As a midwife leading the way to raise the status of complementary therapy in maternity care, Tiran's latest book is a welcome addition to this growing body of knowledge, and is the culmination (but hopefully not the conclusion) of more than two decades of contributing to midwifery literature.
This is a resource for midwives and birth workers, broken down into clear chapters, including common therapies, professional issues and useful topics such as back pain in pregnancy and therapies for post-dates pregnancy. Although the book cites a great deal of research, it is readable and accessible. Therapies are examined in clear sections within chapters, with detailed tables and diagrams. Tiran doesn't just list the range of therapies available; she also synthesises the comparative uses and weighs up the evidence in a way that empowers midwives to consider therapies according to clinical need and make professional judgements on their use.
As a midwife in a city where these therapies are widely used among pregnant women and parents of small children, this book is timely and highly useful. There are many specialist alternative practitioners in the UK who claim expertise in the field of maternity, and women are also saturated with ‘expert’ opinion online. When women experience common problems and symptoms in pregnancy, in my experience, they tend to access the internet before speaking to their midwife. This may potentially lead to uneven and possibly unsafe use of herbal remedies and treatments during a vulnerable and important life transition. In my Trust, aromatherapy has been included as a tool to support women in labour. This alone necessitated a thorough examination of its use, appropriate training and clear protocols to ensure safety and effectiveness. A common misconception of complementary therapies is that they are safe and applicable generically; however, this book asserts the importance of evaluating the validity and effectiveness of any therapy or method. This book would also be valued outside the UK, where in some maternity systems there is not yet integration between traditional midwifery methods and evidence-based care.
I found the chapter breakdown for common pregnancy issues, such as nausea and back pain, particularly helpful. In my clinic where I see women antenatally, this is a valuable tool to consult when exploring possible treatment approaches with women, some of which they may already be accessing. The subject index at the back is invaluable, aiding quick referencing during a busy clinic.
This book would also be useful for GPs involved in antenatal care, particularly in cases of hyperemesis and back pain. At present, NHS guidelines are limited and tend towards pharmacological treatment, which not all women feel confident or satisfied in accessing. Student midwives and doulas will also find this book useful, as indeed will any complementary therapists working with pregnant women.
This book highlights research that the reader can explore further, thus satisfying academic as well as clinical needs. Something I would personally find helpful in my practice would be all of these essential bullet points of information (such as contraindications to raspberry leaf in pregnancy) as well as diagrams such as the ones on acupressure points, collated together in an appendix at the back of the book. It would be useful to highlight the different symptoms (such as nausea) and phenomena of pregnancy (such as hip/backache) in a chart form with the relevant suggested therapies available, detailing what level evidence there was for each approach (with references), together with anecdotal evidence from a range of women. This might be quite an undertaking, and could be a separate book in itself. I would have also been interested in more on yoga and exercise in pregnancy, although, again, this is a potential book in itself.
Overall, this is a quality and highly usable resource for midwives and birth workers. With over 50 pages of references and international research, the therapies discussed are relevant, comprehensive and up-to-date. Tiran has synthesised an astonishing wealth of knowledge and research around complementary therapies in the peripartum period and I'm confident this will become a well-used item in my own clinical toolbox.