Lucy wrote this project back in 2004, and it was on the old site. I thought it was still interesting reading. It is interesting at the time in 2004, integrating complementary therapies into midwifery was becoming more accepted.
Shiatsu Practitioners’ Role in Maternity Care
by Lucy Trend, shiatsu practitioner and Wellmother teacher
‘Maternity care – naturally’, was a conference jointly hosted by MIDIRS (Midwives Information and Resource Service) and The Prince of Wales’s Foundation for Integrated Health .
MIDIRS (Midwives Information and Resource Service) is an educational charity based in Bristol . Their mission is ‘To be the central source of information relating to childbirth and to disseminate this information to midwives and others, both nationally and internationally, thereby assisting them to improve maternity care.’ MIDIRS Midwifery Digest provides maternity health professionals with an overview of key midwifery and medical research to inform their practice. MIDIRS Enquiry Service provides access to more in-depth information from a database of over 100,000 articles.
The Prince of Wales Foundation for Integrated Health (FIH) aims to facilitate the development of safe, effective and efficient forms of healthcare to patients and their families by supporting the development and delivery of integrated healthcare. This means encouraging conventional and complementary practitioners to work together to integrate their approaches. The Foundation acts as a forum to promote and support discussion and as a centre for driving forward the integrated healthcare agenda.
The two-day conference held at Cheltenham Racecourse Conference Centre on 13th & 14th October 2004 , was the first of its kind in the UK .
The event was billed as “an insight into the use of complementary therapies in maternity care”. It focussed on the issues surrounding regulation and standards for practice and practitioners in the area of complementary therapies in maternity care.
It was an interesting programme of international speakers attended by over 200 midwives, obstetricians, gynaecologists, nutritionists and complementary therapy practitioners, mostly UK based. The majority of speakers were medical practitioners within the NHS or education, some trained in therapies, some not. Consequently issues of regulation of practise and accountability were much in the foreground throughout the two days. Complementary therapists in their own right were also speaking. Their issues primarily concerned research, the practise of their discipline, and the logistics of integration as limited by regulation. Delegates were mainly midwives, some either trained, or interested in training in a complementary therapy, predominantly massage, or in using certain techniques and remedies in practise. A minority of delegates were complementary therapists and a very few obstetricians.
This dissertation is a record of and commentary on the two day event from the point of view of a private Shiatsu practitioner on the outside of the Health Service. It seeks to serve as information equally for practitioners involved in the field of maternity care, and practitioners interested in issues concerning Integrated Health Care.
Vicky Carne, MIDIRS Head of Midwifery commented:
‘Within maternity care the interest in, and request for, natural remedies is increasing. Maintaining the well being of the developing foetus and the mother can often mean that the routine use of pharmaceutical agents is contraindicated. Similarly, the commonly experienced and sometimes distressing ‘minor’ symptoms of pregnancy are expected to be ‘tolerated’ until they resolve spontaneously, regardless of their debilitating impact on a woman’s daily functioning. Complementary therapies can, however, offer a natural respite from these symptoms’.
Regulation of Practise
The subject of ‘complementary and alternative medicine’ ( CAM ) and it’s regulation is a massive one with many different angles. At one end of the spectrum we have Peter Hain, the Leader of the Commons, recently reported to have promised that the next Labour Government would make its therapies “free” on the National Health. At the other end we have medical celebrities condemning it as quackery:
“Patients seem to love it, probably because of our inherent need to believe in magic and mysticism. But I just can’t do the patter that goes with it, and keep a straight face. “You’ve got too much jitsu in your tsubo, Mrs Jenkins. I’m going to stick a needle in your encircling glory.” For me, complementary medicine has always been fantastic laughter therapy. Maybe that’s how it works.”
Dr. Phil Hammond NHS Magazine October 2004
However, nothing speaks more about the status of CAM than the figures. In the UK in 2003 £130m was spent on herbal medicines and essential oils, a figure expected to rise to £200m by 2008. In Germany the current figure is £1.3 bn. 50% of the general public are estimated to have visited a practitioner.
