title: Determinants of use of care provided by complementary and alternative health care practitioners to pregnant women in primary midwifery care: a prospective cohort study.
abstract: BACKGROUND
  Pregnant women visit complementary/alternative health care practitioners in addition to regular maternal health care practitioners. A wide variation has been reported with regard to rates and determinants of use of complementary/alternative medicine (CAM), which may be due to heterogeneous populations. The aim of this study was to examine the prevalence and determinants of use of CAM practitioners by a homogeneous population of low-risk pregnant women in the Netherlands.
  
  
  METHODS
  Data from the population-based DELIVER study was used, concerning 1500 clients from twenty midwifery practices across the Netherlands in 2009 and 2010. CAM use was measured based on patient reports. Potential determinants were derived from Andersen's behavioural model of health care utilization.
  
  
  RESULTS
  The prevalence of CAM practitioner use by low-risk pregnant women was 9.4 %. Women were more likely to use CAM if they had supplementary health care insurance (OR 3.11; CI 1.41-6.85), rated their health as 'bad/fair' (OR 2.63; CI 1.65-4.21), reported a chronic illness or handicap (OR 1.93; CI 1.14-3.27), smoked during pregnancy (OR 1.88; CI 1.06-3.33), or used alcohol during pregnancy (OR 2.30; CI 1.46-3.63).
  
  
  CONCLUSIONS
  CAM is relatively frequently used by low-risk pregnant women. Determinants revealed in this study diverge from other studies using heterogeneous populations. Maternal health care practitioners must be aware of CAM use by low-risk pregnant women and incorporate this knowledge into daily practice by actively discussing this subject with pregnant women.
authors.affiliation: Department of Midwifery Science, AVAG, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. esther.feijen@inholland.nl.|Academy of Midwifery Amsterdam-Groningen, Dirk Huizingastraat 3-5, 9713 GL, Groningen, The Netherlands. esther.feijen@inholland.nl.
authors.forename: Esther I
authors.initials: EI
authors.lastname: Feijen-de Jong
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. d.e.m.c.jansen@umcg.nl.|Department of Sociology, Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Groningen, The Netherlands. d.e.m.c.jansen@umcg.nl.|, PO Box 196, 9700 AD, Groningen, The Netherlands. d.e.m.c.jansen@umcg.nl.
authors.forename: Danielle E M C
authors.initials: DE
authors.lastname: Jansen
authors.affiliation: National Association for Specialty Training for General Practice and GP Trainers, Utrecht, The Netherlands. f.baarveld@huisartsopleiding.nl.|, PO Box 20072, 3502 LB, Utrecht, The Netherlands. f.baarveld@huisartsopleiding.nl.
authors.forename: Frank
authors.initials: F
authors.lastname: Baarveld
authors.affiliation: Department of Midwifery Science, AVAG, and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. evelienspelten@yahoo.com.|Faculty of Medicine, Nursing, and Health Science, Monash University, Melbourne, Australia. evelienspelten@yahoo.com.|Academy of Midwifery Amsterdam-Groningen, Dirk Huizingastraat 3-5, 9713 GL, Groningen, The Netherlands. evelienspelten@yahoo.com.
authors.forename: Evelien
authors.initials: E
authors.lastname: Spelten
authors.affiliation: Department of General Practice, Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. f.schellevis@nivel.nl.|Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. f.schellevis@nivel.nl.|, PO Box 1568, 3500 BN, Utrecht, The Netherlands. f.schellevis@nivel.nl.
authors.forename: François
authors.initials: F
authors.lastname: Schellevis
authors.affiliation: Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. s.a.reijneveld@umcg.nl.|, PO Box 196, 9700 AD, Groningen, The Netherlands. s.a.reijneveld@umcg.nl.
authors.forename: Sijmen A
authors.initials: SA
authors.lastname: Reijneveld
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D002908:Chronic Disease; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000379:methods / Q000706:statistics & numerical data*; D008880:Midwifery / Q000706:statistics & numerical data*; D009426:Netherlands; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D012907:Smoking; D055815:Young Adult