Teaching midwives homeopathy a Belgian pilot project
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1 Teaching midwives homeopathy a Belgian pilot project Authors: Christel Lombaerts, MSc Education Sciences, MSc Homeopathy, RHom, Centrum voor Klassieke Homeopathie, Belgium, christellombaerts@ckh.be Hilde Vanthuyne, MSc Pedagogy, RHom, Centrum voor Klassieke Homeopathie, Belgium, hilde_vanthuyne@hotmail.com Abstract Recent Belgian legislation generated the need for homeopathic training of midwives. The CKH offered a 50-hours course in homeopathy as a pilot project within the CPD program of Thomas More College. This article reports on the design of the course, its evaluation and lessons learned. This report may inspire educators in their endeavours to help healthcare professionals integrate homeopathy in their practices. Background Since 2014 Belgian law allows midwives to practise homeopathy provided they take a 50 hours theoretical course and 50 hours of clinical training in an obstetric practice. To date no official educational organisation is offering this training. The Belgian Centre of Classical Homeopathy (CKH) has been organising professional training in classical homeopathy for medically qualified and nonmedically qualified (future) healthcare professionals in line with the education guidelines of the European Central Council of Homeopaths (ECCH) since The CKH was given the opportunity to provide the legal 50 hours training in homeopathy for midwives within Thomas More College s (TMC) continuing professional development (CPD) program, called MoreCare. Logistic and administrative support were offered by TMC. The expertise in homeopathy education was delivered by teachers from the CKH. Homeopathy Research shows that 5,6% of the Belgian population consults a homeopath; 75% several times in 12 months (De Gendt et al., 2011). Chaufferin (2000) calculated that the price of homeopathic products comes down to a quarter of the average amount of refunded medical products and the refunding of homeopathic consultations on only half of those of mainstream general practitioners. Bornhöft & Matthiessen (2011) concluded from Swiss real-world research that homeopathy is clinical- and costeffective. In Belgium, Van Wassenhoven and Ives (2004) found that in 782 patients treated with homeopathy, complaints improved significantly at a significantly lower treatment cost than with conventional treatment. Despite these findings homeopathy remains a controversial treatment today because of its use of highly diluted substances, above the number of Avogadro. Research of homeopathy is hindered by its core tenets regarding individualisation and holism that complicate a research design with RCT s ((Milgrom, 2014). Nevertheless, several hypotheses have been formulated to explain the working mechanisms of homeopathic remedies, based on principles of system-, quantum- and chaos theories (Bellavite & Signorini, 2002) and current research is focusing on the principles of nanoparticles (Bell &
2 Schwartz, 2013). Meanwhile homeopathy has been integrated in the national healthcare systems of Germany, Switzerland and Portugal and has been regulated in Belgium since May Homeopathy in obstetric practice Homeopathy as a complementary treatment can be of value in pre- and postnatal care, alleviation of non-life threatening but taxing ailments during delivery, supporting breastfeeding, and alleviation of non-life threatening but taxing complaints of the new-born in the first months (H.G. Hall, McKenna, & Griffiths, 2012), and last but not least in supporting treatment in infertility problems. Homeopathy can play its part in the de-medicalisation of childbirth, whilst encouraging the strengths and abilities needed to be a mother - abilities such as - taking responsibility for one's health; - adopting a measure of independence; and - nurturing the mental, emotional, and physical growth of a child as well as meeting one's own needs. A number of complaints during and after pregnancy are closely linked to the mental-emotional condition of the woman. Since the homeopathic remedy also acts on these levels, a well-considered and competent prescription in an early stage can prevent an escalation of certain problematic situations (Gregg, 2006). In contrast to the average homeopathic practice, midwifery is a special case. For a start, not one, but two persons are treated: mother and foetus, or mother and new-born, or the couple that struggles to get pregnant. Therefore it is important to distinguish between the various ways that homeopathy can safely and effectively be used, and to work within those boundaries (Castro, 1999). Furthermore a conscientious and frequent monitoring by a licensed midwife is of the utmost importance, since a normal and healthy condition can suddenly and quickly turn into a problematic one due to heightened sensitivity and vulnerability. Despite this rather acute aspect of midwifery, the individual context and specific concomitant symptoms of every case should be