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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.


Q: I  have been having accupunture for birth preparation.  I would like to know how accupunture during labour could be helpful for labour other then as pain relief.  I am also wondering if it is difficult to have the needles inserted during labour and contractions, and if it reduces mobility since the needles are in?

A:  The received wisdom of using acupuncture during labour is that as well as providing some pain relief it helps to facilitate the transitions through the various stages. This is, of course, only based on the experience of members who regularly attend and assist at births, and women who have had both acupuncture assisted and unassisted births. This could hardly count as research for the purpose of making authoritative claims, but as out fact sheet shows
there is a small amount of evidence supporting claims for pain reduction, and studies such as this one
repeated on a larger scale may make the treatment more acceptable and accordingly more available.
One of the groups which has organised itself to provide this service to women puts the overall perspective far more eloquently than we can:

Traditional acupuncturists believe that labour should be a natural process in which the progression is directed by the flow of energy in the mother’s body. Ideally labour should move smoothly from one stage to another. This does not mean that the labour is painless, but that the contractions are efficient, so that the mother does not become exhausted and can remain calm and in control. We believe that the woman in labour should enter a state in which she can focus totally on what is happening in her body, supported by birth attendants and free from distractions.

Acupuncture in labour also works towards this ideal. In the early stages of labour, the insertion of needles and massage of acupuncture points can be used to smooth the flow of energy to support the efficiency of contractions. Acupuncture can also be used during the transition between the first and second stages of labour. Once the baby has been born, acupuncture can be used to assist the physiological third stage.

Treatment in labour often requires that a few needles are inserted into points, and then left in place. Common sites include the ear, the lower back and the hands and feet. Deep massage of energy pathways or acupuncture points may also be used to help smooth the flow of energy and support the mother during contractions. An additional role of the acupuncturist is to encourage the mother to stay in a focused and calm state throughout the labour. Acupuncture treatment in labour can be used in conjunction with conventional methods of pain relief and will often complement their effectiveness.

We are not aware of anyone reporting difficulties with movement after the needles have been inserted. The practitioner would ensure that they were never placed anywhere where sudden movement might cause physical injury, and we are equally sure that it is unlikely that a fear of needles being displaced would prevent someone from moving pretty much as the contractions made them move.

There are now several groups of BAcC members working around the country who offer specialist support in this area, and while we are unable to make individual recommendations, it is a relatively straightforward matter to google acupuncture, childbirth and your geographical area to locate practitioners who attend births. Even if you choose not to go ahead with an acupuncture assisted birth, we are certain that anyone involved in these groups would be more than happy to offer you advice.


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. 

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