Midwives and complementary and alternative medicine: a grounded theory study.

The use of Complementary and Alternative Medicine (CAM) during pregnancy is becoming increasingly popular in Australia and midwives are often enthusiastic advocates. Some believe the therapies are congruent with professional ideology and provide useful options to reduce the medicalisation of childbearing. However, currently there are limited educational opportunities, a lack of clinical evidence and few specific guidelines to assist midwives make informed CAM decisions. How midwives navigate between the fundamentally different assertions held by CAM and conventional medicine, and the challenges they encounter when considering its use in an environment dominated by biomedicine, is largely unknown. The purpose of this study was to generate theory about the processes midwives engage in when considering the use of CAM in clinical practice. The research also aimed to identify and explain the factors that mediate midwives’ utilization of these processes. The findings of the study contribute towards a body of knowledge that will result in better educational and practice guidelines for midwives. Grounded theory, underpinned by the theoretical framework of symbolic interactionism was employed for this study. Twenty five midwives who worked in four hospitals and associated community clinics in Victoria, Australia, participated. Data were collected from 25 semi-structured interviews and non-participant observation of a subgroup of nine midwives as they interacted with women during 39 antenatal appointments and nine hours of childbirth classes. The central problem participants experienced is described as ‘Integrating diverse perspectives; considering the use of CAM in a hospital environment.’ The basic social process (BSP) midwives utilised to deal with this problem is conceptualised as, ‘Navigating a safe path together.’ The BSP is at the heart of the theory and although it embraces a range of responses, the process is common to all participants. It elucidates how midwives moved through three transitional phases of individualising pregnancy care, encountering diverse perspectives and expectations, and minimising the risks associated with childbearing, when confronted with the central problem. Four interrelated categories represent the various strategies participants engaged. The first, communicating about CAM, encompasses the key strategies that midwives employed when exchanging information with women. The second category, determining the role of CAM, explicates the strategies they used when considering the place of the therapies in contemporary maternity practice. The third category, influencing CAM use, highlights the processes utilized to encourage women to make safe therapeutic choices. The final category, managing the conflicts, reveals how midwives responded when confronted by divergent approaches to maternity care. Contextual conditions were found to have a significant influence on midwives’ behaviour towards CAM in clinical practice. Three broad mediating factors were identified. The context of professional work encompasses an expansive set of workplace and occupational conditions that exert a significant effect. The individual midwife’s beliefs and knowledge and the woman’s expectation and health, also moderate participants’ behaviour. Navigating a safe path together offers a possible explanation of midwives’ responses to the use of CAM by childbearing women. The theory explicates how midwives’ system of meaning around safe childbearing and their professional role directs their actions. Midwives engage a process where they work in partnership with women in a pragmatic quest to individualise the childbearing experience while prioritising safety. The theory demonstrates that many struggle to reconcile the professional discourse of facilitating women informed choices with the realities of daily practice.