Alongside this consumer expenditure, therapies are becoming integrated into NHS practise, and from the point of view of the Government, regulation is not only inevitable but necessary. The dilemma is how to do this. Existing protocol is prohibitively tailored to popular allopathic medical practise i.e. drug use and surgical intervention. Inherent problems with regard to regulation of CAM arise out of the difficulty in providing the double blind randomised control trials (RCTs), which are the industry standard for proof of effectiveness and safety.
In the year 2000 a damaging report on CAM was published by the House of Lords:
“Many CAM therapies are based on theories about their modes of action that are not congruent with current scientific knowledge. That is not to say that new scientific knowledge may not emerge in the future. Nevertheless as a Select Committee on Science and Technology we must make it clear from the outset that whilst we accept that some CAM therapies, notably osteopathy, chiropractic and herbal medicine, have scientifically established efficacy in the treatment of a limited number of ailments, we remain sceptical about the modes of action about many of the others.
“Quantitative survey data in this area are somewhat patchy and are beset by questions of definition which are hard to resolve.”
The current status of CAM in the eyes of the DoH (Department of Health) is directly related to the lack of RCTs, which in turn is due to lack of opportunity both financial and logistical to carry out such trials because the of exclusion of CAM from public health provision. 25% of patients use complementary therapy, yet less than 1% of the medical research budget is spent on it. We have a catch 22 situation, of cultural attitudes that are constantly reinforced by doctors in positions of influence:
“I have always advocated the scientific evaluation of CAM using controlled trials. If “alternative” therapies pass these rigourous tests of so called “orthodox” medicine, then they will cease to be alternative and join our armamentarium. If their proponents lack the courage of their convictions to have their pet remedies subjected to the hazards of refutation then they are the bigots who will forever be condemned to practise on the fringe.” An open letter to the Prince of Wales: ‘With respect, your highness, you’ve got it wrong’, Michael Baum, professor emeritus of surgery and visiting professor of medical humanities, University College London, BMJ July 2004.
Professor Baum’s criticism is itself influenced by bigotry since he was completely uninformed of the issues concerning research into CAM .
From the point of view of a CAM therapist, practising on the fringe is not necessarily a bad thing. An acupuncturist colleague of mine she feels that for her entire career she has been practising on the fringes of the medical profession. However, now regulation is on the cards, and many in her profession wish to “medicalise” acupuncture. She finds herself practising on the fringes of her own profession. The experience of a doctor with six months training is considered to be superior to her own 15 years as a practitioner.
Happily, a response to Professor Baum came from a Prince of Wales spokesman:
“The Prince of Wales is not promoting alternative medicines over orthodox treatments. He is simply reflecting the wishes of 80% of patients who wish to use alternative treatments alongside conventional treatments. He wants to see more of these treatments available on the NHS and more research into alternative therapies. The Prince of Wales is passionate about an integrated approach to healthcare.”
Speaker Denise Tiran is the Principal Lecturer in Complementary Medicine / Maternity Care Programme Leader, BSc (Hons) Complementary Therapies, School of Health and Social Care, University of Greenwich , London . She informed us that 34% of UK midwives used CAM in 1997, indicating a trend back towards more natural childbirth. This reflects a questioning of conventional practise as well as a desire to integrate the new, or should we say old, since 55% of women world-wide use natural remedies. NICE (National Institute for Clinical Excellence) guidelines are not promoting of CAM , they are very much cautionary guidelines. Many midwives use them as an excuse not to integrate complementary practises.
Tiran’s priority is that intention of practise must be clear, so hospital permission must be granted to midwives to administer CAM, and a woman has the right to self administer remedies or to decline CAM. She thought that a therapist was less likely to rush in with inappropriate complementary remedies or techniques than a midwife, an indicator of the problems that arise when health care professionals receive limited CAM training.
