Effects of acupuncture during labor and delivery in a U.S. hospital setting: a case-control pilot study.

OBJECTIVE: The objective of this study was to assess clinical effects and logistical feasibility of acupuncture given during labor and delivery in a U.S. hospital setting. DESIGN: A case-control pilot study was conducted with 45 parturients receiving acupuncture during labor and delivery alongside standard care. Primary outcome endpoints were incidence of cesarean section, amount of parenteral opioids used, use of epidural anesthesia, and duration of labor. Secondary endpoints included patient satisfaction and nursing staff acceptance as assessed by postpartum questionnaire, maximum flow rate of oxytocin, incidence of instrumental delivery, Apgar score, and incidence of adverse event. RESULTS: Forty-five (45) patients receiving acupuncture were compared to 127 historical controls matched for maternal age, gestational age, parity, and use of oxytocin (augmentation and induction were matched separately). Acupuncture patients underwent significantly fewer cesarean sections (7% versus 20%, p = 0.004). No significant differences were noted in other clinical endpoints. Seventy-eight percent (78%) of nurses reported a subjective perception of improvement in patients' comfort with acupuncture, while 83% reported that the acupuncturists' presence never interfered with their work. Eighty-seven percent (87%) of patients reported that acupuncture had helped them. CONCLUSIONS: Acupuncture during labor and delivery is well tolerated by patients and medical staff. It should be further evaluated for its promise in potentially reducing the incidence of cesarean section.

Communication between CAM and mainstream medicine: Delphi panel perspectives.

Healthcare practitioners' models of health affect their patient interactions and services. We surveyed mainstream (MM), integrative (IM) and CAM providers to investigate their models of health. This study generated ideas for actions to improve MM/CAM communication based on survey findings. Through the Delphi technique, a panel of 14 MM, IM and CAM experts participated in two rounds of questioning regarding survey findings. MM panel members were less supportive of almost all suggestions for actions than IM and CAM members. Suggestions most likely to be implemented were enabling the patient to take an active role in care, establishing understanding between patient and practitioner of treatment and its goals, fostering patients' taking responsibility for their health and communicating about patient assessment in ways understandable to others. Actions to foster better MM/CAM communication promote focus by a team of providers on the patient's goals, functioning and involvement in their care.

Models of health: a survey of practitioners.

PURPOSE: Models of health influence providers' practice and delivery of health care. This study surveyed a random sample of providers to determine if health care providers from mainstream medicine (MM), integrative medicine (IM), and complementary and alternative medicine (CAM) hold mutually exclusive models of health or combine notions from models thought to be contradictory. METHODS: A survey was created through qualitative research, piloted, and mailed to a wide variety of MM, IM, and CAM health care professionals. RESULTS: All providers combined various models and definitions of health. Most utilized the biomedical approach to some extent. Balance (holistic model) and functioning in daily life were essential to most respondents' models of health, disease, and healing. Close communication between MM and CAM systems was preferred over complete separation or a single system. CONCLUSIONS: Many providers of all types combine widely disparate components in their definitions of health, providing keys for improving communication.

Definitions of health among healthcare providers.

Providers' definitions of health may affect the kind of care they provide. This study examined healthcare practitioners' definitions of health across practitioner types. Interviews with 73 healthcare practitioners were analyzed for themes. Most practitioners identified health as the interrelatedness of several factors. Physical, mental, and spiritual factors all played important roles. Mainstream and integrative practitioners emphasized health as good functioning, absence of disease, and chronic disease under control. Integrative and alternative practitioners emphasized health as balance and as the free flow of elements such as motion and energy. All types of practitioners freely combined elements from models of health described as separate in the literature. Understanding providers' definitions of health could enhance communication among them.