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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Headaches / Migraines

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From the Washington Post,  an account of treating migraines well with acupuncture,

“A month into my treatment, after eight sessions, I noticed that my migraines had begun to slow down in frequency and weaken in intensity. At the end of two months, I felt strong enough to scale my appointments down to once a week. Five months after I started acupuncture, I felt essentially cured. I rarely got the drowsy fog of fatigue — and if I did, it almost always went away on its own. I could work on my computer and spend time on the beach, and I was able to drink wine again. It has now been five years since I discovered acupuncture. I still occasionally get migraines, and if they seem to be amping up, I’ll use acupuncture, even a couple of times a week. But there have been months when I don’t need it at all.”

https://www.washingtonpost.com/national/health-science/migraines-were-destroying-my-life-heres-what-finally-cured-me/2016/05/02/7007b840-f6b1-11e5-9804-537defcc3cf6_story.html?postshare=461462290441410&tid=ss_tw

I’d like to add a couple notes:

  1. Please notice that the patient really tried acupuncture. She didn’t just come once or twice but having noticed that she was trending well after a round of eight treatments, she continued on for further benefits.
  2. It’s not often that I’ll quote WebMD for acupuncture because quite frankly, I don’t always see them mention acupuncture as a viable treatment option for conditions that I’ve seen treated first-hand with acupuncture. But times may be a’changing and headaches are commonly treated by acupuncture so here you go, titled “Acupuncture May Be Effective for Migraines” at http://www.webmd.com/migraines-headaches/news/20120112/acupuncture-may-be-effective-for-migraines — Here’s a quote from the article, “Three months after treatment, people who received traditional Chinese acupuncture continued to report a reduction in migraine days, frequency, and intensity.” There was also this gem, “Another study of nearly 800 people showed that 11 acupuncture treatments over six weeks were at least as effective as the blood pressure drugs called beta-blockers — often used for migraine prevention — taken daily for six months, Molsberger tells WebMD.”
  3. An essay exploring acupuncture for migraines (particularly in pregnant women) from a 4th year medical student in London: “acupuncture for migraine relief has been recommended by NICE…Since acupuncture has the potential to relieve migraine pain without the added fear of teratogenicity…necessary to carry out further research on the effects of acupuncture on those who are pregnant.” http://www.cmir.org.uk/kcl-ssc-student-submissions
  4. Here’s a nice link about tension-type headaches from Cochrane last month: http://www.cochrane.org/CD007587/SYMPT_acupuncture-tension-type-headache — First line, “The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with frequent tension-type headache.” This was a review of 12 trials with 2,349 adults!

I hope more people suffering from headaches will consider acupuncture!

 

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Gentle Acupuncture & Needle Fear

I think I’m pretty good at working with people who have some fear about acupuncture because of the needles. For one, I let patients know that in No Event am I going to do something they don’t want me to do and that I will only perform acupuncture after asking them if it’s okay. I also remind them that I will only be working in a specific location that we’ve talked about and that they have the power to say “not there”.

So essentially, I:

  • remind them that they’re in control
  • that nothing happens without their consent
  • that they can consent and then change their mind

In the treatment room, I can use needles that are more gentle, intended for children or babies, and employ techniques that are mild in nature.

I let them know that some patients, on the other end of this spectrum, prefer “stronger techniques” and that as practitioners, we don’t always know which techniques a patient will prefer or respond best to. Communication is key.

I assure them that I’ll be conservative in my approach and will give a lighter treatment, even at the risk of non-effectiveness, instead of a stronger treatment, and that we can always build up to stronger-feeling treatments if they like and as they’re ready.

Some patients prefer to see the needles first while others prefer not to, so together we decide best approaches to facilitate comfort and ease. I can also describe how thin needles are, more similar to the width of a hair than what they may have experienced at doctor’s offices. I also ask if they have any concerns or questions around safety and that I’m trained to be safe.

Also, some prefer to chat or listen through the act of insertion and others prefer silence so they can breathe in/out without disruption. We discuss their preferences and then I take steps to honor them. At any time, we can slow down or stop altogether.