considered within the framework of a homeopathic treatment. Midwives have an edge in doing this because they have already been thoroughly trained in observation and anamnesis (Cummings, 1998). Moreover, midwives have known for generations that there is a deep intuitive wisdom guiding mothers and midwives during births that need not be ignored just because it cannot be measured (Cummings, 1998). Integration of homeopathy into obstetric practice Any CAM practice needs extra patience, time and energy (Tiran, 1995). Often the energy involved for the treatment to be accepted, is so great, that midwives leave the NHS and start private CAM practices (Cant, Watts, & Ruston, 2012). Surveys in the UK (Mitchell & Williams, 2007; Mitchell, Williams, Hobbs, & Pollard, 2006) show that midwives were often motivated to practice homeopathy by personal or family health issues (Duckworth, 2015; Stewart, Pallivalappila, Shetty, Pande, & McLay, 2014), or because they felt it was congruent with their philosophy (Duckworth, 2015; Helen G. Hall, McKenna, & Griffiths, 2013). Equally Duckworth (2015) found that studying homeopathy is adding to the authenticity of the midwife, eventually forcing her to leave a mainstream medical context. Training of midwives Tiran (1995) advocates the development of a new clinical specialist role within midwifery with an expertise in CAM. Therefore basic midwifery education should include a compulsory element of CAM to allow appropriately trained midwives to safely administer CAM (Steen & Calvert, 2007). Cant, Watts, & Ruston (2012) mention that midwives are considered responsible for their own education in
3 CAM; however, authorities do not specify what competencies are involved. Midwives find this lack of prescription troublesome as it leaves them dependent on informal advice as to which training courses to undertake. According to Castro (1999), a working understanding of the principles of homeopathy is crucial to successful prescribing. However, the practice of classical homeopathy requires a lengthy training, differing from the much simpler acute prescribing or self-administration (Steen & Calvert, 2007). Curriculum of the theoretical course Indeed, a standard curriculum of a full training in homeopathy covers contact hours and about 7 times as much study hours. A large part of this time is devoted to assimilate and adopt the homeopathic paradigm and revolutionize one s thinking that normally underpins the conventionally trained (para)medic s decisions. Belgian law, however, only requires the midwives to follow a course of 50 contact hours and 50 hours of clinical training. The tension caused on the one hand by the limited duration of the course and the strongly dissimilar decision process on the other, has largely informed content and form of the trajectory in this pilot project. On the other hand, midwives have already acquired professional consultation skills. Hence the focus of the course was put on the introduction of the homeopathic philosophy and the skills to find information and independently gain knowledge. As a result following learning objectives were adopted: 1. The student gets in touch with the homeopathic/holistic philosophy and leaves the notion of prescribing something for or against a condition. 2. The student starts to let go of the causal relationships and rather accepts what is. 3. The student has learned to respect the individual characteristics of the pregnant woman and the baby and uses these as a basis for a prescription, at the same time temporarily letting go of medical labels and protocols. 4. In homeopathic treatment of a case, the student takes into account the totality as well as the essence of the remedy to be selected. 5. The student knows where and how to find literature on homeopathy. The program was divided in two parts; the first (22 hours) focusing on gaining insight in the homeopathic paradigm and the second (28 hours) aiming at its application in obstetric practice with delimited instruction in materia medica and obstetric case-taking. Participants, all licensed midwives, might have had some previous knowledge on homeopathy. Therefore, during the first day of the course, ample opportunities were incorporated for feedback on previously acquired knowledge and skills. The first three course days the holistic aspect, homeopathic sources and the homeopathic conversation were discussed. The following three course days covered homeopathic support during pregnancy, homeopathic interventions during labour and homeopathic support for breastfeeding and during the first stage of life of the new-born. On the last course day infertility problems were discussed. The total of seven course days was spread over four months. The topic of each course day was consigned to the teacher best qualified and most experienced on the matter to assure that all learning content was delivered with maximum expertise. The eventual disadvantages of dispersing the learning content over different teachers were circumvented by recording the lessons and making the recordings available for all teachers in the team. The small size of the student group allowed for interactive sessions, promoting transfer to practice. A reading list
