Positive Health Online

Complementary therapies can be described as those therapies or treatments which complement or supplement what is already on offer as a treatment on planned programme of care and are also used independently as a means of relaxation, health promotion.

The last decade has seen an enormous rise in interest by the general public in the use of complementary therapies as an alternative or addition to traditional methods of health care. Health care professionals have been unable to ignore this rise in interest as requests for such therapies have been interwoven with rejection of the invasive ‘magic bullet’ approach of western medicine and the need to try something, anything when all else failed.

Midwifery practitioners in many parts of the country receive requests from pregnant women who are interested in or are already using complementary therapies. The holistic ethos of complementary therapies lives very happily with the art and science of midwifery. About 70% of pregnant women will achieve a normal delivery, with the most senior person present to conduct the delivery being a midwife. If pregnancy and childbearing is viewed as a normal biological event, a rite of passage from one role to another (wife/partner to mother/couple to family unit), then the concept of using complementary therapies in an arena of physiological normality (ie the parturition process) hang very well together.

Midwives wishing to practise complementary therapies within their clinical remit are bound by legislation to adhere to what is already laid down in statute and must therefore be aware of the potential transgressions that may occur if the laws that they are professionally judged by are not strictly adhered to.

The UKCC Scope of Professional Practice states that: ‘It is essential that practice is based on sound principles and all available skill and knowledge – you should familiarise yourself with the policies of any authority by which you are employed’.

Any therapy that is offered by the midwife, should be preceded by appropriate training. This is in itself has been a problem as many organisations embracing different complementary therapies validate courses using different levels and length of training.  Formal, recognised training aimed specifically at the pregnant, labouring or post partum women has, until recently been few and far between.

Rule 40 and 40(2) of the Midwives Rules states categorically that midwives should not attempt to undertake any complementary therapy or give any alternative forms of care unless they have received formal, recognised training. Failure to follow these rules could mean referral to the Preliminary Proceeding Committee or Professional Conduct Committee and could certainly jeopardise the Royal College of Midwives Medical Malpractice Insurance Cover.


Ideally training that leads to a recognised certification and admission to a specialist register will demonstrate professional credibility.

Although a midwife may have participated in appropriate training courses and be well qualified, the issue of local policy and procedure in the arena that he/she is working, ie NHS Trust, private wing, Independent Practitioner attached to a GP Practice etc. must be addressed in order to further protect the professional and the general public.

Who should practice complementary therapies within a clinical setting? Potentially, midwives and nurses who have received further training in complementary therapies can. Women or patients may wish to bring their own complementary therapist into their own clinical treatment area.

If massage was being offered as an additional course of pain relief to labouring women, would it be appropriate for health care workers who have received further training to offer this sort of service? One can immediately see that a number of different policies could be needed, tailored to fit the individual professional background.

The Midwives Rules (3) cover responsibility and sphere of practice, including both Complementary and Alternative Therapies. There is emphasis on responsibility not only for professional practice but also for future professional development, as the midwife must follow the UKCC‘s The Code of Professional Conduct and the principles of The Scope of Professional Practice. The UKCC (United Kingdom Central Council for Nurses, Midwives and Health Visitors) Standards for the Administration of Medicines point 3a states that re: complementary and alternative therapies’ – ‘It is essential that practice in these respects, as in all others, is based upon sound principles available knowledge and skill’ (UKCC 1992 page 24).

The UKCC Standard for the Administration of Homeopathic or Herbal Substances 1992, page 23, point 38 states that: ‘practitioners should therefore make themselves generally aware of common substances used in their particular area of practice’.

At all times midwives must ensure that they comply with relevant UKCC requirements. The UKCC’s Code of Practice, responsibility for competency in new skills (section 20–23) states that the midwife is:

20.    Developing competence you have acquired during your initial and subsequent midwifery education.
21.    Some of the developments in midwifery care can become an integral part of the role.
23.    When your practice requires the acquisition of new skills, you should consult with your Supervisor of Midwives with regard to the requisite preparation and experience.

Section 56 Re: Complementary and Alternative Therapies states that some practising midwives, having gained a qualification in complementary or alternative therapy, may wish to apply this additional knowledge and skill in their practice and such practice may involve the use of substances such as essential oils, or specific equipment. It is essential that practice in these respects, as in all others, be based on sound principles and all available and current knowledge and skill. The importance of consent by the mother of the use of such a therapy must be recognised. So too, must the practitioner’s personal accountability for his or her own professional practice.

To ensure vicarious liability cover by the Trust that the midwife is employed by, it must be ascertained that the Trust Board has sanctioned use of complementary therapies, and has specific policies set in place that sanction, control and monitor the use of such therapies. If a midwife offers complementary therapies as a treatment on a private basis (i.e. outside her working hours for the NHS) then she must take out private insurance cover.

There are a number of midwifery practice issues that need explaining in order to highlight potential problems and to help practitioners avoid pitfalls.

