Elizabeth Oswald Dip.Ac; Ac.Mass

Member of the Royal College of Midwives

An Introduction to Acupuncture and Traditional Chinese Medicine - Liz Oswald

Acupuncture in Midwifery

·        Acupuncture can be used in the treatment of:

·      Nausea and hyper-emesis

·      Varicose veins

·      Vulval varicosities

·      Haemorrhoids

·      Constipation

·      Headaches

·      Heartburn

·      Carpel tunnel syndrome

·      Oedema

·      Backache and sciatica

·      Abdominal pain

·      Skin problems

·      Anxiety

·      Breech presentations

·      Pain relief in labour

·      Induction of labour

·        Is acupuncture safe in pregnancy?

Acupuncture treatment is generally considered safe, however there are some acupuncture points that have traditionally been considered ‘forbidden’ in pregnancy. These are the same points that can be used to induce labour and assist in delivery and there actions are obviously not appropriate in any other situation during pregnancy. However if you are already receiving acupuncture for other conditions it is important that you tell your practitioner of your pregnancy.

It is not unusual for anyone to become drowsy or dizzy during their first session of acupuncture. As in pregnancy these can be more common it is important that you negotiate a safe and comfortable position for your treatment (ie: not laying flat)

There have been several studies into the safety of acupuncture and most of these have concluded that the treatment form itself is safe, however there are good and bad practitioners in every field. I recommend that you visit a practitioner who is a member of the British Acupuncture Council (www.acupuncture.org.uk) -and who will therefore have undergone a ssatisfactory training course and carries insurance. Some G.P’s practice acupuncture but perhaps have only completed a short course.

·        Disorders of pregnancy

Acupuncture practitioners will approach these disorders such as back ache, pain, anxiety, headaches etc in a similar way to in a non-pregnant patient. The practitioner will question the patient in order to gather information that will enable them to make a holistic diagnosis and develop an individual prescription of acupoints to be used. The pregnancy and its effects on the body will be taken into consideration in this process.

·        Nausea and vomiting in pregnancy

There has been a great deal of interest in the effect of acupuncture on nausea and vomiting. Most of the research that has been done in this area focuses on the benefits for post-anaesthesia sickness and the side effects of chemotherapy. However, similar techniques have been used for thousands of years in China to counteract the very uncomfortable and sometimes distressing condition of nausea and vomiting in pregnancy.

A study at Queen's University, Belfast involving 350 women with morning sickness showed a significant reduction in symptoms after acupressure at point Neiguan P-6. A new report now claims that women are being denied the proven benefits of this technique. Dr. George Ghaly, consultant anaesthetist at Wigan Infirmary says "It's a great shame that so few doctors are aware of the benefits of acupressure", whilst George Lewith, of the Centre for the Study of Complementary Medicine in Southampton says "Theoretically and practically, implementing acupressure in many NHS hospitals would be very simple and save the country a great deal of money".

The point that is most effective in the calming of nausea is found on the wrist. It is possible to purchase aids such as travel sickness wrist bands that stimulate this point and ease the symptoms. Many pregnant women may also benefit from these bands, but more persistent cases may require more intense treatment.

·        Moxibustion and Breech Presentation

Again the use of moxibustion to turn breech presentation has been well documented in china for centuries. It has also been used in the West in recent years due to its ease of application and good results.

Moxibustion is the burning of the herb moxa or mugwort to warm a specific acupuncture point. It is used in the treatment of many conditions.

The treatment for breech presentation involves using a large roll of moxa (rather like a big cigar). It is lit at one end and the warmth is pointed towards a point on the outside edge of the little toes. Of course the hot moxa does not make contact with the skin but is held at a safe distance to provide a very gentle and pleasant warm feeling.

The point that is warmed – Zhiyin (BL 67) is used as it is the last point on the meridian channel that begins in the uterus. It is seen as the most outward point of this channel and therefore can be used to indirectly effect the most internal end of the channel. Warming of the point encourages fetal activity and enhances uterine contractibility, encouraging the baby to turn.

