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Complementary Therapies in Clinical Practice (2005) 11, 48–50

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Complementary therapies in maternity care:personal reflections on the last decade

Denise Tiran

Expectancy Ltd., Expectant Parents’ Complementary Therapies Consultancy, London, UK

I first became interested and involved in comple-mentary medicine in the late 1980s, when it wasstill largely viewed by sceptics as ‘‘fringe’’ medi-cine, and its use alongside mainstream conven-tional care was virtually unknown. When Iimplemented an introduction to massage intomidwifery training courses in 1987 and used it inmy work with students caring for labouring women,I think I was seen as the ‘‘resident witch’’ offeringsomething which was rather odd or ‘‘new age’’.Perhaps also it was seen as something which hadmore suspect connotations, particularly when Istarted to offer a relaxation service to maternityunit staff, including the (male) doctors! I wasfortunate to be at the forefront of the movementwhich propelled complementary therapies intoorthodox care, and, in the field of midwifery, oneof very few who were able to combine midwiferyand complementary therapy practice, educationand research. My own complementary therapiesantenatal clinic at Queen Mary’s Hospital, Sidcup inKent was established as part of my university work,linking theory and practice and, increasingly now,providing opportunities for teaching, audit andclinical studies.

Having been a member of the CTNM editorialcommittee since its inception, I have also beenprivileged to assist in the task of informing othersand advocating the safe and effective use of

ee front matter r 2004 Elsevier Ltd. All rights reservtnm.2004.07.002

ess: expectancy04@hotmail.com (D. Tiran).

complementary therapies into midwifery practice.I well remember the somewhat heated debateamongst the early committee members regardingthe name of the journal, in which I adamantlyadhered to the belief that the title should include‘‘midwifery’’ as different from ‘‘nursing’’, but thisdid of course, commit those of us who weremidwives to commissioning sufficient papers re-lated to maternity care—or to writing themourselves. However, looking back now, thereappears to have been no shortage once the journalbecame established, and I feel that the midwiveshave ‘‘held their own’’ when compared to thevariety of nursing and health visiting paperspublished over the last 10 years. It is a measureof how interest amongst conventional healthprofessionals has blossomed, that a name changefor the second decade of the journal intends toencompass other healthcare disciplines.

Reviewing the papers published in the journalover the last 10 years, it is fascinating to find atrend in the content of maternity-complementarytherapy papers which mirrors trends in practice,although it is difficult to determine whether theseare related—perhaps it is rather a ‘‘chicken andegg’’ situation. Early papers described the comple-mentary therapy work in which a few midwiveswere involved, and discussed the value of differenttherapies for pregnant and childbearing women.1–7

These may have contributed to informingcolleagues about the process of implementing

ed.

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Complementary therapies in maternity care 49

complementary therapies into their personal prac-tice, and they continue to be a valuable feature ofthe journal.8,9 Several papers have explored theholistic nature of complementary medicine andrelated this to the woman-focused care which is somuch a part of normal midwifery.10–15 There havebeen numerous papers on the use of herbalmedicines by pregnant women;5,6,16–18 baby mas-sage has featured,19–21 as have alternative relaxa-tion and breathing techniques.22,23 Several papersare pending on the use of acupuncture in mid-wifery. More recently the focus—and caliber—ofpapers has changed to reflect the increasingamount of complementary therapy research andaudit being done by midwives,24–26 while otherpapers have highlighted concerns around safety,efficacy and professional accountability.27,28

It is in no small part due to my involvement withthe journal that I have personally been facilitatedin developing my career. In 1995, when the journalbegan and I was working at the University ofGreenwich, we had just commenced the UK’s firstcomplementary therapy programme—the Diplomaof Higher Education in Complementary Therapy(Aromatherapy)—aimed specifically at conven-tional health professionals, primarily nurses, mid-wives and health visitors. This progressed to a BSc(Hons) in Complementary Therapies, which was oneof the first undergraduate programmes in the UK.Ten years later, complementary therapy educationis firmly established in many universities, and wehave seen massive changes in both regulation andtraining of practitioners who do not possess anorthodox healthcare qualification.

Public demand for alternatives to mainstreamtreatment, particularly in maternity care, hasspawned numerous service initiatives, both privateand NHS. There is a plethora of books, mediaprogrammes and internet sites devoted to alter-native and complementary medicine, and pregnantwomen present a particularly receptive audience.They are keen to access high-quality complemen-tary therapy services—and are prepared to pay forthem, especially the relaxation therapies which arenot readily available on the NHS. Women alsofrequently request information on aspects ofcomplementary medicine such as homeopathicarnica for perineal care after delivery, herbalraspberry leaf for uterine toning, or natural meansof dealing with the myriad symptoms and anxietieswhich they experience at this time.

