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

23 questions

Q:  I m trying to be  convinced , but my period stopped from three months.  My doctor says I m passing through the premonopouse.  I am 37 years old.  Should I get pregnant ? What should I do to get  my period back?

A:  We are sorry to hear of your problems. Early menopause can be a terrible blow when someone decides to have a child at what should be a perfectly normal age to conceive.

As our factsheets show

the treatment of fertility and menopausal problems has been an area of great focus within the last decade, and a significant proportion of BAcC members undertake postgraduate training in treating fertility issues. We are actually on the verge of agreeing standards which allow someone properly qualified to claim to be an expert provider. Speaking to someone with this kind of training background who may be based near to you would be an extremely useful thing to do. We cannot tell, for example, whether your doctor's view that you are peri-menopausal or menopausal is based on blood tests of hormone levels or just an assumption based on the fact that your periods have stopped and you are in the right age group. There may also be family history which would give some insight into what is happening. If there is a history of early menopause in your family that could make a significant difference to what you could expect from treatment.

Once someone is armed with this background information it is possible to offer a much better idea of what may be possible. As this rather dense and heavy study shows

there have been interesting and often successful studies of almost all aspects of women's reproductive health, so there is every reason to believe that if you have not fully entered the menopause treatment may be able to enhance the remaining functions of your body.

Our advice, as always, is to visit a BAcC member local to you who can tailor the advice to your specific circumstances. The one thing they will need to know is whether your doctor has checked your hormone levels and if they show that you are truly in the menopause. This will have a huge impact on the advice they can offer you.

Q:  Could acupuncture be used to reduce anti thyroid anti bodies? I have had a number of miscarriages and this was found on one of my blood tests. I have normal thyroid function

A: We are always very cautious in answering questions like this. Although there are studies of the treatment of thyroid problems and thyroid antibodies, as our fact sheet shows

there can be considerable confusion in trying to look at how one system of medicine treats problems in another. You can find any number of studies which will say that the use of this or that acupuncture point will affect this or that hormone level, but the pathway of causation is usually not that straightforward. Chinese medicine is based on theories of energy, called qi, and its rhythms, flows and balances in the system. If a practitioner tries hard to restore balance to the whole system, inevitably when it works better all sorts of levels of hormones will adjust themselves - it's all the same body, after all. That's a long way from saying that x 'causes 'y', though.

What we often find is that there are imbalances in the system, when viewed from a Chinese medicine perspective, which might have an impact on the physical functioning of the body in such a way as to normalise the functions out of sync. There are also a number of points which have been discovered to have a direct effect on specific organs; the Chinese have in the last twenty years become very focused on trying to marry the best of East and West in finding specific points for named western conditions. It may be that a combination of the two approaches may help, but we have to be realistic and say that the evidence we can find is not that great.

What may be of greater benefit is to visit a BAcC member local to you who specialises in working with women with fertility issues and throughout pregnancy. Although we have yet to finalise agreed standards, there are three areas - paediatrics, obstetrics and mental health - where we have recognised that there is a legitimate claim to expert practice based on postgraduate training. A large number of our members have undertaken training which means that their websites make it very clear that this is a focus of their work. There being no agreed standards we are unable to tell you who can or can't lay claim to this, but our experience is that unless you live in a remote part of the UK, a google search for place name, acupuncture and pregnancy/fertility will generate at least half a dozen hits within reasonable distance.

The main benefit of finding someone qualified in this way is that they will very probably have had experience of seeing women with similar problems, and while it may not make a huge difference to the Chinese medicine involved many patients are reassured by the fact that they are seeing someone whose working knowledge of the problem is slightly more advanced than the average practitioner. That said, this particular expert has dealt with a couple of cases like this simply by using Chinese medicine as it is intended to be practised, i.e. treating the person, not the condition, and everything has turned out fine.

What we can never offer, however, is guarantees. Maximising someone's function may still not lead to changes in the blood chemistry, and a practitioner has to be realistic about this. However, it is certainly worthwhile giving treatment a go, and you won't be doing any harm in trying.

