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Complementary and alternative medicine in the labor and delivery suite.

Complementary and alternative medicine (CAM) is defined as those medical systems, practices, interventions, applications, theories, or claims that are not currently part of the dominant or conventional medical system. Conventional medical care providers have shown increasing interest in CAM. Two recent national surveys have found that the use alternative medicine by adults in the United States has increased from 34% in 1990 to 42% in 1997. The use of unconventional therapy was common among those of reproductive age, and almost half of all women (48.9%) reported use. It is possible that a significant number of pregnant women are currently using CAM to treat disorders of pregnancy. The percentage of pregnant women currently using CAM therapies in pregnancy is unknown. A recent survey of Certified Nurse Midwives suggests that the use of alternative medicine by pregnant women is common. More than 90% of midwives reported recommending CAM for their pregnant patients. The most common indications for CAM involved use in laboring women for stimulation of labor or maternal relaxation in labor. Nearly 80% of respondents who used herbal therapy cited stimulation of labor as an indication. Limited quality literature exists concerning the use of CAM in pregnancy for induction or augmentation of labor or analgesia in labor. A recent survey of the literature suggests that quality scientific research evaluating the efficacy and safety of these agents is limited. This review assesses the scientific evidence available on the efficacy and safety of CAM therapies for intrapartum use for labor analgesia, induction, and augmentation. This review should be helpful for the practitioner who is caring for a pregnant woman who expresses interest in CAM therapies. It also should help guide future research activities to those modalities in common use that have not been satisfactorily investigated. Correspondence: Alexander D. Allaire, MD, 214 MacNider Campus, Box 7570, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599–7570. CLINICAL OBSTETRICS AND GYNECOLOGY Volume 44, Number 4, pp 681–691 © 2001, Lippincott Williams & Wilkins, Inc.