and Western medical philosophy which defines the systems and frameworks into which other modalities find they may have to fit. Add in the turf wars fought between different groups, the issues raised by the notions of professionalisation and registration and the economics of using complementary medicine in a system based on Western approaches and you have a recipe for confusion and conflict.
Moving Towards Holism
As midwives know, a good number of women use non-Western healing modalities during the childbearing year (e.g. Long et al 2001), and a fair few of them will do this without consulting (or, in some cases, even telling) a conventional practitioner. Perhaps they have an existing relationship with a therapist; perhaps they are following up a recommendation from their midwife or a friend; or perhaps they have reached the end of their tether because a particular issue is bothering them and Western approaches are either ineffective or (as is sometimes the case when pharmaceutical drugs are recommended during pregnancy or breastfeeding) unacceptable to them. Whatever the individual situation, my point is that women’s use of a range of healing modalities is a very real part of their childbearing experiences. Fortunately, many midwives also use these therapies themselves, and are thus able to talk through the issues with interested women, and an increasing number of midwives have studied one or more therapies, which they have then brought into their practice. Add this to the relationships that midwives are developing with therapists who are experts in their own areas, and we have the potential for an expanded and more holistic approach to health in the childbearing year.
However, I would like to gently raise the question of whether, within the maternity services, we are using holistic therapies in holistic ways, or whether, sometimes, we are using holistic therapies as alternative treatments within a medical model framework? I am not necessarily saying that the latter is wrong, and, indeed, you will find other articles which further describe this approach to using complementary therapies, but I do feel the time has come to begin to unpack these issues. For example, many labour wards now offer approaches such as aromatherapy for pain relief in labour and, while it is wonderful that this offers women an alternative to pharmaceutical analgesia, it still suggests that there is a problem – pain – which may necessitate treatment. To what extent is this holistic?
Is the use of acupuncture, herbs, homeopathy or castor oil to induce labour holistic? With this example, we are replacing the medical treatments of prostin, ARM and intravenous oxytocics with substances or treatments that are deemed more natural. However, natural does not necessarily equate with safe and I would further argue that the concept of ‘natural’ is a rather tricky one to pin down; many pharmaceutical drugs are derived from ‘natural’ substances, but would we consider them natural?
If the benefits of induction of labour truly outweigh the risks in a particular instance, then some women may be very happy to access what they deem a less invasive treatment option, and one which they can use at home, in order to achieve the goal of starting labour. However, using these therapies as ‘alternative’ interventions within allopathic frameworks is very different from using them in the philosophical context in which they developed; frameworks which often focus on the concept of balance and seek to include the dimensions of mind and spirit as well as matter, or the physical. It is also very different from taking a more holistic approach and looking at the bigger picture around issues such as post-term pregnancy or other factors which are deemed, within a Western model, to necessitate induction of labour.
Since I wrote this article, my thinking has developed quite a bit (partly because I wrote a PhD thesis on this topic!) and I wrote a further article a couple of years ago looking at the notion of so-called natural induction.
The use of alternative medicine as treatment within an allopathic framework may be connected with some of the problems that arise when we consider the evaluation of non-Western treatments. In Chinese traditional medicine, for example, one of the core beliefs involves balancing the energy known as Chi, and diagnosis is based on a multitude of factors which are very different from those used in the West. In fact, as Kaptchuk (1983) notes, from the perspective of Chinese traditional medicine, the Western idea of seeking one specific thing to create a cure itself appears unbalanced. Holistic approaches are not easily compressed into the framework of the randomised controlled trial, so can we really evaluate the healing modalities rooted in one set of philosophical beliefs by using tools designed to evaluate the effectiveness of interactions and treatments rooted in another belief system? (Sheran and Wickham 2006)
Yet the push for evidence-based practice and the location of midwifery within professional guidelines mean we cannot ignore the need to evaluate the complementary therapies that we are using or recommending. There is a positive side of this; it means that we are able to appropriately respond to the modern need to demonstrate the effectiveness and safety of our practice. But there is also a downside. The current dominance of research methods such as the RCT mean that non-Western healing modalities are being forced into frameworks that fail to explore the wider aspects of these modalities, reduce entire belief systems to treatments for specific conditions and may unfairly lead to the conclusion that particular therapies are ineffective.
Continuing the Debate
It seems vitally important to me that, as individual midwives, we have an awareness of our own beliefs in this area, amidst a sense of our unique philosophy of childbirth and midwifery practice. I see no problem with the fact that we all have slightly differing perspectives on this, as this will serve to help the debates to continue and expand. It remains equally important to find out where each individual woman is on her own journey in relation to these questions. Some women feel that West is best, and they will continue to place more trust in hypodermic than in acupuncture needles. By contrast, some women will be actively seeking a more holistic approach, and others will have no personal experience of complementary therapies but will be very open to the idea of trying them. I know of one woman for whom the raspberry leaf tea suggested by her midwife was the first step on a journey of thinking about healing modalities which eventually led to her training as a practitioner. As ever, it is ultimately only by asking women about their feelings, beliefs and experiences in this area that we can be with them in the ways that they prefer.
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Kaptchuk TJ (1983) The Web That Has No Weaver: Understanding Chinese Medicine. Congdon & Weed, Chicago.
Long L, Huntley A, Ernst E (2001) Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Complementary Therapies in Medicine 9; 178-185
Sheran I and Wickham S (2006) Chapter 6. In: Wickham S (2006) Appraising Research into Childbirth: An Interactive Workbook. Butterworth Heinemann, Oxford.
A version of this post was originally published as an article: Wickham S (2006). Holistic tensions: Is west really best? TPM 9: 3, 4-5.