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Introduction A holistic approach to medical care is a key component of integrative medical practice. As an alternative to biomedical emphasis on illness and disease, integrative medical practice focuses on wellness. Principles of vitalism and humanism inform complementary and alternative medicine (CAM) approaches to health and healing, thus integrative medical practitioners have capacity to extend ideas of healing from the individual biology to broader public health trends and concerns. Methodology and approach We report on qualitative semi-structured interviews with 23 integrative medical doctors. Our research explored how they drew on CAM philosophical approaches to health and healing and how such approaches shaped their approach to practice. Results Integrative medical practitioners draw on CAM to understand causes of health problems, approaches to healing, and the role of the individual in healing. The key tenets of the philosophical approach identified by doctors were holism, vitalism, and empowerment. These notions inform their health practice. They focus on helping patients to become actively engaged in their health, in particular, in lifestyle change. These doctors see their practice as distinctly different from biomedicine, seeing biomedicine as too limited to in its approach. Conclusions While the principles underpinning CAM may open up opportunities for integrative medical practitioners to take a public health stance in their work, this approach is limited. Integrative practitioners see their approach as different to their biomedical peers, but their capacity to re-orient health from cure to prevention is often limited to notions of lifestyle advice and individual responsibility for health and healing.

Introduction Increasing numbers of general medical practitioners in Australia define themselves as integrative practitioners, incorporating both allopathic and complementary and alternative medicine (CAM) in an environment where evidence-based medicine is the hallmark of best practice in medicine. Methodology and approach We conducted semi-structured qualitative interviews with 23 self-identified integrative medical practitioners in two states of Australia. Participants were recruited from publicly available lists of self-identified integrative medical practitioners – the local telephone listing and the website of their professional organisation. Interviews explored how doctors define and use evidence in their practice. We undertook a thematic analysis of the interview transcripts with particular exploration of the key ideas that emerged about their use of evidence. Results These practitioners are sceptical about the dominance of the evidence-based medicine movement, and push to reclaim their autonomy based on the indeterminancy of individual cases. They acknowledge that an understanding of clinical benefit may not be scientifically evidenced and utilise discourses of experience and safety in discussing their clinical practice. Conclusions Our findings provide further insights into how medical practitioners work within their own profession, their relationships with other care providers (specifically CAM practitioners), their views about their non-integrative medical peers and their resistance to prescribed ways of clinical practice.

The use of complementary and alternative medicine (CAM) has increased in Western countries, with women identified as the primary users. Women's use of CAM in reproductive health is well documented; however, little is known about the use of CAM to enhance fertility, despite anecdotal evidence that this is a growing trend in reproductive medicine. The objective of this review was to examine the literature on women's use of CAM to enhance fertility, focusing on prevalence, motivations for use, and how information is sourced.A systematic search of multiple databases was conducted using key words and selection criteria.A total of eight articles that met the selection criteria, published between 1990 and 2010, were found and included in the review. The articles were analyzed under five key themes: "user prevalence," "user profile," "motivation for use," "expectations and satisfaction," and "referral and information sources." This review demonstrates important gaps in the evidence regarding women's use of CAM for fertility enhancement. There are no population-based studies with representative samples, no commonly accepted definitions of CAM research, and few studies describing women's motivations for and experiences of using CAM for fertility enhancement. Importantly, little is known about women's sources of information about CAM in this context.Nationally representative, population-based studies are required to fill the gaps in the evidence, provide prevalence rates, and inform policy and clinical practice.

Integrative medicine, a popular movement in the USA and Europe, is taught in many US medical schools. This study describes how Australian doctors define integrative medicine, what motivates them to work in integrative medicine and the incorporation of complementary and alternative medicines (CAM) into their practice.Semi-structured interviews were conducted between May and December 2009 with 23 doctors in two Australian states working in integrative medicine. A thematic analysis of interview transcripts was undertaken.Doctors' interpretations of the term 'integrative medicine' varied considerably. All maintained a strong belief in the usefulness of conventional medicine, while a holistic and patient-centred approach, promoting well-being, was central to their practice. Doctors' motivations for choosing an integrative approach to their practice of medicine also varied, but personal and professional experiences of alternative approaches to illness were influential in this decision. The nature of their clinical practice was also diverse; few doctors in this sample practice or professionally use CAM; a small number were happy to advise patients on the use of different modalities while even less referred to complementary practitioners.The concept and practice of integrative medicine among the doctors interviewed were diverse. This has implications for the Royal Australian College of General Practitioners inclusion criteria for the membership of their integrative medicine chapter. More broadly, the findings have implications for all medical practice and the education of medical students, as much of what integrative medicine doctors do may be considered simply as 'good medical practice'.

Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19) and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11). Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth) was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and frequency of visitors. These findings were similar to the public review. Organisational differences in postnatal care were found between the two sectors: private hospitals are more likely to have a separate postnatal care unit with single rooms and can accommodate partners' over-night; very few have a policy of infant rooming-in; and most have well-baby nurseries. Private hospitals are also more likely to employ staff other than midwives, have fewer core postnatal staff and have a greater dependence on casual and bank staff to provide postnatal care. Conclusions There are similarities and differences in the organisation and provision of private postnatal care compared to postnatal care in public hospitals. Key differences between the two sectors relate to the organisational and aesthetic aspects of service provision rather than the delivery of postnatal care. The key messages emerging from both reviews is the need to review and monitor the adequacy of staffing levels and to develop alternative approaches to postnatal care to improve this episode of care for women and care providers alike. We also recommend further research to provide a greater evidence-base for postnatal care provision.

Background Studies exploring the use of complementary and alternative medicine (CAM) to enhance fertility are limited. While Australian trends indicate that women are using CAM during pregnancy, little is known about women's use of CAM for fertility enhancement. With the rising age of women at first birth, couples are increasingly seeking assisted reproductive technologies (ART) to achieve parenthood. It is likely that CAM use for fertility enhancement will also increase, however this is not known. This paper reports on an exploratory study of women's use of CAM for fertility enhancement. Methods Three focus groups were conducted in Melbourne, Australia in 2007; two with women who used CAM to enhance their fertility and one with CAM practitioners. Participants were recruited from five metropolitan Melbourne CAM practices that specialise in women's health. Women were asked to discuss their views and experiences of both CAM and ART, and practitioners were asked about their perceptions of why women consult them for fertility enhancement. Groups were digitally recorded (audio) and transcribed verbatim. The data were analysed thematically. Results Focus groups included eight CAM practitioners and seven women. Practitioners reported increasing numbers of women consulting them for fertility enhancement whilst also using ART. Women combined CAM with ART to maintain wellbeing and assist with fertility enhancement. Global themes emerging from the women's focus groups were: women being willing to 'try anything' to achieve a pregnancy; women's negative experiences of ART and a reluctance to inform their medical specialist of their CAM use; and conversely, women's experiences with CAM being affirming and empowering. Conclusions The women in our study used CAM to optimise their chances of achieving a pregnancy. Emerging themes suggest the positive relationships achieved with CAM practitioners are not always attained with orthodox medical providers. Women's views and experiences need to be considered in the provision of fertility services, and strategies developed to enhance communication between women, medical practitioners and CAM practitioners. Further research is needed to investigate the extent of CAM use for fertility enhancement in Australia, and to explore the efficacy and safety of CAM use to enhance fertility, in isolation or with ART.