Nurse-Midwifery

The Use of Complementary and Alternative Medicine (CAM)
in Pregnancy and Women's Health

The use of complementary and alternative medicine (CAM) has become so common that certain types are currently considered almost mainstream health care. According to a survey by Stanford University, 69% of Americans have used unconventional therapies at some time in their life for a health care complaint. Women are more likely to use CAM than men.

The surge in use of CAM has created a variety of responses by those aligned with more traditional Western (allopathic) medicine. Some practitioners have embraced the options that CAM provides; others have rejected them entirely. All, however, recognize that people use CAM frequently and that these alternative approaches can have an interactive effect, for better or worse, with traditional health care. Therefore, it is critical that physicians, midwives and nurses know something about CAM and, more importantly, include the use of CAM in the patient's health history.

The increase use of CAM has resulted in an increase in research on the safety and efficacy of these therapies. A special branch of the National Institutes of Health now funds studies on various alternative modalities. Whereas resources about CAM used to have virtually no credible scientific references, many compilations now are able to cite data to support (or negate) the use of CAM in various clinical situations. The scientific basis for many types of CAM is still seriously lacking. Much more research is needed to document the safety and efficacy of many forms of CAM, but the recent increase is encouraging.

The use of CAM in women is especially important to understand, for many CAM therapies are recommended in pregnancy or during lactation, and the fetal effects must be considered. These may be therapies that are specific to a pregnancy or lactation condition, or for some other health concern in a woman who happens to be pregnant or lactating. Unfortunately, there is even less information available about the use of CAM in these circumstances than there is about the use of CAM in general. Like the testing of prescription medication, the testing of herbal and homeopathic remedies in the classic randomized controlled trial (RCT) is impossible in pregnancy for ethical reasons. Therefore we must rely on anecdotal reports and observational studies to attempt to document safety issues.

The purpose of this portion of the web site is to provide some basic information about women's use of CAM, especially in pregnancy and lactation, and to point certified health nurses to resources for their own and their patient's use. The focus is primarily upon the use of herbal remedies. Although there are many types of CAM, many of them require the services of a particular type of practitioner - acupuncturist, naturopath, hypnotist, chiropractor, massage therapist and so forth. Herbs are available over-the-counter and can be used without prescription. As a result, many patients self-medicate without the background to understand the potency and potential for side effects and drug interactions. Practitioners need to be informed of the most common usages, and have resources to access quickly the information they need when patients present with questions or issues regarding the use of herbal medications.

Resources include some excellent recently published books, articles and a selection of web links. Caution must be used in the evaluation of web links. Although many exist that are clearly designed to "sell" their therapy or products, more and more reputable web sites (e.g. government, universities) are beginning to appear. The sites listed on these pages have been reviewed by OHSU's midwifery faculty. However, the review has been focused more on the reputation of the institution and the scientific approach than for the actual content. Users of these sites must make their own determination of their trust in the published content.