Q:  I am 37 weeks pregnant and was told this week my baby is in a breech position. I am rhesus negative. I've heard that it's not a good idea with my blood type. Surely this is a natural process as to whether the baby decides to move or not. It's not like the cpv procedure that forces the baby to move.  I'm booked into see an acupuncturist and she said she had not heard about this.

A:  As we are sure that you know from your own research, the use of acupuncture and moxibustion, mainly the latter, for breech presentation is well documented. The technique has been used in Chinese medicine for thousands of years, and involves the use of moxa, a smouldering herb, on a specific point on the foot. If the treatment is performed around the 33rd or 34th week of the pregnancy there is a significant amount of evidence which seems to show that the treatment works. Indeed, if you google acupuncture/moxibustion and breech presentation, you will find at least a dozen reasonably well constructed trials which appear to confirm this.
Of course, one of the factors which you have to take into account is that many babies spontaneously fall into the correct position after the 35th week anyway, so one has to take this into account in assessing the efficacy of the treatment. However, the technique is now being used by other healthcare professionals, and while we do not endorse the cherry-picking of our work, this is something of an empirical treatment, i.e. it works because it works, and this expert has never heard a conclusive argument for why this specific point should have this effect which would mean that its use was only legitimate in the hands of a professional acupuncturist.
However, when we look at your question small but significant alarm bells ring. 37 weeks is at the very end of the range of possibilities for this treatment working. At this point the baby is usually too large to encourage this movement. That said, many women, with the approval and encouragement of their midwives and obstetricians, try the treatment in order to head off a C-section. In your case, however, the Rhesus negative factor becomes slightly more crucial. We always advise members to speak to the medical team in charge of the pregnancy if someone is Rhesus negative. This is one of a number of conditions which we believe warrant additional care. In this case, if the treatment does encourage vigorous movement and a minor bleed, there could be serious consequences for the baby. A practitioner needs to know whether the woman has been given anti-D treatment, less likely on a first pregnancy but still possible, and also whether the risk assessment made by the obstetric team favours the use of the technique. If the midwife or consultant advises against it, that's the end of the discussion.
We are a little surprised that this is news to the practitioner. If she is a BAcC member, not only is the advice printed in or Guide to Safe Practice and also on our members' website, but it also forms a part of the training which all entrants have. If she is not a BAcC member, we are sure that most of the reputable professional associations take the same view. The increase in risk is sufficient to warrant conversation with the obstetric team.
We have had some lively and vigorous debates inside the profession about some aspects of treating late stage pregnancy, and the question of whether we are intervening to make something happen that otherwise would not or whether we are simply encouraging a natural process is a vexed one. Sometimes it is important to be clear what one is actually trying to achieve, and many practitioners regard themselves as simply trying to encourage a natural process, which is generally how we perceive what we are doing. This line can get a little blurry when people start to talk about induction by acupuncture because the very use of an imported conventional term implies a level of direct causation, not simply a speeding up of a 'stuck' rhythm. There are also a number of points whose use is expressly forbidden during pregnancy because they can cause serious problems, so not all treatment can be perceived as 'helping nature along'.
We would put this treatment in that same category, as something which is done with a specific and predictable effect in mind, this time for the benefit of the patient. If doing 'x' causes 'y', then it is crucial to ask oneself what might go wrong if the desired effect takes place. We would be reassured to know that either you or the acupuncturist has contacted your midwife or obstetrician to get advice and clearance for the use of this treatment, and if they say 'go ahead' we wish you every success and in any event, a trouble-free delivery!  

Q:  I am  39 weeks pregnant and was wondering if you do acupressure massages to induce labour? I'm desperate and my doctor has given the go ahead.

A:  This topic, at least for acupuncture rather than acupressure, was the cause for a very heated debate inside the profession a few years ago. We had received a number of enquiries from women who wanted to choose the time of their delivery, and one in particular who wanted to speed up the labour process so that she could give birth before, rather than during, her holiday. On the one side were practitioners who argued that a woman had a right to control her own health, and that this extended to choosing when she wanted to go into labour. On the other side were those who argued that childbirth is a natural process and it is not appropriate to interfere with its timing. Indeed, many argued that you couldn't force a natural process to speed up anyway, only make sure that there were no sticking points in the transitions which held things up.

