The demand for natural childbirth is fuelling a growing interest in alternative remedies in maternity care for women who may be unable to use pharmaceutical drugs for fear of harming the baby.
Midwives are offering scented oils, massage and techniques such as reflexology (manipulation of the feet) to help women cope with problems in pregnancy and labour.
A survey of the use of complementary therapies in the National Health Service found that midwives were the most likely of all professional groups to have incorporated the techniques into their practice.
The survey, published yesterday by the NHS Confederation and conducted in Leices- tershire, found examples of the use of the therapies in GP surgeries, health clinics, hospices and old people's homes. However, there was a lack of funds for the treatments and concerns about safety and effectiveness.
Denise Tiran, a midwife and lecturer in complementary therapy and midwifery at the University of Greenwich, said the demand for the therapies in maternity care was coming from the women. "Women want control. It is the one time in their lives when they are involved in a genuine partnership over their health care. They are taking a greater interest in their own health because it affects the health of their baby."
Aromatherapy and massage are the chief treatments in use because they are quickly learnt and easier to incorporate into midwifery practice. Some midwives offer homeopathy and a few practise acupuncture. Ms Tiran, who practises reflexology in the maternity department of Queen Mary's Hospital, Sidcup, and who is chair of the Complementary Therapies in Midwifery Group, said: "What most of us are doing is symptom control - for things like morning sickness, heart burn, backache and constipation.
"These are problems the obstetrician would not see as an abnormality and it is the responsibility of the midwife to help women over them. So often the physiological disorders of pregnancy and childbirth cannot be treated with drugs.
"One of the major benefits is relieving stress. A lot of my time is spent talking to women. They feel here is someone who has got 20 to 30 minutes, who is knowledgeable about midwifery and who they can discuss things with."
There are dangers. Some oils can stimulate uterine contractions, raise or lower blood pressure or induce epileptic fits. Ms Tiran said: "There is a lot of controversy over lavender oil. It is extremely useful and versatile, but it may induce uterine bleeding. Raspberry leaf tea, a herbal remedy which can help tone the uterus, should also not be given until the last three months of pregnancy. It is not enough for midwives to use oils simply because they smell nice and are relaxing. They must know their effects and what the contra- indications are."
There are an estimated 200 midwives in the complementary therapies group and many more are believed to be keen to use the techniques. Although nurses and physiotherapists are also interested in providing alternative remedies, midwives have more professional autonomy, work independently and have the scope to introduce them.
The NHS Confederation, which represents health authorities and trusts, has called for a government funded national programme to look at the effectiveness of complementary medicine and the training of practitioners.Reuse content