I found Tiran ‘s perspective interesting in that she is of the view that the midwife or obstetrician is best placed to administer CAM since they hold overall responsibility for the patient; only a midwife or a doctor is legally allowed to take care of labour. Denise was keen to point out that induction is a medical procedure carried out for specific reasons on the sole recommendation of the consultant. The midwife has no power of decision over this. She believes that CAM can be used as a precursor to induction, not to replace it. It appears from this opinion that the lack of an RCT as proof can stand in the way of practitioners, medical and complementary, accepting what we know through experience, that holistic care in pregnancy with a specialist therapist leads to less complications in labour and birth.
Speaker Peter Bowen-Simpkins form the Royal College of Obstetricians and Gynaecologists felt it is important for therapists to be able to use a title that regulation provides, and that both patient and therapist are protected by disciplinary procedures. He spoke of the standards in the seeking of “proof” – that conventional medicine must be shown to be of “benefit” to the patient, whereas complementary therapy should “do no harm”.
Michael Pittilo University of Hertford, was of the view that regulation is the necessary first step towards integrated health care. He argues for multiple councils, as they will promote interdisciplinary work and reduce costs to practitioners. Single regulatory councils for each therapy would be less cost efficient and so require higher membership fees, and he feels they promote regulation to a higher level. This can potentially result in increased self interest, where a desire to be considered medical mainstream as opposed to complementary could begin to prevail, as in the case of some osteopaths who prefer to be considered orthodox medical practitioners. We must be vigilant, Pittilo says, to ensure that through regulation professional self interest is not seen to dominate over the needs of the patient.
Optimising opportunities for natural labour and delivery
Ethel Burns, Research Midwife, developed her interest in aromatherapy as a result of observing a lack of confidence, and consequently competence, among midwives becoming increasingly dependent on props and interventions. “Midwives were losing their belief in and understanding of the physiology of labour and birth. I also noticed accelerating stress levels in response to increasing performance expectations from both managers and mothers and their families”. She investigated suitable oils, but as much as the effects of the oils benefit the mothers, she found that engaging the midwives in discussion and administration of the oils helped them adapt their practise towards a less technocratic model.
Burns is currently involved in an RCT at San Gerardo maternity unit in Italy . The primary aim is to explore if the application of aromatherapy reduced intrapartum interventions. The RCT was facilitated by Italian Anita Rogalia and has received no funding beyond an £800 award which covered 30% of the cost of the oils used. At present the trial is incomplete, but she is hopeful for the outcome.
Francesco Cardini co-ordinated a chinese-italian RCT on the efficacy and safety of moxibustion for the correction of breech presentation, published in JAMA in 1998. Despite its positive results the study was not influential, having been a single blind, not a double blind trial. Cardini has gone on to attempt the same trial in Italy . After experiencing great difficulties the trial was not completed. Compliance of treatment in Italy was very different from the Chinese. Women found the treatment unpleasant and they were inadequately taught how to apply the technique. Essentially the problems arose out of the different ethnic, social and cultural contexts.
Cardini’s experiences stand as a reminder that movement towards a more holistic approach to the provision of medical treatment must be a gradual change, involving not just regulation, but also introduction to both public and professionals through communication and education. Francoise Freedman learned about maternity care form the Amazonian people. She has found that teaching perinatal yoga is an excellent way to introduce these teachings to western people, as yoga is familiar to us and its benefits in perinatal care are acknowledged through its existing integration with ante natal care as a form of exercise.
She sees this modern age of the focus on the foetus rather than the mother to create stress for the mother. Her Amazonian experience was very much about being nurtured as a mother: “self nurture may be the most important skill in the transition to motherhood in today’s world”. Yoga breathing has positive effects on the endocrine, nervous and immune systems, and when the mother relaxes the foetus plays.