The treatment is most effective when carried out around 34 weeks gestation, and performed twice daily for nine days. Your practitioner will be happy to educate you and a willing helper in the technique so that you can carry it out at home.

Studies from China claim 85 –90% success rate, and a pilot study carried out in the UK by Sarah Budd (1992) reported a large increasing of fetal movements during and after the treatment.

·        Acupuncture, Induction of Labour and Childbirth

Acupuncture was traditionally used in China in cases of slow or prolonged labour, and to relieve pain and anxiety, and is still used today in hospitals in China.

A variety of points can be used but there are some that have been traditionally indicated for stimulating uterine contractions.

The technique is similar to routine acupuncture and women find that once inserted they can move around with the needles in place comfortably and safely. Occasionally a practitioner will use an electro-acupuncture device along with the needles. Electro-acupuncture is similar in principle to TENS but uses the needles to connect the flow of electro stimulation instead of skin pads. This results in a more direct and intense effect making it very effective in the relief of more severe pain.

There are midwives that are also qualified in acupuncture but I’m afraid they are very few. If you wish to have acupuncture in labour you will have to locate a practitioner first and notify your midwife in advance of your wish for them to be present at the birth.

 In China it is common for women to rely on acupuncture as the only anaesthesia for caesarean section.

In a study carried out in Sweden, the analgesic effect of acupuncture during childbirth was assessed by comparing the need for other pain treatments such as epidural analgesia, nitrous oxide/oxygen etc. in 90 women given acupuncture (acupuncture group) compared with 90 women not given acupuncture (control group). 52 women (58%) in the acupuncture group and 13 (14%) in the control group managed their deliveries without further pain treatment. The groups were similar with respect to age, parity, duration of delivery, use of oxytocin and incidence of Caesarean section. Acupuncture treatment was found to have no major side effects, and 85 women (94%) given acupuncture reported that they would reconsider acupuncture in future deliveries. The authors concluded that acupuncture reduces the need for other methods of analgesia in childbirth (Acupuncture Electrotherapy Research, 23(1):19-26 1998).

·        Post-natal Acupuncture

There are many post-natal conditions that can be treated by acupuncture:

·        Post-natal depression

·        Urinary dysfunction

·        Post-operative pain/ scar reduction

·        Backache

·        Anaemia

·        Back pain

·        Tiredness

·        Insufficient lactation

Again these are all conditions that will be individually assessed by a practitioner and treatment will be tailored to the individual.

·        Traditional Chinese Perspective of Pregnancy and childbirth

Over 2000 years ago the Chinese people developed a system of medicine that they hoped would allow them to understand the human body and is ailments.

Pregnancy was considered a very special and spiritual state. The Chinese identified a bodily substance called ‘Jing’ that they felt was responsible for reproduction, growth and development, and could be compared to our modern understanding of genes or DNA.

They felt that your ‘Jing’ was your blueprint for life and determined if you would be healthy or ill throughout life. It was thought that the quality of your Jing was determined at the point of conception and was influenced by the health of both parents at this time. This is why when planning children the Chinese would ensure their own health first.

Throughout life your activity would gradually use up your Jing until in old age you stopped growing and eventually lost the ability to reproduce.

Pregnancy is considered so special as it is the only time in her life when a woman has the opportunity to replenish her Jing by eating well and resting. It is thought that the fetus opens up an energy channel from heaven, through which the mother can also benefit. Therefore pregnant women were revered and allowed time to rest and follow spiritual practices throughout pregnancy.

However the physical turmoil of childbirth was seen as a dangerous time for women’s long-term health. The Jing would be vulnerable to the elements and infections and therefore could be depleted.

Women would be encouraged to stay indoors for a month after birth and members of the extended family would visit to care for her needs.

References:

West, Z. (2001)  Acupuncture in Pregnancy and Childbirth,  Churchill Livingstone, London

Yelland, S (1996) Acupuncture in Midwifery, Books for Midwives Press, Hale

 Copyright © 2002 Elizabeth Oswald. All rights reserved.

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