Demand for integrative medicine among women in pregnancy and childbed: a German survey on patients’ needs

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Abstract

Background

Although integrative medicine is gaining increasing attention and is claiming more and more its place in modern health care, it still plays a marginal role in conventional maternity care. The present study aims to examine the patterns of Complementary and Alternative Medicine (CAM) use and the demand for integrative therapies, including CAM, relaxation therapies, nutritional counseling, and psychological assistance, among women in pregnancy and childbed.

Methods

The survey was conducted from April 2017 to July 2017 by means of a pseudo-anonymous 38-item questionnaire at the Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technical University of Munich. Eligible participants were women hospitalized due to pregnancy related complications and women in childbed. Descriptive statistics were generated to determine patterns of CAM use and demand for integrative therapeutic approaches. Univariate analysis was used to detect associations between patients’ characteristics and their interest in the different integrative therapies. Furthermore, binary logistic regression was used to estimate the odds ratio of demand for CAM.

Results

A total of 394 out of 503 patients participated in the survey (78%). 60% declared using CAM in general, 45% specifically in relation to their pregnancy or childbed. Most commonly used modalities were vitamins (31% of all patients), yoga (24%), and herbal supplements (23%). Most popular sources of recommendation of CAM use were midwives and gynecologists. Integrative therapy options patients would have wanted alongside conventional maternity care were CAM (64%), relaxation therapies (44%), dietary counseling (28%), and psychological counseling (15%). Furthermore, associations between patients’ sociodemographic characteristics and their demand for integrative therapies were identified.

Conclusions

The results of this study demonstrate that there is a considerable demand for integrative medicine and widespread use of CAM among women during pregnancy and childbed in Germany. Maternity health care providers should be aware of these findings in order to be able to better address patients’ needs and wishes. Our study findings should be interpreted with regard to patients in an hospital setting.

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Most cited references 48

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Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice.

Christine Dunkel Schetter, Lynlee Tanner (2012)

To briefly review results of the latest research on the contributions of depression, anxiety, and stress exposures in pregnancy to adverse maternal and child outcomes, and to direct attention to new findings on pregnancy anxiety, a potent maternal risk factor. Anxiety, depression, and stress in pregnancy are risk factors for adverse outcomes for mothers and children. Anxiety in pregnancy is associated with shorter gestation and has adverse implications for fetal neurodevelopment and child outcomes. Anxiety about a particular pregnancy is especially potent. Chronic strain, exposure to racism, and depressive symptoms in mothers during pregnancy are associated with lower birth weight infants with consequences for infant development. These distinguishable risk factors and related pathways to distinct birth outcomes merit further investigation. This body of evidence, and the developing consensus regarding biological and behavioral mechanisms, sets the stage for a next era of psychiatric and collaborative interdisciplinary research on pregnancy to reduce the burden of maternal stress, depression, and anxiety in the perinatal period. It is critical to identify the signs, symptoms, and diagnostic thresholds that warrant prenatal intervention and to develop efficient, effective and ecologically valid screening and intervention strategies to be used widely.

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Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey.

David M Eisenberg, Ronald C Kessler, Maria I Van Rompay … (2001)

Little is known about perceptions of complementary and alternative medical (CAM) therapy relative to conventional therapy among patients who use both. To document perceptions about CAM therapies among persons who use CAM and conventional therapies. Nationally representative, random-household telephone survey. The 48 contiguous U.S. states. 831 adults who saw a medical doctor and used CAM therapies in 1997. Perceptions about helpfulness and patterns of CAM therapy use relative to conventional therapy use and reasons for nondisclosure of CAM therapies. Of 831 respondents who saw a medical doctor and used CAM therapies in the previous 12 months, 79% perceived the combination to be superior to either one alone. Of 411 respondents who reported seeing both a medical doctor and a CAM provider, 70% typically saw a medical doctor before or concurrent with their visits to a CAM provider; 15% typically saw a CAM provider before seeing a medical doctor. Perceived confidence in CAM providers was not substantially different from confidence in medical doctors. Among the 831 respondents who in the past year had used a CAM therapy and seen a medical doctor, 63% to 72% did not disclose at least one type of CAM therapy to the medical doctor. Among 507 respondents who reported their reasons for nondisclosure of use of 726 alternative therapies, common reasons for nondisclosure were "It wasn't important for the doctor to know" (61%), "The doctor never asked" (60%), "It was none of the doctor's business" (31%), and "The doctor would not understand" (20%). Fewer respondents (14%) thought their doctor would disapprove of or discourage CAM use, and 2% thought their doctor might not continue as their provider. Respondents judged CAM therapies to be more helpful than conventional care for the treatment of headache and neck and back conditions but considered conventional care to be more helpful than CAM therapy for treatment of hypertension. National survey data do not support the view that use of CAM therapy in the United States primarily reflects dissatisfaction with conventional care. Adults who use both appear to value both and tend to be less concerned about their medical doctor's disapproval than about their doctor's inability to understand or incorporate CAM therapy use within the context of their medical management.

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Integrative medicine and patient-centered care.

Victoria Maizes, David P Rakel, Catherine Niemiec (2015)

Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.

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Author and article information

Contributors

Nikolas Schürger:

ORCID: http://orcid.org/0000-0002-1612-9955

nikolas.schuerger@tum.de

Evelyn Klein: evelyn.klein@tum.de

Alexander Hapfelmeier: alexander.hapfelmeier@tum.de

Marion Kiechle: marion.kiechle@tum.de

Daniela Paepke: Daniela.Paepke@mri.tum.de

Journal

Journal ID (nlm-ta): BMC Complement Altern Med

Journal ID (iso-abbrev): BMC Complement Altern Med

Title: BMC Complementary and Alternative Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6882

Publication date (Electronic): 15 June 2018

Publication date PMC-release: 15 June 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 187

Affiliations

[1 ]Department of Gynecology and Obstetrics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany

[2 ]ISNI 0000000123222966, GRID grid.6936.a, Institute of Medical Informatics, Statistics and Epidemiology, Technische Universität München, ; Munich, Germany

Author information

Nikolas Schürger http://orcid.org/0000-0002-1612-9955

Article

Publisher ID: 2249

DOI: 10.1186/s12906-018-2249-y

PMC ID: 6003184

PubMed ID: 29907100

SO-VID: 877f5219-7e40-4320-a9f5-5c3fe7479d4a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 9 March 2018

Date accepted : 6 June 2018

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ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: complementary and alternative medicine (cam),psychological counseling,nutritional counseling -- pregnancy,childbed,integrative medicine,obstetrics

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ScienceOpen disciplines: Complementary & Alternative medicine

Keywords: complementary and alternative medicine (cam), psychological counseling, nutritional counseling -- pregnancy, childbed, integrative medicine, obstetrics

Demand for integrative medicine among women in pregnancy and childbed: a German survey on patients’ needs

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Most cited references 48

Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice.

Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey.

Integrative medicine and patient-centered care.

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