Complementary Therapies in Practise
Linda Gwillim, homeopath, also believes that personal support leads to better obstetric outcomes. She finds herself performing a multiple role during the birth process, like a “Doula with the Pills”, being an advocate for the labouring mother, with whom there is an existing relationship of trust. She describes the wonderful experience of the first birth she attended. She had no prior agreement to attend the birth, but received a call from the hospital saying her client was asking for her. She arrived to find her client in a bath, terrified and convinced she was unable to continue, not wanting the baby anyway. Labour had come to a complete standstill. Within 10 minutes of taking Pulsatilla her client grabbed the sides of the bath and yelled “What are you all standing there for? I want to push!”
Fiona Mantle, Hypnotherapist, also helps women through support and nurture. She describes her therapy as the therapeutic use of the daydreaming state. She uses anchoring and deep relaxation between contractions, modifying the perception of pain and helping labouring women to feel in control. Hypnotherapy is useful as a rehearsal for a positive labour.
Suzanne Yates, Shiatsu Practitioner and Director of Wellmother explained that Shiatsu is a useful therapy on many levels. A midwife’s role is to support the process of labour and birth. Shiatsu facilitates connection to the birth process for mother, birth partner and midwife. The mother is supported to focus within herself during pregnancy and certain stages of labour, the Yin experience, and also supported to express the Yang energy of the birth itself. Ki is life’s emanating force, and therefore Shiatsu related exercise is beneficial to help ki to flow during pregnancy – optimising health and well-being in preparation for a natural labour. So Shiatsu works not just to support the mother, but also to benefit her physical health. Suzanne trains midwives in the Shiatsu techniques and exercises that they are well placed to use with mothers throughout pregnancy, birth and post natally. She says CAM can change the view for conventional medicine by giving another way of looking at the body.
Renzo Molinari of the European School of Osteopathy gave a fascinating talk about how misalignment on a musculo-skeletal level can have serious consequences in labour, yet be easily spotted and corrected by a trained osteopath. He described how the utero-sacral ligaments are attached to S2 and S3 (the same site as the piriformis) and also the cervix. When these ligaments are contracted the the cervix is retracted, compromising dilation and resulting in Caesarian delivery. Tonicity can be restored using a 90 second muscle energy technique. What I find really interesting about Molinari’s enlightening information is that:
i) osteopathy is recognised by the medical profession, yet not routinely used in obstetrics – since it is not available on the NHS
ii) an osteopath uses the term “energy” without being questioned, yet it is the difficulties in defining and quantifying Ki that alienate Western doctors from eastern therapies. (Unless of course it involves an invasive procedure such as needling – which would appear to make it more acceptable. Smelly practises such as moxibustion are less acceptable, or time consuming ones i.e. involving supportive touch. Touch therapies seem to be better viewed if they involve quick techniques, such as Bowen technique, and osteopathy).
Issues of conception were also covered by presenting therapists. Xiao-Ping Zhai is a Harley Street doctor (TCM). She explained TCM within a framework of fertility issues and presented several statistics to the conference to show its efficacy. She presentated the dry facts with the confidence of a practitioner who has no doubts as to the efficacy of her therapy. I felt that perhaps because of her Chinese background, she was somehow beyond the struggle to integrate, since in China her profession does not suffer from these issues of integration. Dr. Marilyn Glenville, Nutritionist, and author of “Natural Solutions to Fertility” gave nutritional guidelines for conception and pregnancy. Interestingly my personal experience in Glasgow is that midwives are even uncertain of nutritional supplements – preferring to seek the advice of a specialist, who is of course inclined to advise according to their limited knowledge of nutritional issues.
Michael McIntyre, Medical Herbalist, would like midwives and the general public to have more information on the safety and efficacy of commonly used herbs. He gave information on various herbs and this was eagerly received by the midwives present.