In the event, as a regulator our decision was much more prosaic and driven by medical concerns. In conventional medicine no consultant, doctor or midwife would agree to any attempts to a medical induction of labour until the baby was at term and already overdue, usually at least 41 weeks, and our members were entitled, with the express permission of the person in charge of the delivery, to attempt to help the labour to start if and only if a medical induction was pending and acupuncture was tried to see if the use of drugs could be avoided.

At least some of the argument which kicked off was about trust. If someone says 'my doctor has said it is OK', then in 99 times out of a hundred, this is likely to be the case. The retort, that 'this is what someone would say, wouldn't they?', was correct in at least one case we were made aware of where the mother chose not to involve her care team but told her practitioner that she had done. We had to tell members that for their own protection they had no choice but to ensure that they spoke directly for the midwife or consultant. Our view was that if anything went wrong it was extremely likely that the mother's permission would exonerate them from liability.

We think that you could usefully talk to one of our members who spends a great deal of time working with late stage pregnancy for personal advice. We do not keep a database of members who have expert skills in this area (not until we have finally agreed standards for what counts as being an expert) but if you google 'acupuncture' and 'childbirth' together with where you live we are certain that you will find a BAcC member local to you from whom you can get face to face advice on what to do for the best. The fact that your doctor has given the go-ahead suggests that there may be reasons to expedite labour, but formally at 39 weeks we have to say that this decision rests with him or her and that our member would not proceed unless and until this consent had been gained.

Q:  My daughter is expecting a 2nd baby in Jan. Her first delivery was by 'C' section as she was so slow to dilate the baby became distressed (3cm after several hours) She is convinced that a 2nd delivery would be similar and is considering an elective 'C' section. I wonder if acupuncture before/during labour may assist dilation & help labour progress at a more reasonable pace. If this is the case, how many sessions & how close to due date. Would an acupuncturist attend the birth & would this be tolerated in an NHS hospital.

A:  A growing number of our members now offer treatment around the late stages of pregnancy and during childbirth itself, and there are several sub-organisations and interest groups within the BAcC which have sprung up which network to share best practice. We cannot name individual groups because of our commitment to our members as a whole to maintain a level playing field, but a google seach of 'acupuncture', 'childbirth' and the place where you live should quickly generate a few useful leads. The advice you get from these groups will be much more specific than we can give here.

Broadly speaking, acupuncture treatment helps to ensure that the stages of delivery follow their natural pace more easily, and especially help during the transitions which occur. We have to be a little cautious in our advice because the research evidence for this is not available, not because there is no evidence but because the format of the trials which count as evidence which we could cite are not well suited to areas like childbirth. There are many confounding factors in play which make it difficult to establish that 'x causes y'. Word of mouth has meant, however, that a growing number of women now actively seek out practitioners who are ready, willing and able to assist at the birth. Most NHS hospitals and childbirth units have no objection to the presence of a practitioner, and most practitioners who undertake this kind of work know how to work around, and keep out of the way of when necessary, the staff dealing with the delivery.

The number of sessions is impossible to determine. Generally speaking, the practitioner does the least possible to achieve the most effect, and intensive treatment would be unusual. Since the treatment is aimed at ensuring the transitions between stages are as smooth as possible, there would be times during the labour when treatment might have to be more specific, but in the absence of any direct cause and effect relationship between treatment and effect (i.e. no point which directly causes dilation), the practitioner's judgement and professional skill would determine how much treatment and when.

It is very, very important that your daughter feels entirely comfortable if she chooses to have acupuncture treatment, however. If she is worried about whether she is doing the right thing when the labour kicks off, this might be counter-productive and end up in the same result as the last time. The practitioner would also have to work very closely with the midwives as well. There would have to be a point where treatment ceased and a C-section take place if the baby becomes agitated, and a trained practitioner will know when to draw a line.

On the positive side, though, many hundreds of women every year now report very good outcomes from having treatment near or at the birth, and there is every reason to hope that your daughter will be able to benefit too.


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