Acupuncture in Pregnancy

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Recently I ran into a patient who I had worked with across two pregnancies. It brought so much joy to see her out with her baby. While chatting, she told me how acupuncture helped her through each of her pregnancies. I love that!

I really enjoy working with pregnant women. It’s such a special time in life and I feel lucky to be able to offer something tangible that may help them through this time of great transition. 

Women’s bodies are going through so much change during pregnancy and I find, anecdotally from my own clinical experience, that their bodies are often more sensitive and receptive to the gentle art of acupuncture. During gestation, we give careful consideration to both the mother and fetus so as to nurture and support the process. 

Pregnant women are often particularly careful about what they consume and receive advice from their doctors about which over the counter and prescription medicines are safe while pregnant. Knowing that acupuncture can be safe and effective offers another treatment option where other options may not be advised. 

Another thing with pregnancy is that underneath the exterior of a what a blessed time this is, is perhaps a woman with stress.

Questions about readiness and change, possibly coupled with low energy, diminished sleep, appetite changes (to name a few) are often occurring simultaneously as they continue with regular responsibilities of work and/or childcare, making plans for changes in the future, re-shaping their homes, etc. It’s a lot! Getting acupuncture is a quiet time and allows them a place to rest and receive support. Patients often tell me they feel better coming in. 

Here is a partial list of general conditions common to pregnant women that I’ve worked with and found acupuncture to be helpful:

Fatigue 

Musculoskeletal aches and pains

Headache 

Nausea and/or vomiting

Stress

Depression

Constipation 

As we move towards greater integration of conventional / Western care and treatment with other complementary modalities (such as acupuncture), I hope we’ll see more studies on the safety and efficacy of acupuncture as part of a potential treatment plan for those with risk of pre-eclampsia (PE), gestational diabetes, and other riskier pregnancies. We’ll see… 

In the meantime, here are some links to scientific evidence around acupuncture and pregnancy: 

Debra Betts’ robust website with links to research for pelvic pain, nausea, breech presentation, prebirth, cervical ripening, and depression in pregnancy. Here’s the link to pain relief in labor: http://acupuncture.rhizome.net.nz/acupuncture/research/reducing-labour-pain/

Nei-Guan point acupressure is a useful treatment for relieving symptoms experienced by women with hyperemesis gravidarum.” http://www.ncbi.nlm.nih.gov/pubmed/17645494

There is high-quality evidence reporting the benefits of herbal medicines and acupuncture to treat nausea in pregnancy.” http://www.ncbi.nlm.nih.gov/pubmed/26866600

In women’s health, acupuncture has been found to be beneficial for patients with premenstrual syndrome, dysmenorrhea, several pregnancy-related conditions, and nausea in females who have cancers.” http://www.ncbi.nlm.nih.gov/pubmed/18803496

[This study was designed to check for a different condition, but also said the following.] Good clinical evidence has been reported for the effect of PC6 acupuncture in preventing or attenuating postoperative and pregnancy related nausea.”  http://www.ncbi.nlm.nih.gov/pubmed/18356796

[Fourth year medical students in London can take a course in Chinese Medicine. Here’s an essay on migraine + acupuncture + pregnancy.] “…acupuncture for migraine relief has been recommended by NICE as a non-pharmacological measure for migraine headaches(59). Since acupuncture has the potential to relieve migraine pain without the added fear of teratogenicity, it may be a useful alternative or adjunct for analgesic medications given in pregnancy.” http://www.cmir.org.uk/kcl-ssc-student-submissions

“Given the high prevalence of nausea and vomiting in early pregnancy, women and health professionals need clear guidance about effective and safe interventions, based on systematically reviewed evidence. There is a lack of high-quality evidence to support any particular intervention. This is not the same as saying that the interventions studied are ineffective, but that there is insufficient strong evidence for any one intervention. The difficulties in interpreting and pooling the results of the studies included in this review highlight the need for specific, consistent and clearly justified outcomes and approaches to measurement in research studies.” http://www.ncbi.nlm.nih.gov/pubmed/26348534

The summarized findings indicated a small but growing body of acupuncture research, with some evidence suggesting a benefit from acupuncture to treat nausea in pregnancy. Findings from the review also highlighted promising evidence for the effectiveness of acupuncture to manage back and pelvic pain, acupuncture-type interventions to induce change in breech presentation, and pain relief in labor. The methodological quality of recent trials has improved, and the quality of systematic reviews was high. CONCLUSIONS: Interest is growing in the use of acupuncture to treat some complaints during pregnancy and childbirth, and evidence is beginning to consolidate that acupuncture may assist with the management of some complaints during pregnancy. However, definitive conclusions about its effectiveness cannot be reached and further research is justified.” http://www.ncbi.nlm.nih.gov/pubmed/19747272

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What about the research (RCT, randomized controlled trial) on Chinese medicine?

Search to see if there’s published research in a subject area that interests you.