Models of Integrated Practise
Referrals to complementary therapy from a medical practitioner are not possible at this early stage of integration. Delegation however, is. Michael Doula, consultant obstetrician and gynaecologist is the founder of the Poundbury Clinic, an integrated health clinic for women in Dorchester . From his position he is able to offer choices to women and give guidelines. He wants practitioners to talk to each other, he believes in communication as a tool for promotion and education. “To create success everyone’s noses must be pointing in the same direction”. He would like to see a system of co-operation cards – like the old NHS cards, where each client has a card for practitioners to record treatment, providing information for one another on an individual’s treatment history.
He believes that although RCTs are out with the scope of many therapists and organisations, our anecdotal evidence is valuable and should be published despite the fact it does not reach DoH requirements for proof.
[BMJ 2002 Prayer and IVF, HRT and IMT]
Linda Kimber is a Midwife and Massage Therapist at Horton Maternity Unit. with the support of her delivery suite manager Anne Haines, she has been providing massage to women in labour and training their partners antenatally. She finds “T-massage” most effective for pain relief in labour, which is essentially stimulating the Bladder and Kidney areas of the sacrum and hips. She comments that from 35 weeks on pain rises in relation to oxitocin levels, which massage helps to lower. Kimber and Haines carried out a feasibilty study with 35 couples, high and low risk, using massage techniques including T- massage which was shown to stimulate women out of a lull in labour, avoiding to use of cyntocinin. An RCT is planned for 2004.
Wendy Gadsden and Janet Malpas of Northampton General Hospital have been implementing gradual integration of CAM into the Maternity Unit. Therapies include Shiatsu, Reflexology, Yogacise (from the bIrthlight Trust). Their experience is that an umbrella complementary therapy policy is needed to promote such progress. Planning and preparation are vital: policies, protocol, scope of practise for midwives (continuing professional development), and referral criteria. Essentially a sound Business Plan is required. Above all a pro-active manager, initial funding, and commitment are the essential ingredients for progress.
This is evident form the experiences of Jani White, Acupuncturist, and the Acupuncture Childbirth Team, who work as private practitioners attending labour as engaged by the mother. They set up independently and then informed the hospitals concerned of their protocols. Working in Oxford, which has the highest percentage of acupuncturists per capita in Europe, the individual contracts they offer emphasise safe practise, keeping the process as natural as possible: “personal support improves obstetric outcomes”. They teach acupressure to fathers – giving them courage to become more proactive (as in Northampton, where Linda Kimber teaches massage to partners for a fee of £20). Midwives find that the therapists presence is positive and can actually free up their time because of the extra support provided. They have hospital badges, which supports their role within the labour team and helps the parents because it gives them recognised standing in the birth team.
They see women for one month – 2 weeks either side of the due date. Full details are taken prior to labour. A practitioner cannot be guaranteed to attend labour but there is a root in operation that allows 24 hour provision of a practitioner. Fees are charged in line with standard charges. The Team is non-hierarchical. They have 8 meetings a year, 4 of which are educational, and they find great strength in collective learning. They believe that a double blind RCT is not an appropriate modality for research – it should be qualitative not quantitative.
Sara Budd is a trained acupuncturist and Midwife at Derriford Maternity Acupuncture Service, providing acupuncture to pregnant women at the unit since 1988, in a structure very different to th3e Oxford team because she if a midwife. Like White, she also believes that RCTs are not the answer – especially since she already has an evidence base of over 5000 women treated with acupuncture within the NHS since 1988. She has recently published and distributed a document to 332 NHS Trust managers: “Guidelines for Implementing Maternity Acupuncture Service for Managers.” She followed up with a questionnaire, receiving a 30% response rate, of which 85% had read the document, 80% found it to be comprehensive, and 60% were interested in setting up a service. This is a positive result and to me indicates that with perseverance recognition of the benefits of CAM will come about, and with this recognition will come funding. Budd believes that the worse thing we can do is nothing. Whatever your dream is – pursue it. She has also taught moxa to midwives, which they offer at 34 weeks for turning breach presentation, along with teaching scanning, in order to ascertain if the turn was successful.
