Walking in Two Worlds: Midwives’ Relationship with Complementary and Alternative Medicine and Evidence-Based Practice

Abstract

The thesis investigates the use of complementary and alternative medicine (CAM), by caseloading and independent midwives located in Canada and New Zealand. The study examines the relationship between midwifery, CAM and evidence-based practice in these two populations and reveals that the tensions existing between conventional medicine and CAM are mirrored in the relationship of midwifery with obstetrics. CAM offers supportive, nurturing and regenerative options reflective of a holistic approach to health and well-being that has an inherent appeal for midwives whose philosophical traditions are based on holism. Holism therefore provided a natural philosophical foundation for the study. The study was conducted using a pragmatic mixed method approach incorporating a survey, interviews and focus groups to gather data from midwives in both countries. The survey incorporated an in-depth examination of one empirical intervention, evening primrose oil, to provide an exemplar of CAM use in contemporary midwifery practice. The findings of the survey revealed that CAM is widespread and interwoven into primary care midwifery practice. The qualitative data indicated that CAM is used to support normalcy and women's autonomy in birth. The patterns and concepts that emerged from the analysis of each form of data were interpreted using the lens of complexity science and the properties of complex adaptive systems. This interpretation revealed why evidence-based practice is not a strong presence in midwifery practice. The complexity science perspective identified that an attractor, "Keeping Birth Normal", has a stronger influence in supporting the holistic principles important to midwives, rather than the scientific principles of evidence-based practice. The thesis argues for a different perspective on evidence that could be provided within a concept of evidence-'informed' midwifery that is more congruent with a holistic framework of midwifery care. A need for midwives to critically reflect on their use of CAM in a meaningful way is uncovered. The thesis challenges midwives to move forward and participate in creating the evidence that will validate midwives' art and practice relating to CAM, thus contributing to the knowledge and understanding of how CAM can play an effective and appropriate part in the childbearing process.