4 with seminal works on homeopathic philosophy, theory and materia medica was provided, listing general information on homeopathy as well as information on homeopathy in obstetrics in particular. In order to enable time spent on appropriate exercises and practice, the materia medica lessons on 25 specific remedies were delivered by 30 minutes video clips, presenting the absolute minimal insight in each specific remedy. Powerpoints, exercises, textbooks and other learning materials were shared with the participants after the sessions. Clinical training As there existed no by Belgian law registered obstetric practice at the time of the course, the legal requirements for the clinical training could not be met. Therefore, clinical training was to take place in the midwife s own obstetric practice under supervision of a homeopath, or in the practice of a homeopathic medical doctor, who would take the obstetric case in the presence of the midwifetrainee. Evaluation of the learning process Participants were asked to write maximum three pages, taking a case from their conventional obstetric practice. They should describe shortly how they were thinking through that case previously to the course, what considerations led them to the treatment they decided upon and how they evaluated their treatment at the time. Next they were asked to describe how they would now approach the same case from a homeopathic perspective. How would that change their thinking? What observations or information would lead to a decision on a possible homeopathic prescription and how would this differ from their earlier approach? They were asked to discuss their proposed prescription based on information from the homeopathic literature. All participants submitted their paper and were graded with distinction. Evaluation of the course After the last session, all eight participants filled out a questionnaire with partly closed and partly open questions. The quality of the training was evaluated on four elements: content, transfer to practice, didactics and organization of the training. Recommendations to optimize the training were queried. The answers were analysed using thematic analysis. Content All participants found the content offered very interesting and totally fulfilling their expectations. Participants mentioned that in spite of the short timeframe of the course, teachers succeeded in conveying a lot of important information. The sequence in which the content was offered was felt as somewhat overwhelming, hindering immediate integration of the material. The following topics were considered most interesting: - the homeopathic vision, - how symptoms of the pregnant woman can lead to a prescription for the baby, - case taking techniques, - materia medica grouping the remedies (e.g. according the table of Mendeleev, plant families), - the cases presented, and - homeopathic support for breastfeeding. In general participants thought the series was too short and felt there remained a hunger for more. For instance, the postpartum period could have been treated more extensively. Also more help is needed to learn to use the repertory and how to interpret the essence of a case in a homeopathically correct way. Equally learning from their own cases, looking for the thread in the case and improving case taking skills required considerably more time.
5 Transfer to the obstetric practice All participants found the material offered in line with their obstetric practices and felt able to use what they had learned. Participants thought the training was a good introduction but asked for an extension in order to be confident midwife-homeopaths. Indeed, the limited time frame was seen as a significant threshold. Moreover, participants not only asked explicitly for more contact hours but also for more time in between sessions to process and study the material. Regular get-together days would be needed to check out each other s practice or to make case taking exercises. One participant strikingly claimed we ve only seen the top of the iceberg. Didactics According to the participants, teachers succeeded in delivering complex content in a demonstrative and analytical way. However, at times there was a need for more concrete examples. Teachers authenticity in taking a vulnerable position was especially appreciated. The validity of the cases (real cases from practice) with powerful examples was highly valued, as they facilitated transfer to practice. Finally participants highlighted the importance of interactive sessions. They found it exciting to look for the essential information in a case and appreciated the hermeneutic way (asking helpful questions) in which they were guided through these exercises. Recommendations for the future Participants unanimously recommended supplementing the material from the current