On 3/1/2016, I searched several acupuncture topics (for fun) on MedPub (a database of the US National Library of Medicine, National Institutes of Health). I could have easily chosen other search examples such as “acupuncture + digestion” or “acupuncture + nausea and vomiting” but here are some examples of how many research trials were found:

“acupuncture” yielded 24,194 results

“acupuncture pain” yielded 6,493 results

“acupuncture low back pain” yielded 607 results

“acupuncture cancer” 1,263 results

“acupuncture chronic pain” 1,392 results

“acupuncture pregnancy” 849 results

“acupuncture migraine” 403 results

“acupuncture anxiety” 548 results

“acupuncture depression” 793 results

And one example:

JAMA, journal of the AMA, a meta analysis (comparing research studies) of 17,922 patients, regarding back and neck pain, osteoarthritis, chronic headache, and shoulder pain, found that “acupuncture was superior to both sham and no-acupuncture control for each pain condition – – Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option”

[ Oct 2012:   http://archinte.jamanetwork.com/article.aspx?articleid=1357513 ]

Definition “Research”: Webster’s 2nd Edition, c.1934 (1910)

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From http://www.merriam-webster.com March, 2016:

Full Definition of research

  1. 1:  careful or diligent search

  2. 2:  studious inquiry or examination; especially :  investigation or experimentation aimed at the discovery and interpretation of facts, revision of accepted theories or laws in the light of new facts, or practical application of such new or revised theories or laws

  3. 3:  the collecting of information about a particular subject

What conditions does acupuncture treat?

“Since at least 200 BC, the application and effects of acupuncture and herbs have been documented. It is only recently, however, that systematic exploration of Chinese Medicine using the scientific method has become more recognized and accepted in the West.

Chinese and Western scientists have proven that acupuncture does indeed increase levels of endogenous morphine-like substances. Clinical studies of acupuncture in the treatment of a wide range of illnesses have led to acupuncture’s acceptance beyond pain control.

The following is the World Health Organization’s now famous list of diseases that lend themselves to treatment by acupuncture. The inclusion of herbal remedies in a scope of practice may broaden the range of disorders that may be successfully treated.” 

http://www.pacificcollege.edu/resources/about-medicine/treatable-disorders ]

Gastrointestinal Disorders

Acute and chronic colitis

Acute and chronic gastritis

Acute bacillary dysentery

Acute duodenal ulcer (without complication)

Chronic duodenal ulcer (pain relief)

Constipation

Gastric hyperacidity

Gastroptosis

Diarrhea

Hiccough

Irritable bowel and colitis

Paralytic ileus

Spasms of esophagus and cardia

Gynecological Disorders

Benign amenorrhea

Benign irregular menstruation

Dysmenorrhea

Infertility (Not WHO recognized. Clinical experience proves effective.)

Menopause syndrome

PMS

Cardiovascular Disorders

Essential hypertension

Neurological Disorders

Cervicobrachial syndrome

Disc problems

Facial palsy (early stage, within three to six months)

Headache and migraine

Intercostal neuralgia

Meniere’s Disease

Neurogenic bladder dysfunction

Nocturnal enuresis

Paresis following stroke

Peripheral neuropathies

Trigeminal neuralgia

Musculo-skeletal Disorders

Arthritis

Fibromyalgia

“Frozen shoulder”, “tennis elbow”

Localized traumatic injuries, sprains, strains, tendonitis, contractures

Low back pain

Muscle pain, swelling, stiffness and weakness

Osteoarthritis

Sciatica

Work and sports related injuries

Respiratory System Disorders

Acute bronchitis

Acute rhinitis

Acute sinusitis

Acute tonsillitis

Bronchial asthma

Common cold

Disorders of the Eye, Ear, Nose & Mouth

Acute and chronic pharyngitis

Acute conjunctivitis

Cataract (without complications)

Central retinitis

Gingivitis

Myopia (in children)

Toothaches, post extraction pain

Psychological Disorders

Anxiety

Depression

Hypersomnia

Insomnia

OCD

PTSD

Somatization disorder

Other Disorders

Appetite suppression

Withdrawal from street and pharmacological drugs

One of my favorite questions people ask me about acupuncture…

Question: Do I get acupuncture and who do I see?

Answer and Explanation: Yes, I do (sometimes) and I sometimes see different practitioners based on what health concern(s) I’m working on, usually not at the same time. If it is at the same time, I tell each practitioner what kinds of other work I’m getting or doing so we’re all on the same page and so recommendations don’t overlap (for example, I’ll take herbs from only one practitioner at any given time).

Sometimes I’m using Chinese medicine to treat one thing and sometimes I’m using it to treat another, or another, etc. For example, if the condition is physical pain-related, I may opt for a practitioner who works with that specific condition or otherwise treats a lot of musculo-skeletal pain. Generally-speaking, we all work with conditions of pain, but some will have sub-specialties in certain types of pain (example: someone who focuses on the neck or joints or whatever).

Because acupuncturists (as we are called) often have specialties or sub-specialties, I try to pay attention (and ask questions!) regarding what practitioners are focusing on in their continued studies, which we all do. Some may be particularly strong in the area of herbal medicine, medicinal massage, a particular style of acupuncture (of which, there are many), etc.

If I’m looking instead for treatments for a different kind of health concern, like to improve my energy levels, sleep, digestion, stress, than I may work with another practitioner based on fit, their training and approach, etc.

I think Chinese medicine generally works better when utilized as a series of appointments so depending on whether it’s an acute or chronic condition, I consider how many appointments, and how often will I get them (weekly, 2x p/week, more often?) and for how many weeks. Sometimes I like to consider a routine 4-6 appointments just to see how I’m responding to a round of treatments.

As a general note: For acute conditions, sometimes one can need less appointments and for chronic conditions, sometimes one can need multiple rounds of treatments. Alternatively, sometimes just a random appointment on a monthly basis can be very nice as a “tune-up” (of sorts) or perhaps, as a preventive measure to help the body stay in harmony.

It’s amazing how much variety can be found within the field of acupuncture! I can’t emphasize that enough.