This study of a large, nationally representative sample of Australian women who had recently given birth provides the first examination of consultancy patterns across conventional maternity care providers and CAM practitioners during pregnancy. The study presents four key findings. First, the study reveals a substantial level of CAM practitioner use with nearly half of the pregnant women consulting a CAM practitioner concurrent to conventional maternity care. This finding highlights the supplementary nature of CAM use during pregnancy, in line with results from previous studies of CAM consumption both specific to women  and in the wider population [8, 9].
Second, within the wider pattern of concurrent care, we identified a more complex relationship between the two broader provider groups – for high users of GPs, consultation with some CAM practitioners (eg. acupuncturists) is associated with less frequent visits with a GP. It is possible that this finding reflects a change in women’s health-seeking behaviour as a result of what they perceive as a discouraging response by their GPs to their concerns or preferences [26, 27]. It may also highlight a discord between what pregnant women seek  and what some GPs may consider unhelpful or irrelevant [28, 29]. Alternatively, this finding may be due to a perception amongst these pregnant women that GPs are not core to their maternity care needs (instead addressing such needs with CAM practitioner services), although earlier work suggests that such a view is unlikely to be encouraged by the majority of CAM providers .
Third, the findings reveal that frequent midwifery care users are more likely to consult acupuncturists and doulas. This finding supports previous research identifying midwives as a popular source of CAM information for pregnant women  and often encouraging CAM use for women in their care . Alternatively, this finding could suggest that women choosing different models of maternity care also hold different values and approaches to CAM use, an issue identified in more general CAM utilisation research  but still requiring further investigation in relation to maternity care . Previous research identifies midwives as referring to a range of CAM practitioners - naturopaths/herbalists, homeopaths, chiropractors, osteopaths and massage therapists . The difference between these results and our study findings may be due to the various political and cultural contexts affecting CAM (e.g. political legitimacy) and midwifery (e.g. structure of maternity care provision) across different health systems.
Fourth, our analysis of consultation patterns for the management of specific pregnancy-related conditions suggests pregnant women are making discretionary decisions regarding whom to consult depending on their immediate health concerns. Chiropractors are frequently consulted for back pain and sciatica, massage therapists consulted more commonly for neck pain, and naturopaths and acupuncturists more likely to be consulted for pregnancy-related nausea. Women are consulting with CAM practitioners most commonly for management of pain-related conditions. This may be due to women’s perceptions of CAM treatments as safer (while being equally effective) than conventional pain management . However, this perception is only held when the condition is self-assessed by the women as low risk to them or their babies and women are only rarely consulting with CAM practitioners for more serious complications. Attempts to complement conventional treatments with the care of other therapists still occur - we identified a substantial rate of concurrent CAM and conventional practitioner use amongst pregnant women with gestational diabetes - and this may be the result of women seeking an improved prognosis for these serious conditions and/or a more active role in maintaining their health .
Our results highlight a substantial level of CAM practitioner use during pregnancy and a pattern of selective use across different CAM practitioner groups for different health conditions. Our study findings illustrate the inconsistent relationship between the available clinical evidence and the CAM practitioners used by pregnant women. Whilst there is partial alignment between some of the CAM practitioners consulted and the limited existing clinical evidence there are also a number of women consulting CAM practitioners for specific conditions despite an absence of clinical evidence. This underlines concerns that women may be accessing unsafe and ineffective practices. In order to help inform safe, effective and coordinated maternity care that reflects the full breadth of practitioner consultations amongst pregnant women, future research must include examination of decision-making and communication between pregnant women and their maternity care providers about CAM practitioner use. The absence of sufficient clinical evidence regarding many commonly used CAM practices during pregnancy also requires urgent attention.
The main strengths of this study are the high response rate, sample size and national representative sample of pregnant women . This is also the first study to provide insights into the relationship between women’s consultation practices with CAM and conventional care providers for pregnancy-related health conditions. The interpretation of our findings is potentially limited by the fact that health care utilisation is self-reported by the participants and as such our results may be open to the effects of recall bias. In addition, the medical conditions and symptoms were defined by self-report and the lack of confirmatory diagnosis could potentially bias findings. Previous research in this area has identified recall bias is more likely to have affected participants self-report of health conditions related to maternal health during pregnancy such as nausea and vaginal bleeding  whilst other more general aspects of health and care provision are less affected . Despite this the ALSWH is a respected source of data for epidemiological research relating to women’s health in Australia, and these limitations are far outstripped by the opportunities provided from conducting the first analysis of CAM and conventional practitioner use amongst a large, nationally representative sample of pregnant women.