training with more practice and cases, and expanding the course to a full year s training, allowing more time between sessions for processing the material. Also repertorisation techniques should get more attention. Most participants claimed that the ideal outcome of the course would be to acquire sufficient knowledge and background enabling them to take a two hours homeopathic consultation on top of their normal routine work. Some participants thought a complete training as a homeopath would be necessary to reach this level of proficiency. Other participants, however, would rather use homeopathy for acute prescribing, in which case more training on repertorisation techniques and materia medica knowledge would be required. Discussion and Conclusion Currently universities and colleges in Belgium are opposed to offering homeopathy education as part of the curriculum in midwifery teaching programs. However, public demand for homeopathy and Belgian law has put midwives in a position where they could serve the public with complementary homeopathic treatment in a cost-efficient and safe way, provided they have had an appropriate training on homeopathy. Such training, whether offered as part of the standard curriculum or as a CPD training, would require considerably more time than the 50 contact hours stipulated by law and would be best offered as interactive sessions providing powerful concrete case examples, spread over the course of one full year to allow for integration of the material into practice. Ample attention should be given to repertorisation, case taking and analysis techniques and exercises. Possibly an introduction and acute prescribing course could be followed by more in-depth training for those wishing to practice on a more proficient level. Further research into the training needs of midwives regarding homeopathy is required. References
6 Bellavite, P., & Signorini, A. (2002). The Emerging Science of Homeopathy: Complexity, Biodynamics, and Nanopharmacology. North Atlantic Books. Retrieved from Bell, I. R., & Schwartz, G. E. (2013). Adaptive network nanomedicine: an integrated model for homeopathic medicine. Frontiers in Bioscience (Scholar Edition), 5, Bornhöft, G., & Matthiessen, P. (2011). Homeopathy in Healthcare: Effectiveness, Appropriateness, Safety, Costs. EACH, Baden-Baden. Retrieved from Cant, S., Watts, P., & Ruston, A. (2012). The rise and fall of complementary medicine in National Health Service hospitals in England. Complementary Therapies in Clinical Practice, 18(3), Castro, M. (1999). Homeopathy. A theoretical framework and clinical application. Journal of Nurse-Midwifery, 44(3), Chaufferin, G. (2000). Improving the evaluation of homeopathy: economic considerations and impact on health. British Homoeopathic Journal, 89, Supplement 1(0), S27 S30. Cummings, B. (1998). Empowering women: Homoeopathy in midwifery practice. Complementary Therapies in Nursing and Midwifery, 4(1), De Gendt, T., Desomer, A., Goossens, M., Hanquet, G., Leonard, C., Pierart, J., Kohn, L. (2011). Stand van zaken van de homeopathie in België. (No. 154A). Brussels: Federaal Kenniscentrum voor de Gezondheidszorg. Retrieved from zotero://attachment/185/ Duckworth, J. E. (2015, April). Straddling Paradigms: An interpretive hermeneutic exploration of midwives practising homeopathy (doctoral). University of Central Lancashire, Preston. Retrieved from uckworth%2520jean%2520final%2520e- Thesis%2520%28Master%2520Copy%29.pdf+&cd=1&hl=en&ct=clnk&gl=be Gregg D. (2006). Birth herbs and homeopathics: stats and stories. Midwifery Today, (80), p. Hall, H. G., McKenna, L. G., & Griffiths, D. L. (2012). Midwives support for Complementary and Alternative Medicine: A literature review. Women and Birth, 25(1),
7 Hall, H. G., McKenna, L. G., & Griffiths, D. L. (2013). Contextual factors that mediate midwives behaviour towards pregnant women s use of complementary and alternative medicine. Special Issue on Public Health/health Services Research and Integrative Medicine, 5(1), Milgrom, L. R. (2014). Living is easy with eyes closed on blinded RCTs and specific and non-specific effects of complex therapeutic interventions. European Journal of Integrative Medicine, 6(5), Mitchell, M., & Williams, J. (2007). The role of midwife-complementary therapists: data from in-depth telephone interviews. Evidence-Based Midwifery, 5(3), Mitchell, M., Williams, J., Hobbs, E., & Pollard, K. (2006). The use of complementary therapies in maternity services: A survey. British Journal of Midwifery, 14(10). Steen, M., & Calvert, J. (2007). Self-administered homeopathy part two: A follow-up study. British Journal of Midwifery, 15(6), Stewart, D., Pallivalappila, A., Shetty, A., Pande, B., & McLay, J. (2014). Healthcare professional views and experiences of complementary and alternative therapies in obstetric practice in North East Scotland: a prospective questionnaire survey. BJOG: An International Journal of Obstetrics & Gynaecology, 121(8),
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