Ask an expert - body - women's health - pregnancy

17 questions

Q:   Iam  34 weeks pregnant but because my waters broke when I was 30 weeks,  I will need to be induced at 36 weeks. I would like to know whether inducing labour with acupuncture could work that early. If so, can you please advise me on when is good time to start and whether I can go to any acupuncturist or shall I look for a  specialist for inducing labour?

A:  The issue of early induction has been the subject of some very heated debate within the profession in the last few years, brought about by a request made to a member to try to induce a birth pre-term because it would be more convenient for someone's holiday arrangements to be carrying a baby than a large bump. The issue boiled down to whether someone could exercise their own right to have a baby whenever they chose, or whether the medical team retained control of the pregnancy to birth and afterwards.
 
Our decision was very clear. The only basis on which our members are allowed to use acupuncture to help to facilitate or speed up the delivery process is when it is medically necessary, when the medical team are considering either a drug-driven induction or a C-section and when the medical team have given someone express permission to go ahead. In this last condition it is important that the practitioner is able to speak to the midwife or consultant directly. I'm afraid this caution is a direct result of one patient telling one of our members that the doctor had OK'd an intervention when they hadn't.
 
We are always a little cautious too about the evidence for acupuncture and induction of labour. It is a matter of terminology. Acupuncture treatment can facilitate or speed up a natural process, but this is not quite the same as a direct causal relationship between a specific set of points and a defined outcome. The research studies which have been done, and most of which are inconclusive or report no effect, tend to be based on formula treatments which may not be appropriate for all of the subjects in the trial.
 
In an earlier response to a question about the safety of acupuncture as a potential inducer of labour we wrote:
 
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.
 
This advice still holds good. Although we do not yet recognise specialisms, we have spent a great deal of time trying to define what counts as expert practice for those members who spend most of their time working with pregnant woment and who have undertaken postgraduate training in the field. When we ahev finally agreed standards we may be able to make definite recommendations, but in the interim a google search of 'BAcC member' with 'pregnancy' and the area where you live will almost certainly generate a number of options.
 
We wish you a safe and happy delivery, and a healthy baby!  
 

Q:  I am wondering if accupunture is recommended for the last trimester of pregnancy and if it helps dialation and to get the baby into a good position for birth. Also is it safe to do at the same time as osteopathy?

A: Acupuncture treatment is perfectly safe throughout all stages of a pregnancy when undertaken by a properly trained and qualified practitioner. However, the majority of BAcC members tend not to treat in the later stages of pregnancy unless they have undertaken postgraduate training specific to issues surrounding pregnancy. There are now an increasing number of courses available for members who want to work with the pregnant woman from pre-conception to post-birth, and many advertise on their personal websites that they offer this focus of treatment. There are also a number of well-known training courses whose details and whose graduates are easily identified on the internet, although we are unable to provide direct referrals or namechecks.
 
We understand that the techniques trained in these courses are intended to facilitate the later stages of a pregnancy, and are based on a Chinese medicine understanding of the energetic changes taking place at this time. However, all acupuncture treatment is aimed at enhancing the natural energetic processes, and in theory all treatment should help the pregnancy to progress as it should. However, many women find it reassuring to seek treatment with someone who has undertaken specialist training in this area and is completely au fait with the conventional medical understanding of what is happening.
 
It should be relatively straightforward to find a suitably qualified practitioner by using the BAcC search function for practitioners in your area and running a rapid google search on keywords like pregnancy and their names. Even 'acupuncture' and 'pregnancy' with your own area should find you a practitioner who can help you. 
 
We know of no reason why someone should not have osteopathy treatment at the same time as acupuncture and often find that the two treatments are complementary to each other, with osteopaths often reporting that acupuncture treatment allows for easier manipulation of the joints and tissues.  
 

Q:  I am wondering about acupuncture on the perineum during the last weeks of pregnancy. What would this do and is this commom practice/becoming more common practice in order to try to prevent perineal tears during childbirth? Do you reccommend this?

A:  We tread rather carefully in answering questions like these. Although there is an increasing number of BAcC members who use acupuncture both to help women to become pregnant and to assist them through the pregnancy and childbirth, we have not yet fully agreed the standards which someone would need to meet to declare themselves to be an 'expert practitioner', nor the standard treatment patterns over and above the chinese medicine patterns in which all members are already fully trained. It is quite possible, therefore, that some members may have been using perineal acupuncture as well as forms of massage to help prepare the area for childbirth and avoid tearing, but we could not make this a recommendation because we do not have the evidence which can show us that it is effective and safe.
 
Our understanding, and we would not profess to be experts, is that factors which predispose to tearing are less to do with the physical condition of the area and more to do with the size of the babies and sometimes the speed with which they are delivered. Acupuncture treatment which encourages the natural sequence of events at childbirth may have an impact on the speed of delivery and make it more consistent with the mother's ability to go easily through the process.
 