So this:

  • creates the expectation of mellow, starting simple/light
  • reminds them that different people respond and prefer different techniques
  • reminds them they’re in control and we’re in this together

If they elect for just one insertion, I let them know this is a great start and that some entire treatments are just that: they shouldn’t feel like it’s not a full treatment. If they like, I will hang out with them for a few minutes making sure they’re comfortable with the feeling acupuncture produces, which is typically quite calming but is also something one feels.

We discuss whether they want me to check in on them and I give them a bell to ring me if they need me to come for immediate assistance. If they say they want to be checked in 5 minutes, I tell them that “I will return in 5minutes, not 6 or more minutes. I’m going to set a timer” and then I do.

Together, we make agreements that are followed, which helps establish trust. Anxiety and/ or panic can rise and blossom so I try to be very diligent in approach so that they trust that I’ll be there if they need me.

Acupuncture is typically relaxing, calming, sometimes even sedating, and some describe a sort of floaty sleep-like session, an “acu-nap”. Acupuncture can be very good for people who have anxiety, insomnia, depression, etc. Once they feel it, they typically come back for more. Acupuncture can be great for sensitive people.

 

 

Evolving Ancient Medicine

Often when I see writings about Chinese medicine, including my own, there’s some mention about how old it is, which is thousands of years.

Sometimes we may be highlighting this, in part, to help substantiate it, as if to lend credence. Of course, just because something’s old doesn’t make it better, nor does it make it worse. But with thousands of years of practice, it does mean that there’s been a lot of experience, many treatments, and many patients.

Even if one can’t quickly go find the perfectly matching RCT (randomized-controlled trial) that best matches the condition for which one seeks medical evidence of efficacy, that doesn’t necessarily mean that acupuncture hasn’t helped someone with it before. It also doesn’t mean it doesn’t exist (might need translation.)

So, how old is this medicine?

A longer timeline of Chinese medical history can be found at http://www.shen-nong.com/eng/history/chronology.html , but summarized parts of it (with my notes) are here:

~2000 BC, Antiquity: Yellow Emperor & Shen-nong: They are said to be the founders of traditional Chinese medicine (TCM).

1700-1100 BC, Shang: Inscriptions on bones describe the use of wine and hot water, use of needles and knives for surgical instruments, diseases and illnesses discussed.

1100-221 BC, Zhou Dynasty: Organized medical system in the emperor’s court. Specialties in surgery, diet, disease, veterinarians. The Huang Di Nei Jing: The Yellow Emperor’s Internal Classic: A&P of the human body. Foundation for TCM. Yin Yang and Five Element Theory.

221 BC-220 AD, Qin and Han Dynasties: Earliest reference to Chinese pharmacology: Shennong Bencaojing. List of 365 Chinese medicines and herb prescriptions / combos. Zhang Zhongjing: establishes diagnosis based on signs and symptoms. Shang Han Lun

220-580 AD, Chinese Middle Ages: Pulse Classic. Earliest complete reference guide to acupuncture and moxibustion. 349 acupuncture points with therapeutic properties for each. A handbook written for Emergencies.

618-907 AD, Sui and Tang Dynasties: Imperial Medical Academy. The first medical encyclopedia comprised of 30 volumes and 5,300 prescriptions, also disease prevention and health preservation. (Sun Si Miao) — NOTE: Preventive health

960-1279 AD Song Dynasty: First official prescription book with 16,834 prescriptions. (weblink lists ~40 books/treatises during this period) — NOTE: That’s a lot of prescriptions! 

More dynasties and many more books: The Jin Yuan period, Ming Dynasty, Qing Dynasty, Modern China (1950 future medical policy to include both Chinese and Western medicine options)…

There’s been a lot of time to practice, theorize, iterate, publish, proliferate, and evolve. 

Balance

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Our bodies are in transition. We are always in transition. As long as we are alive, change is inevitable. Chinese medicine looks at normal and abnormal patterns of change and gently moves the body towards harmonious balance.

This constant ebb and flow is also recognized in Western medicine through a primary concept of homeostasis, meaning we maintain balance in the body through multiple physiological processes. Homeostasis is the continual balancing act. There are many examples of homeostasis in the body: I can’t begin to count them all nor do I believe science has identified them all. We are all still learning. 

