Factors Affecting Midwives' Decision to Offer Complementary and Alternative Medicine/Nonpharmacological Pain Relief Methods for Labor and Birth

Complementary and alternative medicine (CAM), which includes evidence-based nonpharmacological pain relief methods, are known to be effective in reducing labor pain and should be available for women who desire them. Unfortunately, these methods are not always offered as options to women in some birth settings. The purpose of this study is to examine how factors/characteristics of the birth setting environment influence a midwife's decision to offer CAM/nonpharmacological pain relief methods to their patients in labor.;Extensive literature review indicates that certain factors/characteristics in the birth setting environment (policies/protocols, the level of technology, knowledge and beliefs of healthcare providers, and the relationship of the midwife with the collaborating obstetrician) influence a midwife's decision to offer CAM/nonpharmacological pain relief methods in labor and birth.;A convenience sample of midwives (n=520), members of the American College of Nurse-Midwives (ACNM), were surveyed via Survey Monkey using a Likert-scale type 51-item questionnaire developed for this study. Midwives were assigned to one of three primary birth settings for data analysis: hospital, birthing center, home birth. Findings indicate that knowledge and beliefs of other healthcare providers (nurses, physicians/residents, midwives) most influence the midwives' decision to use CAM/nonpharmacological pain relief methods in labor in all three birth settings. Midwives working in settings with high technology use report that such an environment influences their decision to use CAM/nonpharmacological pain relief in labor. A midwife's relationship with the collaborating obstetricians was not seen as a major influence on the use of CAM/nonpharmacological pain relief methods in labor and birth. There are statistically significant differences in the use of specific CAM/nonpharmacological pain relief methods and specific pharmacological pain relief methods across the three birth settings.;The findings indicate that although some factors/characteristics of the birth setting environment influence a midwife's decision to offer CAM/nonpharmacological pain relief methods in labor, they do not prevent midwives from using most of these alternatives during labor and birth. It would appear that the midwives' philosophy of care more than the factors/characteristics of the birth setting environment influence their decision to use CAM/nonpharmacological pain relief methods in labor and birth.