OBJECTIVE: Our earlier study on complementary and alternative medicine (CAM) methods showed that acupuncture, homeopathy, and aromatherapy are available in most obstetrics departments in Germany but it did not evaluate the clinical indications for using CAM. The present study aimed to explore further the effectiveness of CAM use in obstetrics. STUDY DESIGN: We sent all departments of obstetrics in North Rhine-Westphalia a questionnaire designed to delineate their use of acupuncture, homeopathy, and aromatherapy during childbirth. It sought details on who provided the CAM therapy (midwife or physician). We asked respondents to indicate on a five-point scale how reasonable or otherwise they would consider the provision of CAM in each of six common problem situations and to estimate for each the proportion of patients given the CAM treatment. Respondents were also asked about the rationale for offering CAM, quality assurance and side effects. Spearman's bivariate correlation, cross-tabulation and Pearson's chi(2) test were used for statistical analysis. RESULTS: About 73.4% (138/187) of the departments responded. Acupuncture and homoeopathy were most widely used. Although obstetricians are responsible for patient care, decisions to provide CAM were largely taken by midwives, and the midwives' belief in the methods' effectiveness and patient demand were the principle motivating factors. Rates of CAM use in the six problem scenarios evaluated were directly related to practitioners' perceptions of the methods' therapeutic effectiveness. CONCLUSIONS: CAM methods were widely offered despite the lack of evidence of effectiveness or information on adverse consequences. In Germany, including CAM in the mandatory national quality assurance measures and perinatal surveys would provide valuable information; CAM use elsewhere merits further study.

Eur J Obstet Gynecol Reprod Biol. 2009 Sep;146(1):50-4. Münstedt K, Brenken A, Kalder M. Department of Obstetrics and Gynaecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de

By Sharon Esonis, PhD

The "Relaxation Response" is a powerful meditative technique that effectively reduces stress. Herbert Benson, a cardiologist, researcher and Associate Professor at Harvard Medical School, coined the term in his book, The Relaxation Response, first published in 1975. The term refers to an inborn capacity of the body to enter into a special state characterized by lowered heart rate, a decreased rate of breathing, lowered blood pressure and an overall reduction in the speed of the metabolic processes. The changes produced by this response counteract the harmful consequences and uncomfortable feelings of stress. This form of meditation has been an effective tool in treating medical conditions such as hypertension, angina, sleep disorders and chronic pain.

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