Acupuncture and Pregnancy

ACUPUNCTURE DURING PREGNANCY

Acupuncture is a 3,000 year old medicine that is finally starting to get recognized in the west as a safe alternative practice for many conditions. Both the National Institute of Health (NIH) and the World Health Organization (WHO) recognize acupuncture to be effective in the treatment of a wide variety of medical problems. The 1997 NIH Consensus on Acupuncture reports that “studies have demonstrated that acupuncture can cause multiple biological responses, mediated mainly by sensory neurons, to many structures within the central nervous system. This can lead to activation of pathways, affecting various physiological systems in the brain , as well as in the periphery.” (1) Traditional Chinese Medicine (TCM) is a wonderful tool to use during pregnancy. It’s drug-free, and relaxing for both the baby and the mother. It can be used throughout the entire pregnancy, and even after delivery.

In Chinese medical theory, acupuncture works by balancing the body’s “Qi”. “Qi” can be described as a form of bioenergy that runs along 12 major meridians. If “Qi” is blocked, it shows up as an imbalance or illness. Basically, if you have a health condition, some part of your body’s system is out of whack. Chinese medical theory allows us to diagnose the imbalance… and balance it.

In Western medical theory, acupuncture appears to work by stimulating parts of the brain. It also stimulates the body to release natural biomolecules such as neurotransmitters, vasodilators, and hormones. The NIH Consensus also suggests acupuncture “may activate the hypothalamus and pituitary gland, resulting in a broad spectrum of systemic effects. Alterations in the secretion of neurotransmitters and neurohormones, and changes in the regulation of blood flow, both centrally and peripherally, have been documented. There is also evidence of alteration in immune functions produced by acupuncture.” (2)

A good example of this is the use of acupuncture to induce labor. Specific points cause the release of oxytocin, which is the hormone that naturally induces labor. Studies have shown that using acupuncture to induce labor reduces the active (painful) phase of labor by an average of 3.6 hours.

Acupuncture as it is practiced today is a safe, comfortable and cost effective treatment for many of the problems that commonly develop in pregnancy. This is especially true since most pharmaceuticals are contraindicated in pregnant women. Treatment during pregnancy benefits both mother and child due to certain organ systems developing with each trimester. Babies may be influenced by what is known as “maternal toxins,” resulting in more frequent childhood illness, a tendency for skin problems such as diaper rash and eczema, and a tendency for higher fevers when sick.

Uses of Acupuncture during pregnancy include

1. Acupuncture for the health of the mom (colds, allergies - ect.).
2. Acupuncture for the treatment of pre-existing medical issues (pain, digestive health- ect.).
3. Acupuncture for pregnancy related conditions:

• Psychological issues
• Physical problems
• Fatigue
• Morning Sickness
• Heartburn
• Constipation
• Hemorrhoids
• Back Pain and Sciatica
• Edema
• Carpal Tunnel Syndrome
• Rhinitis of pregnancy

4. Breech Presentation
5. Induction for post due date
6. Labor
7. Acupuncture for Post-partum disorders:

• Fatigue
• Postpartum vaginal discharge
• Postpartum Depression
• Mastitis
• Insufficient or Excessive Lactation
• Post Operative Healing

Acupuncture for pre-existing medical issues:

Acupuncture can be used to treat conditions that occur before the pregnancy, such as migraine headaches or colds and allergies (just a few of the 55 conditions the National Health Institute (NHI) and World Health Organization (WHO) recognize that acupuncture can effectively treat). In most cases acupuncture is a safer approach than the use of prescription medications.

Acupuncture for pregnancy related conditions:

In Traditional Chinese Medicine (TCM) we look at the severity of symptoms that a pregnant woman often experiences as a reflection of the health and lifestyle choices of the woman before getting pregnant: What was her diet like? Did she smoke or use alcohol? Did she have alot of emotional stressors? If so, her “Qi” may be depleted, out of balance or blocked and the added burden of the growing fetus may make her more symptomatic.

1. Psychological issues

Women tend to stress about getting pregnant and then once pregnant they continue to worry, are anxious and remain tense throughout their pregnancy. All pregnant women are concerned about their pregnancy and the transitions happening in her life. Acupuncture is deeply relaxing and helps to promote internal balance as well as an outwardly balanced perspective, as well as a general sense of well-being.

Some women are clinically depressed in the course of their pregnancy. This can occur in TCM terms when there is blocked energy in the liver organ system from anger, resentment, frustration or mechanical damage to the liver from chemical or viral sources. By addressing the underlying disharmony we can help decrease the symptoms in pregnancy and potentially avoid post-partum depression of the same origin.

Substance abuse can also be addressed using acupuncture. The treatment can help women who are trying not to smoke cigarettes or who have trouble avoiding alcohol or psychoactive drugs including sleeping medication.

2. Physical problems

Fatigue
Because of the intense demand placed on the mother’s resources by the growing fetus, all pregnant women experience fatigue. While nothing can substitute for sleep and a nourishing diet, acupuncture ensures that the internal organs are functioning optimally, that the “Qi” is flowing freely without blockages and that there is a harmonious balance of the yin and yang forces in the body. Acupuncture can also help with the increased production of blood and other fluids in pregnancy.

Morning Sickness
The first trimester is often accompanied by morning sickness marked by nausea and sometimes vomiting. In TCM, these symptoms are a reflection of an underlying “Qi” imbalance in the digestive function of the internal organs. Often it can be attributed to the Spleen organ system. The Spleen is particularly sensitive to worry. This condition is responsive to acupuncture treatment. Pericardium 6 is the most famous point used since it harmonizes the digestion. The aim of the treatment is to subdue rebellious Stomach Qi moving in the wrong direction. Ginger, an ingredient commonly used in Chinese herbal formulas to assist assimilation, can also be used as a digestive aid.