A simple example illustrating homeostasis is our body’s relatively narrow range of normal temperature. If we get too hot, we sweat to cool down. If we get too cold, we shiver to generate warmth. 

A concept of balancing is essential to Chinese medicine. If something is moving too fast, we attempt to slow it. Too slow, quicken it. Too hot, cool it. Too cold, warm it. Too wet, dry it. Too dry, moisten and lubricate it. And so on…

Where did this ancient but ever-evolving medicine look to produce theories of change in the human body? They went macro: they looked at patterns of change in nature, on the land, in the sea, and in the sky. They looked at harmonious nature, always in flux, and they considered what happens when the ever-balancing act is not functioning properly. If we move outside the norm of balance, we either recover and get back in balance, or we develop pathology. Chinese medicine has treatments to support normal physiology as well as pathophysiology. It’s all a spectrum. 

Examples with conditions and balancing treatment principles: 

Too hot: fever -> clear heat

Too cold: some infertility -> warm the uterus

Too wet: moist rash -> dry it out

Too dry: itchy flaky skin -> moisten and lubricate

Too slow: elderly constipation -> move the bowels

Too fast: anxious mental chatter -> slow, calm mind

Or, another way to consider this is to examine one common condition, for example, constipation. We look at the root, the cause of constipation, to determine principles of treatment. Example:

Constipation caused by slow motility -> move the bowels (abdominal massage, acupuncture)

-or- 

Constipation caused by dry stools -> moisten (fluid intake) and lubricate (oily foods)

-or-

Constipation caused by too much heat creating dryness -> clear heat and moisten

Whereas constipation is one common symptom, there are different treatments depending on cause. Chinese medicine seeks to discern patterns of harmony and disharmony in the body to help bring them back into balance.

One reason Chinese medicine can preventively treat a condition is because patterns of disharmony arrive before disease. If we can recognize the pattern early, it’s easier to treat.

Commonly quoted but still so useful to remember, “An ounce of prevention is worth a pound of cure.” -Benjamin Franklin

Heart

I will always treasure this heart, made and given to me by my friend’s aunt, a retired pediatrician, and someone I got to know while helping out recently.

My friend’s success story:

Not long ago, a dear friend called as she was leaving her doctor’s appointment with medical news that no one wants to get. The next morning we drove over to the hospital and spent the day in appointments.

It was a challenging day, but her doctors and nurses were amazing. Their approach was so spot-on and it really helped her (and me) in staying calm, a gift in and of itself.

My friend went through the whole thing with unflagging positivity coupled with down-to-earth honest vulnerability. She was so inspiring! She was fierce in her dedication to address all that she could and work hard to be her best, even in the wake of so many uncertainties. She was so lucky too as she attained the best possible outcome. Such a relief!

Language Curiosities

Studying Chinese medicine entails some study of the language itself even though (unfortunately) I don’t speak Mandarin or Cantonese. Here’s something I find curious about the Chinese language: 

Say you’re trying to talk with someone who speaks another language, like you’re monolingual and you only speak English and you try to talk with someone in Spanish, typically you’ll resort to hand gestures or something to communicate a simple thing, like “Where is the bathroom?”

However, something different happens with Chinese. Characters that make up written Chinese are shared among multiple spoken languages. You can have someone who only speaks Cantonese communicating with someone who only speaks Mandarin and instead of resorting to hand gestures, they can use a language they do share: written Chinese.

While studying abroad in China, I was told that I might see two people get stuck on a word/concept they don’t share a language for and one will draw the character in the palm of their hand to communicate meaning.

This quote from Wikipedia (https://en.wikipedia.org/wiki/Chinese_language)

“The written form of the standard language (中文; Zhōngwén), based on the logograms known as Chinese characters (汉字/漢字; Hànzì), is shared by literate speakers of otherwise unintelligible dialects.”

So two people who don’t understand what each other says, can read the same paper. Fascinating.

Even two people don’t know written Chinese, with Google translation one can enter “Hi. How are you?” and quickly get the written Chinese for it. It also provides the Pinyin (a transliteration that romanizes Chinese to aid in pronunciation). Neat! USEFUL.

Example:

Hi. How are you? – English

你好。 你好吗?- Chinese (simplified)

Nǐ hǎo. Nǐ hǎo ma?  – Pinyin