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

15 questions

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.

 

Q: Is moxibustion safe and effective for turning around breech babies for someone without rhesus negative condition but who has experienced spotting in the third trimester? If so, at how many weeks of pregnancy is it recommended?

 

A: We publish very comprehensive guidelines for our members about using moxibustion for trying to turn breech babies, and one of the contraindications is any bleeding during the pregnancy.
 
This does not mean, though, that using moxa is totally out of the question. If the pregnant woman has the OK from the midwife or consultant in charge of her pregnancy and they are happy for her to go ahead with an attempt to turn the baby in this way, our members are more than happy to accept the delegated authority to get on with it. Our caution is based on the fact that we cannot be sure that a member has a sufficiently comprehensive training or other qualifications which enable them to make judgement calls like this. Some bleeding/spotting is not uncommon, but it may have greater clinical significance.
 
Most members try this technique around the 33rd or 34th week, but we have heard of successful cases much later in the pregnancy when the alternative of a C-Section looms large. There is some formal evidence underpinning the use of the technique, and it has certainly been used in China for thousands of years, but it is fair to point out that many babies adjust naturally around this time, so the causal link is not alwatys certain.
 

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. 

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