Research Issues and Practise Development
Jane Thomas of the University of Oxford , reminds us that we are working in a climate where complementary therapies are not generally considered safe and are recommended by NICE to be used as little as possible. Since RCTs reach a wider audience she sees a need to change practise towards more RCTs, as a motivator towards integration, promoting what works and limiting what doesn’t. She finds that RCTs are desirable since they are least biased. Most RCTs on the use of P6 for nausea, for example, of which there are 7 so far, have found improvements and shown no harm. Lorraine Williams of FIH on the other hand prefers to see a model for service delivery guidelines that is more practise focussed.
The concerns of pregnancy on which there is the least research are Carpal Tunnel Syndrome, Backache, Symphysis Pubis Disorder and Nausea. Thomas’s guidelines recommend multidisciplinary working groups researching a diversity of opinions, from both deliverers and receivers. She advocates the delivery of statements to assist practitioner and patients decisions.
Vicky Carne is Head of Midwifery at MIDIRS says that Centre for Reviews and Dissemination (CRD) at York University found that CAMs don’t carry the risks of standard and often used pharmacological alternatives. Also Carne’s view is that working within a medical framework limits the possibilities of meeting women’s requests or preferences. MIDIRS have published “Informed Choice Leaflets” which provide information on CAM that is easy to read for women, yet fully referenced for professionals, and use scientific evidence as a basis. This approach keeps the bias within the thinking model of mainstream medicine, as would be expected from such an organisation, but this is a shame because it discourages people from appreciating all of the wonderful outcomes that are not classed as scientific evidence.
In modern medicine every practitioner has a role. From Anaesthetist to Community Health Nurse every player knows exactly what their role is and what aspect of health care they provide. As a diabetic, we see our diabetes consultant. As a pregnant woman, we see our obstetrician. If we are both pregnant and diabetic, we see both, separately. Within this scheme of things a shiatsu practitioner is commonly seen by our allopathic medicine providers at best as a lay provider of comfort. That is our perceived role. It is rarely recognised that we may specialise in a particular area of health care, that we continue to train and carry out research and may be informed far beyond a very basic level of education and knowledge that we are assumed to be operating with. In a situation where our specialist work may be recognised we find further difficulty in our different models of research. Our empirical knowledge is insufficient for modern medicine to trust as proof, yet the standards of proof in modern medicine are incompatible with our position in medicine. We are in a catch 22. Medical practitioners who are using CAM witin the Health Service are more likely to advocate RCTs than complementary therapists working privately. Whatever the way it happens, when we do become integrated into medical practise it will become clear for all, empirically, how and why our practise is effective in health care. Then, as CAM therapists we will be in a position to be able to operate the studies which either reach the accepted standards of proof (double blind randomised control trial), or by then hopefully more reasonable research study methods will be acceptable. Our current position, however, does not allow us to show these proofs. We are reliant on a slow process of gradual acceptance and understanding.
It is wonderful to see such a conference taking place. Its very happening is a wonderful confirmation that we are on a path towards integration, and it is encouraging to meet so many of the people involved. FIH figures show that in the UK 1 in 5 are CAM users. If you include over the counter remedies it goes up to 1.5. (In US the figure is 1 in 2, or 75% if you include Prayer for Health). Our private clients first come to us because they seek the benefits we offer. They continue to come because they value the health benefits they get. Either they are wealthy enough to afford it, or they appreciate the benefits enough to prioritise complementary health care over other basic needs. 4 out of 5 in the UK are not experiencing the benefits of Shiatsu or other CAM . FIH figures show that in the UK 1 in 5 are CAM users. If you include over the counter remedies it goes up to 1.5. (In US the figure is 1 in 2, or 75% if you include Prayer for Health). We are all familiar with the new client who has been wanting to try CAM but is uncertain what therapy to use or how to find a therapist, or who can’t afford to come regularly. Imagine if therapies were available on the NHS. I would love to look into the future and see how these figures will change!
