title: Clinical indications and perceived effectiveness of complementary and alternative medicine in departments of obstetrics in Germany: a questionnaire study.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Obstetrics and Gynaecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany. karsten.muenstedt@gyn.med.uni-giessen.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Münstedt
authors.forename: Anja
authors.initials: A
authors.lastname: Brenken
authors.forename: Matthias
authors.initials: M
authors.lastname: Kalder
mesh_terms: D015670:Acupuncture Therapy / Q000706:statistics & numerical data; D019341:Aromatherapy / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D000529:Complementary Therapies / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006705:Homeopathy / Q000639:trends; D006801:Humans; D008880:Midwifery; D009774:Obstetrics / Q000379:methods*; D017063:Outcome Assessment, Health Care; D036801:Parturition; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011795:Surveys and Questionnaires