Our own inclination is to keep the interventions to a minimum during the late stages of pregnancy, and to avoid the use of local needles which may have effects other than those intended. There is, for example an extremely powerful acupuncture point on the base of the perineum, and we would have reservations about using this for a local effect at this critical time.
 
There is, of course, a considerable literature for the use of acupuncture in helping the mother to recover from tears after delivery, and also anecdotally many accounts of the benefits of acupuncture for dealing with the discomforts and blockages caused by scarring after a tear.
 
Our best advice to you has to be to check, if someone is offering this as a treatment option, what the provenance of their information and training is. There are several well-recognised postgraduate courses in obstetric acupuncture available in the UK, and graduates of these courses will be only too willing to tell you what they do and why. If someone is doing it because it 'seems like a good thing to do' , tread very carefully. 
 

Q: Can accupuncture help with post natal symptoms to encourage milk flow, increase energy and prevent post natal depression? If so are you able to recommend someone in or near Redhill Surrey who specialises in this.

 

A: As our factsheet on puerperium, the immediate post-birth period, shows please click here
 
there is a small amount of evidence to show that acupuncture may be able to help with stimulating milk production. It is fair to say, though, that the number of studies is small, and some of them involve the use of electro-acupuncture, which is far from the standard treatment used by most BAcC members.
 
As far as increasing energy and preventing post-natal depression is concerned, the best that one can say is that, from a Chinese medicine perspective, the body, mind and emotions have been under a considerable strain for several months, and while a few ripples would be normal in the immediate post-birth period would be considered normal, if they persist into long-term problems of tiredness and depression it would indicate that the system is struggling to regain its balance. Since restoring overall balance was the main premise of traditional chinese medicine, there may well be some possibility that treatment could help to move things along. From a Chinese medicine perspective there are also certain parts of the system which bear a particular amount of strain during the pregnancy, and a skilled practitioner may well be able to target these areas in particular.
 
We do not give out individual recommendations, since we believe that all of our members are equally weel-equipped to deal with any patient who comes to see the. However, a significant number of members have undertaken considerable postgraduate training in working with fertility and pregnancy issues, and you may well find that this focus in their practice may equip them slightly better to discuss the specifics of your presentation. A quick view of the websites of those members nearest to you may reveal one or two who emphasise that they work with this group, and you would be best advised to seek a brief consultation with one, hopefully without charge, to determine whether acupuncture may be the best option for you.
 
We are assuming that you have been down the conventional medical route with your symptoms in case they are attributable to mild anaemia, but if you have not we are sure that our members would want to work in concert with your healthcare team.   

 

Q:  Our baby who is due in late September is breach can acupuncture help turn him around?

 

A: Our arithmetic suggests that you are now about 33/34 weeks into your pregnancy, and there is a technique used by acupuncturists which is often used at this stage with some success. The treatment involves using a burning herb called moxa near or on a specific point on the little toe, often with the mother kneeling on all fours to give the baby space to move. Occasionally the treatment is performed two or three times, and sometimes mothers are given a moxa stick to use at home for a couple of days with explicit instructions on how to use it safely. The treatment is not painful, because the idea is to provide heat, not burn someone, although it can sound a little scary.
 
The reseach for the effectiveness of the treatment is quite hotly debated.  You can easily find studies such as these:
 
http://www.ncbi.nlm.nih.gov/pubmed/20430289
 
http://www.ncbi.nlm.nih.gov/pubmed/9820259
 
which suggest that there is a measurable effect from treatment, and also suggest that the causal link may be that the treatment encourages foetal activity. However, even inside the profession we have colleagues who argue that a great many breech presentations resolve naturally at this stage of the pregnancy, and that anecdotal evidence must therefore be taken with a pich of salt.
 
What we can say, though, is that there are a number of complications or potential complications where we would strongly advise members not to proceed, or to proceed only on the direct and express permission of the midwife or consultant in charge of your pregnancy. The complications include:- 

 

 

 

-         recent uterine surgery, including Caesarean section

 

-         low-lying placenta, placenta previa

 

-         uterine or pelvic abnormalities, eg uterine fibroids, septum (obstetric staff clearance advised)

 

-         insufficient liquor (oligohydramnios) or excessive liquor (poly-hydramnios) (obstetric staff clearance   advised)

 

-         history of any bleeding in pregnancy, antepartum haemorrhage

 

-         threatened premature labour

 

-         any query about ruptured membranes

 

-         any hint of fetal distress

 

-         fetal abnormality, any sign of compromised fetus

 

-         multiple pregnancy

 

-         significant maternal hypertension, any signs of pre-eclampsia, diabetes, cardiac problems or thyroid disease  

           (obstetric staff clearance advised)     

 

-         Rh negativity

 

-         where Caesarean section is to be performed for other reasons.

 

 

 

If any of these apply you should seek the advice of your medical team.

 

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