By offering a complementary therapy, will this alter or diminish the integrity of protocols, policies and procedures already laid down and in use in the maternity unit? Does anyone know if any specific essential oil, for example, interacts favourably or unfavourably with Syntocinon (a drug commonly used to induce labour and stimulate uterine contractions)?

If an epidural is already in situ, but not effective or only working down one side, is it safe to give back massage as well?

Would essential oils react unfavourably with the epidural continuing?

Whose responsibility is it to obtain consent from the mother?

If a complementary therapist is giving treatment in a maternity unit alongside a midwife, is it the midwife’s or the therapist’s responsibility to obtain consent? A midwife must give informed consent including side effects and risks as she is also the advocate of the mother at all times (see Exercising Accountability – UKCC advisory document).

Do we know enough about the interactions of complementary therapies on a pregnant or labouring body to give informed consent?

Are there any research trials that have looked at the possibility that reactions of substances during pregnancy may be different than those that have been documented on non-pregnant women?

Are there any clinical scenarios that would dictate the cessation of use of the Complementary Therapy, or dictate that the Complementary Therapist (if not a midwife) left the treatment/labour room? An issue of confidentiality cannot be ignored. Although a midwife will have full access to a client’s history, and indeed may have taken the history herself with full access to notes and be frequently documenting herself in them, should a Complementary Therapist have the same access, to such information as previous terminations, treatments for various disorders and letters detailing medical disorders when giving treatments in a hospital or home setting? The need for specifically designed policies and guidelines in order to avoid these dichotomies becomes clear.

Although there are potential areas of conflict surrounding confidentiality, Clinicians must not forget that the UKCC in The Scope of Professional Practice (1992b) (2) recognises the dynamic nature of nursing and midwifery practice and paragraphs 8 to 10 provide guidelines for a – ‘context of continuing change and development’.  Midwives should be open to developing and embracing change and welcoming Practitioners of Complementary Therapists into their clinical arena whilst ensuring that codes of practice, rules, policies and guidelines are adhered to in order to protect the public and safeguard their own practice.

Some potential areas of concern that need to be addressed in guidelines and policies are as follows:

1.    Patients attempting to treat themselves or in-patients without the clinicians knowledge!

2.    Breach of Health and Safety Guidelines e.g. producing own aromatherapy ‘burner’ on labour wards and siting it next to oxygen points. (This actually happened to a colleague whilst she was out of the delivery room for a few moments.)

3.    Patients ‘advising’ other patients and lending their own preparations or mixes! We know that in our Western culture that this is very common practice with over-the-counter medicines.

4.    Unrealistic expectations from clients and practitioners. Informed consent should prevent this if realistic outcome of treatments are proffered.

5.    When employing Complementary Therapists within the NHS set, what standards of training, qualifications and experience within the Childbearing Arena should be expected. How would this be monitored?

Midwifery practice is expected to be research based and Practitioners and Complementary Therapists can find support from the Research Council of Complementary Medicine. This organisation promotes rigorous research into Complementary Medicine and seeks to improve understanding between orthodox and Complementary Medicine.

Networking and collaboration between researches is encouraged, in order to share skills and experience, and research awards are available in order to help research take place.

Areas of interest also include examination of means by which research can be introduced into the curricula of Colleges.

A global development service is available to researchers requiring advice on Methodology for Complementary Medicine Research.  There is also an information service available for practitioners, orthodox health professionals, students, the media, researchers and NHS organisations. A database has 30,000 bibliographic references available to help further knowledge and research.

Employers also have a general duty of care towards employees. This duty includes the provision and maintenance of plant and systems of work that are safe and without risk to the health of the employee (Health and Safety at Work Act 1974).

Guidelines for practice for using Complementary Therapists should be viewed as planning the basis of a safe system of work, therefore an equal duty of care lies with employer and employee to ensure that any services offered fulfil a Duty of Care.

Section 3 of the Health and Safety at Work Act 1974 places a duty of care by employers on people other than employees. Because of this there is a need for a common understanding between Complementary Therapists and the employer to ensure exactly what will be on offer, to whom and by whom.

Although there are very many areas of consideration that need to be incorporated into appropriate policy and procedure in order to ensure safety for both professional and client, the possibility that Eastern and Western Concepts of Health Care could live happily side-by-side within our Western ‘Magic Bullet Approach’ culture will delight consumers and professionals alike.

Huge strides in acceptance by General Practitioners and Consultants will slowly erode, I hope, the previous dogmatic, blind rejection of Complementary Therapy and Medicine and allow individuals a hitherto rare luxury of a truly holistic programme of care within an integrated NHS.

References:

West Midlands Regional Health Authority Guidelines for Managers on the Good Practice of Complementary Therapies May 1994.
UKCC The Scope of Professional Practice – July 1992.
UKCC Midwives Rules – November 1993.
UKCC Code of Professional Conduct – June 1992.
UKCC Standards for the Administration of Medicines – October 1992.
UKCC Advisory Document & Exercising Accountability.