A midwife can administer a therapy unsupervised, with very little knowledge of it, yet a therapist must be supervised by a doctor or midwife. =>teamwork
Listening to X-P Z presenting on TCM I made a mental note to always speak of the efficacy of my therapy as a given, to have confidence and not feel that I have something to prove. The proof is in the doing and with the doing perceptions will change for the better.
NICE finds that there is little research and Thomas asks will funders now support that research?
The benefits of deep relaxation
Glover – 2/3’s post natal depression depressed antenatally.
Generic preparation for CAM therapists does not include maternity
List of Subjects and Speakers
Regulation of practise
Professor Michael Pittilo, Pro-Vice Chancellor, University of Hertford:
An overview of the regulation of complementary medicine for healthcare practitioners
Peter Bowen-Simpkins, Honorary Treasurer, RCOG:
A perspective from the Royal College of Obstetricians and Gynaecologists
Denise Tiran, Principal lecturer, Universtiy of Greenwich, London:
The Midwife’s Perspective: Accountability vs Advocacy
Optimising opportunities for natural labour and delivery
Dr Francesco Cardini, MD, Gynaecologist/Acupuncturist/Clinical Researcher, Italy:
Moxibustion for breech – results of study on transferability of treatment to the context of some western hospitals
Dr Francoise Barbira Freedman , Senior Lecturer, School of Social Anthropology , University of Cambridge:
Ethel Burns , Research Midwife/Lecturer, Oxford Brookes University , Oxford:
The use of aromatherapy in labour
Complementary therapies in practise
Fiona Mantle, Health visitor and Hypnotherapist:
Hypnotherapy during pregnancy
Rick Minnery, Charge Midwife & Bowen Technique Practitioner:
The Bowen Technique – gentle therapy for mothers and babies
Dr. Xiao-Ping Zhai, Traditional Chinese Medicine Practitioner:
The use of Traditional Chinese Medicine for pre-conceptual care
Dr Marilyn Glenville, Nutritionist:
Nutrition for pre-conceptual care
Michael McIntyre, Chairman of European Herbal Practitioners Association:
The use of herbal medicine within obstetric practice
Linda Gwillim, Homeopath:
Homeopathy for pregnancy and childbirth
Suzanne Yates, Shiatsu Practitioner and director of Wellmother:
Shiatsu & acupressure in practise
Renzo Molinari, Principal, European School of Osteopathy:
Osteopathy for Pregnancy
Models of integrated practise
Wendy Gadsden, Midwife / Specialist Complementary Therapies Co-ordinator and Janet Malpas, Midwife, Northampton General Hospital NHS Trust:
Gradual Implementation of Complementary therapies within a midwifery unit
Jani White , Acupuncturist, Oxford Acupuncture for Childbirth Team:
Integrated practise, models in provision
Sarah Budd, Sister Midwife /Acupuncturist, Derriford Maternity Acupuncture Service:
National survey on guidelines for implementing maternity acupuncture service
Linda Kimber, Midwife/Massage Therapist, Horton Maternity Unit, Banbury, Oxfordshire:
Does regular massage form late pregnancy to birth stimulate oxytocin induced analgesia?
Formulating guidelines: Research issues and practise development
Jane Thomas, Honorary Consultant Obstetrician and Gynaecologist, University of Oxford:
Formulating guidelines: Research issues and practise development
Christine Grabowska, Senior Lecturer in Midwifery, Thames Valley University:
The development of a study on “turning breach using moxibustion”
Lorraine Williams, Education and Training Development Manager, The Prince of Wales’s Foundation for Integrated Health:
Towards developing national guidelines on the use of complementary therapies for pregnancy and childbirth
Vicky Carne, Head of Midwifery, MIDIRS:
Informed Choice in complementary therapies.
Michael M Dooley, Consultant Obstetritian and Gynaecologist, The Poundbury Clinic, Dorchester:
The Poundbury Clinic – an integrated health clinic for women
Vivette Glover, Professor of Perinatal Psychobiology, Imperial College , London:
The use of infant massage for postnatal depression