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Ask an expert - body - women's health - pregnancy
Q: What can the benefits of having accupuncture throughout pregnancy be(but not for any specific complaint)?
A: A very interesting and good question! We have answered a number of questions about specifics, and there is a growing amount of evidence for the effectiveness of acupuncture for problems like morning sickness and the low back pain which pregnant women often get. However, traditional Chinese medicine was not originally thought of as a system of medicine for treating specifics. Chinese medicine was premised on the simple belief that if everything was functioning as it was supposed to symptoms would disappear. Moreover, the task of the Chinese doctor was believed to be to keep someone well, not to get them better after they had become ill. This was, said one of the ancient texts, 'like digging a well when you were already thirsty or forging a spear after the battle had started.'
How does this relate to pregnancy? Well, from a Chinese medicine perspective, there are a number of major physiological changes throughout the pregnancy and significant strains on the parts of the system. Traditional acupuncturists would see their task as ensuring that the changes which are natural to the process were as smooth as possible, and the parts most under strain as much supported as possible. Chinese medicine is based on theories about the flow of energies, called 'qi', and the appropriate rhythms and patterns of flow. Maintaining these while someone is pregnant should in theory reduce the chances of the kinds of imbalances which generate symptoms. In general, acupuncture is also often used for relaxation, and many women find that this can be a very benefical interlude in a tiring process.
All BAcC members are properly trained and qualified to treat the pregnant woman, and treatment very often tends to be quite conservative. There is a growing number of members who focus a great deal of their practice on the treatment of women in pregnancy, and although we are still in the process of recognising standards for postgraduate qualifications enabling members to lay claim to 'expert' status,. there are a number of networks to which these members belong and which are clearly identifiable from their websites. There may be some advantages to seeing someone who makes this the focus of their day to day work, but rapport with the practitioner can be as valuable as technical expertise, and whichever you choose you will be in safe and competent hands.
Q: I am pregnant again after having had a previous caesarean section. I am hoping for a vaginal birth this time. Is acupunture for induction of labour safe when a woman has had a caesarean in the past?
A: The core of this question is whether it is safe to have acupuncture for induction of labour, to which the answer is yes, as long as it is with the consent of the midwife or consultant in charge of your case. Generally speaking most obstetricians will only consider inducing a labour after 41 weeks or one week after predicted due date, and no acupuncturist will attempt to induce labour before this. Once you have reached this stage the team looking after you will be considering either a medical induction or another caesarean, and this is the point where acupuncture practitioners are often called into the case.
There was considerable debate inside the BAcC some years ago about whether this could or should be done independently of the medical team looking after the mother, but our view was that it is far better for all efforts to be co-ordinated at this point than to have someone operating outside the system. In our experience most conventional teams are happy for the mother to have acupuncture as a means of avoiding medical induction or C-sections, and the crucial things is that if the labour does kick in then all of the next steps are already in place for the birth to take place.
Acupuncture for the induction of labour is a very gentle process and if it works is probably a little less of a jolt to the system than drugs which tend to kick in very quickly, so we would always recommend using it first if the medical team are OK with this. Many of our members now focus their work very much on treating pregnancy and late-stage pregnancy, and checking the websites of a few BAcC members local to you will quickly reveal who has this focus and often what postgraduate training they have had in this field.
Q: I am currently receiving acupunture treatment for fertility and I found out I am pregnant 2 weeks ago. My acupunturist strongly advised that I do not go on my hoilday next week (2 hour flight) due to flying. Is it the general concensus among acupunturists that flying is not safe in early pregnancy?
A: There is no medical evidence that flying in the early stages of pregnancy causes any problems for either the mother or the foetus, and most airlines only start to become cautious if the return flight takes place in the later stages of pregnancy. The website of the Royal College of Obstetricians and Gynaecologists is one authoritative source to which you can refer.
There are a number of practitioners who dedicate their time to working with women either trying to get pregnant or managing their pregnancy and labour with acupuncture, and some run training courses which are intended to pass on their knowledge and experience to other practitioners. One such practitioner makes recommendations to avoid flying
and if your practitioner was trained by her it is quite possible that this is where the injunction came from. You will see from her words on the subject, though, that her primary concern is the radiation, and she is ready to admit that there is no scientific evidence to support the stance.
We obviously cannot give you specific advice because we have no knowledge of your individual case, but we can say that there is no general consensus amongst acupuncturists that flying in the very early stages of pregnancy is to be avoided.
Q. I am a student midwife and have been tasked with presenting information on the use of acupuncture for pain relief in labour. I am particularly keen to find out whether an acupuncturist would be likely to consider accompanying a woman into hospital for this purpose and whether the woman would have to remain still. Also how do acupuncturists normally manage their sharps.
Any help would be much appreciated.
A. An increasing number of BAcC members now attend births at the mother's request to help her through the stages of the delivery. Most hospitals seem to be reasonably relaxed about this, and as long as the practitioner has the consent of the consultant or the midwife in charge, and of the mother, of course, it is simply a matter of doing one's job and keeping out of the way at key moments.
The mother does not have to remain completely still, but there will clearly be limitations on how much movement is acceptable when needles are in place, and a delicate calculation of how many needles constitute a safe amount when the labour speeds up. Rather than set somewhat arbitrary guidelines or rules for this, we leave it up to the practitioner to assess the situation and make their own professional judgement about what it is best to do. For most, less is more at this critical time.
All needles used now are single-use and disposable, and the majority of members use yellow sharp's boxes within their clinics for the disposal of needles and small items of clinic waste. These boxes are collected by regsitered carriers when they are three quarters full, and there are very clear guidelines which we expect members to follow. There are also very clear guidelines for using smaller transportable sharps boxes in the event that the practitioner treats away frmom their normal base.
You may also be interested in the (10 minute) video of BAcC member Sarah Budd at the recent ARRC symposium entitled "Maternity acupuncture in the NHS : a "MYMOP" audit" which deals with pain relief.
The BAcC's factsheet on nausea and vomiting makes the point that the research studies on the effectiveness of using acupuncture to deal with morning sickness are equivocal and need to be of better quality in order for it to be able to say without qualification that acupuncture can benefit in the case of morning sickness. Anecdotally we hear many, many stories and testimonials of how well acupuncture has been able to bring morning sickness under control, but there are a number of problems associated with setting up proper trials which mean that evidence of sufficient quality does not yet exist.
That said, one of the early papers produced by Dundee et al well over a decade ago
seemed to show that acupressure on a point very commonly used in acupuncture treatment seemed to relieve symptoms for over eight hours. Many women purchase and use the anti-sea sickness bands from their chemists as a way of self-treating, and as long as the care team is aware that there is a problem and that you are using something like this to help control it then all is well.
The only concern which we have is that occasionally patients have such faith that treatment will work that they stick with it long after they should have sought further medical help - it is very easy to become severely dehydrated and require to be on a drip, especially in severe cases where it is difficult to keep anything down.
As far as safety is concerned, the points commonly used to treat morning sickness do not represent any risk to the mother or baby. There are one or two points which are contra-indicated for this stage of the pregnancy, but aside from the fact that very few British practitioners will be using techniques vigorous enough to be a risk, all BAcC members are carefully trained in the knowledge of which points are to be avoided in pregnancy and other conditions.