Healthcare professional views and experiences of complementary and alternative therapies in obstetric practice in North East Scotland: a prospective questionnaire survey.

OBJECTIVE: The aim of this study was to investigate the use of complementary and alternative medicines (CAMs) therapy by UK healthcare professionals involved in the care of pregnant women, and to identify key predictors of use. DESIGN: A prospective survey. SETTING: Maternity services in Grampian, North East Scotland. SAMPLE: All healthcare professionals (135) involved in the care of pregnant women (midwives, obstetricians, anaesthetists). METHODS: Questionnaire development, piloting, and distribution. Descriptive and inferential statistical analysis. RESULTS: A response rate of 87% was achieved. A third of respondents (32.5%) had recommended (prescribed, referred, or advised) the use of CAMs to pregnant women. The most frequently recommended CAMs modalities were: vitamins and minerals (excluding folic acid) (55%); massage (53%); homeopathy (50%); acupuncture (32%); yoga (32%); reflexology (26%); aromatherapy (24%); and herbal medicine (21%). Although univariate analysis identified that those who recommended CAMs were significantly more likely to be midwives who had been in post for more than 5 years, had received training in CAMs, were interested in CAMs, and were themselves users of CAMs, the only variable retained in bivariate logistic regression was 'personal use of CAM', with an odds ratio of 8.26 (95% CI 3.09-22.05; P < 0.001). CONCLUSION: Despite the lack of safety or efficacy data, a wide variety of CAM therapies are recommended to pregnant women by approximately a third of healthcare professionals, with those recommending the use of CAMs being eight times more likely to be personal CAM users.

Reducing infant mortality.

PIP: Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.^ieng

Birth of a nation: family planning in Albania.

PIP: Albania's entrance into the world community has exposed some of the consequences of a pronatalist policy of 40 years; high infant and maternal mortality, illegal clandestine abortions leading to morbidity and death, and high fertility at 3.3 children per woman in 1990. The crude birth rate was 25.2 per 1000. The communist dictator Enver Hohxa used extreme measures with his secret police to enforce repressive policies. Birth control was forbidden to be even discussed, and sex was absent from medical literature. The current population of Albania is 3.3 million, with 66% living in remote mountain villages. A national family planning program is currently underway. The goals are to reduce mortality, reduce premature births by 20%, and achieve contraceptive usage among 10% of the reproductive age populations. Medical personnel will be trained in family planning, and family planning will be introduced in the entire health education program. Reliance will be placed on the existing extensive system of primary health care (PHC) facilities. The outreach effort to the 700,000 women of reproductive age will involve all health care professionals. Information, education, and communication will be the main thrust of the program. A model family planning clinic will be established at the Maternity Hospital at Tirana, which already has a teaching capacity for training of medical students, midwives, and nurses. Although a PHC system is in place, buildings and equipment are out of data. The health personnel of the program are excited by the challenge of providing reproductive health care for an woman's entire reproductive life. A new family planning clinic has already been established in Elbasan, a remote village south of Tirana, but public response has been mixed. Another clinic north of tirana has a population that is enthusiastic about family planning, even with a clinic not as well equipped as in Elbasan. The educational outreach must include doctors as well, who have only read about family planning. Teenage pregnancy, as in many other cultures, is becoming a problem, which with greater access to information will hopefully be averted or reduced. The primary thrust of program is still in discovering ways to inform the population about birth control and contraceptives.^ieng

Maternity care for all.

PIP: Until the 20th century, women and families worldwide knew that it was always a possibility that women would die from childbearing (e.g., over 2000 maternal deaths/100,000 births in Europe). Increased knowledge about pregnancy and its complications and the application of that knowledge in maternal health care systems in developed countries reduced maternal mortality considerably (e.g., 20 in northern Europe). Improvements in delivery management helped greatly to reduce maternal deaths, which include aseptic techniques, appropriate use of forceps, safe blood transfusion, sulphonamides, and proper management of preeclampsia and eclampsia. Maternal mortality is still high in developing countries (e.g., 5% of women in some parts of Africa die from a pregnancy-related condition) where 99% of all maternal deaths occur. These pillars of family life die in the prime of their life and often leave other children. Their loss adversely affects social and economic development. Just 78 countries (35% of the world's population) have a vital registration system recording causes of death, thereby making it difficult to understand the extent of maternal mortality. The 1st cause of maternal death to fall in developed countries and now in developing countries is sepsis. Other causes of maternal death are obstetric hemorrhage, eclampsia, ectopic pregnancy, unsafe abortions, and obstructed labor. Lack of access to maternal health services keeps many women with pregnancy complications from receiving the care they need to survive. Trained persons help only about 50% of women worldwide with labor and delivery. Upgrading of local health centers and training midwives in recognizing complications and in aseptic delivery techniques are needed to improve the quality of maternal health care. Each health center must have the means to transport women to district hospitals. Health centers must offer contraception to prevent unwanted pregnancies. Countries need to reduce the social inequalities that women face.^ieng