This thirst for information has recently led to myown change of professional direction, in which Ihave set up Expectancy Ltd.—the ExpectantParents’ Complementary Therapies Consultancy.This offers evidence-based website information to

women on the safe and effective use of comple-mentary therapies and natural remedies duringpregnancy and childbirth, and a range of clinicalservices, based on risk–benefit analyses, providedby midwives with various complementary therapyqualifications. Educational and consultancy ser-vices for professionals, including a university-accredited module on maternity complementarytherapies, are also available, and midwives whocomplete the module can obtain supervised clinicalexperience in the clinics. This venture representsthe culmination of many years’ work in the fieldand is based on my personal professional philosophyof balancing effectiveness with safe practice whilstoffering women increased choice.

I remain committed to promoting the incorpora-tion of complementary therapies into normalmaternity care, but we are still some way off fromseeing comprehensive inclusion in NHS midwiferyservices. However, if I can demonstrate the demandfor, as well as the safety and value of complemen-tary medicine during pregnancy and childbirth,albeit via services for which people must pay, Ihope I may continue to influence the greaterintegration of the two systems of care. My dreamwould be to see complementary therapies consid-ered a normal component of UK midwifery care,with adequate education at both pre- and post-registration levels, the development of a comple-mentary therapy consultant-midwife role and in-creasing opportunities for research.

References

1. Tiran D. Complementary therapies education in midwifery.Complement Ther Nurs Midwifery 1995;1:41–3.

2. Tiran D. Complementary therapies within maternity care:bridging the gap. Complement Ther Nurs Midwifery 1996;2:29–31.

3. Tiran D. Aromatherapy in midwifery: benefits and risks.Complement Ther Nurs Midwifery 1996;2:88–92.

4. Tiran D. The use of complementary therapies in midwifery: afocus on reflexology. Complement Ther Nurs Midwifery1996;2:32–7.

5. Stapleton H. The use of herbal medicine in pregnancy. Part1: an overview of current practice. Complement Ther NursMidwifery 1995;1:148–53.

6. Stapleton H. The use of herbal medicine in pregnancy andlabour. Part 2: events after the birth including thoseaffecting the health of babies. Complement Ther NursMidwifery 1995;1:165–7.

7. Katz T. The management of pregnancy and labour withhomeopathy. Complement Ther Nurs Midwifery 1995;1:159–64.

8. Benor DJ. Spiritual healing for infertility, pregnancy, labourand delivery. Complement Ther Nurs Midwifery 1996;2:106–9.

9. Cummings B. Empowering women: homeopathy in midwiferypractice. Complement Ther Nurs Midwifery 1998;4:13–6.

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10. Garratt R. The midwife as healer. Complement Ther NursMidwifery 2001;7:197–201.

11. Milan M. Childbirth as healing: three women’s experience ofindependent midwife care. Complement Ther Nurs Mid-wifery 2003;9:140–6.

12. Tiran D. A holistic framework for maternity care. Comple-ment Ther Nurs Midwifery 1999;5:127–35.

13. Tiran D. The use of herbs by pregnant and childbearingwomen: a risk–benefit assessment. Complement Ther NursMidwifery 2003;9:176–81.

14. Tiran D. The use of fenugreek for breast feeding women.Complement Ther Nurs Midwifery 2003;9:155–6.

15. Pinn G, Pallett L. Herbal medicine in pregnancy. Comple-ment Ther Nurs Midwifery 2002;8:77–80.

16. Hayes JA. TAC-TIC therapy: a non-pharmacological strokingintervention for premature infants. Complement Ther NursMidwifery 1998;4:25–7.

17. Adamson S. Teaching baby massage to new parents.Complement Ther Nurs Midwifery 1996;2:151–9.

The hardest thing to learn in life is which bridge t

18. Pierce B. The practice of toning in pregnancy and labour:participant experiences. Complement Ther Nurs Midwifery1998;4:41–6.

19. Jones P. The onset of labour: an alternative theory.Complement Ther Nurs Midwifery 1996;2:21–4.

20. Burns E, Blamey C, Errser S, Lloyd AJ, Barnetson L. The use ofaromatherapy in intrapartum midwifery practice; an observa-tional study. Complement Ther Nurs Midwifery 2000;6:33–4.

21. Budd S. Moxibustion for breech presentation. ComplementTher Nurs Midwifery 2000;6:176–9.

22. Tipping L, Mackereth P. A concept analysis: the effect ofreflexology on homeostasis to establish and maintainlactation. Complement Ther Nurs Midwifery 2000;6:189–98.

23. Tiran D. Nausea and vomiting in pregnancy: safety andefficacy of self-administered complementary therapies.Complement Ther Nurs Midwifery 2002;8:191–6.

24. Tiran D. Viewpoint—midwives’ enthusiasm for complemen-tary therapies: a cause for concern? Complement Ther NursMidwifery 2004;10:77–9.

o cross over and which to burn (David Russell)