Excessive vomiting is referred to as hyperemesis gravidum in the medical literature and can be severe enough to require hospitalization. The usefulness of acupuncture treatment for this condition has been widely studied and found to be superior to pharmaceutical intervention.

Other common digestive tract issues that arise in pregnancy that can be treated with acupuncture include:

• Heartburn
• Constipation
• Hemorrhoids

A recent Australian study published in the journal Birth reports that of 593 women less than 14 weeks pregnant who participated, those who received acupuncture reported having less frequent and shorter periods of nausea than the women who received no acupuncture. These improvements were felt immediately and lasted throughout the four-week duration of the study. During the first trimester, acupuncture also relieves fatigue, bleeding and migraines.

Back Pain and Sciatica
Back pain and sciatica from mechanical compression are common complaints in pregnancy especially in the later months. Up to ¾ of women experience some form of this discomfort.  The pain can interfere with sleep. Here again is an instance in which acupuncture treatment can relieve the discomfort when medication is not an option.

Edema
Swelling is common in the second and third trimesters of pregnancy due to the increase in circulating fluid in the body. Fluid accumulates most often in the hands, feet and ankles, but the face and legs can also get puffy. The condition is usually worse at the end of the day and in warm weather. Acupuncture is appropriate to treat this kind of mild swelling. From a TCM perspective the fluid may be from stagnant “Qi”, or deficiency in the Spleen or Kidney organ systems.

The presence of severe swelling, an increase of blood pressure and protein in the urine, are possible warning signs of preeclampsia, a potentially serious complication, and should be evaluated by an obstetrician.

Other common pregnancy associated conditions for which acupuncture is helpful:

Carpal Tunnel Syndrome
Because of the extra fluid circulating in the pregnant woman, there can be compression of the median nerve in the wrist resulting in Carpal Tunnel Syndrome. Other than wearing a wrist brace there is no other Western medical treatment except surgery for this condition. Since it will resolve after delivery, acupuncture is an ideal temporary treatment for Carpal Tunnel Syndrome during the pregnancy.

Rhinitis of pregnancy
The significant nasal congestion that accompanies some women’s pregnancy is a hormonal effect. In fact, some women on birth control pills also have this reaction. Since most decongestant medications are contraindicated in pregnancy, this is another condition for which acupuncture is applicable.

3. Breech Presentation

A fascinating use of Chinese Medicine in pregnancy is its role in turning a fetus that is presenting breech. The technique is most effective between the 28th and 34th week, up to 36 weeks of pregnancy. The optimal time for effectiveness is 32-34 weeks. Past the 36th week there is usually not enough room for the fetus to turn around.

A study published in the Journal of the American Medical Association finds that the use of moxabustion, when applied to 130 pregnant women with breech presentations, increased the number of head-first births significantly. Used in China for centuries as a form of medicine, Chinese mugwort (Artemisia Vulgaris) is lit in stick-form and burned over a point on the fifth toe (not touching the skin). This gentle, smoldering heat treatment should be used at 32-36 weeks and only in healthy pregnancies. For turning the fetus we primarily use the point Zhiyin (Bladder 67) located on the outside corner of the nail on the little toe. The procedure is repeated on the opposite foot and continued for 15-20 minutes, alternating between the right and left foot. The whole procedure (either with the moxa stick or the needle) should be repeated twice a day for a maximum of ten days, yet most babies turn within three days.

An additional Japanese study published in 2000 confirmed that stimulation of acupuncture point Bladder 67 is effective in correcting breech positioning. By studying 357 women with breech presentation they found that the moxibustion treatment group had a correction rate of 92.48 percent compared to the control group which had a spontaneous correction rate of 73.66 percent.

The mechanism of action of the treatment is unknown but here are some findings that suggest what is happening:

• Increased fetal activity
• Relaxation of the uterine myometrium (muscle layer) making a more favorable environment for the fetus to move
• Increased blood flow in the uterine and umbilical arteries

Bladder 67 treatment is cheap, safe, effective, simple, painless and generally well tolerated.

4. Induction for post due date

Many expectant mothers turn to acupuncture for pain relief and to replenish energy during labor. However, acupuncture can also help stimulate uterine contractions without the use of drugs. This is achieved by using acupuncture points not typically used earlier in the pregnancy due to their ability to perform this action. Usually, the expectant mother would have a series of two to three successive days of one-hour treatments, so early referral is essential. A loved one who can provide transportation to and from the clinic is needed as well.

5. Labor

Acupuncture use in labor and delivery is a common practice in China where the birth process is considered natural and to be interfered with as little as possible. Acupuncture’s use is to assist Nature. It can be used to strengthen weak contractions and to diminish pain.

In England it has been observed that acupuncture assisted delivery is shorter, less painful, less stressful for the mother and less likely to result in post partum hemorrhage.

Acupuncture for Post-partum disorders

The new mother should be encouraged to get acupuncture treatment after delivery. The restoration of her own health is imperative for her own well being and for her ability to be present for her newborn. Among the conditions that acupuncture can address after birth are:

• Fatigue
• Postpartum vaginal discharge
• Postpartum Depression
• Mastitis
• Insufficient or Excessive Lactation
• If there has been caesarian section, acupuncture can help with the post operative healing.

Acupuncture is often used to stop or decrease heavy bleeding, and can be especially welcome after delivery. Additionally, the first six weeks postpartum can be an excellent time to address underlying imbalances with acupuncture that possibly have been existing for years, such as mild depression and menstrual irregularities.

In addition to restoring a mother’s energy levels after the stress of delivery and alleviating depression and anxiety, acupuncture can be used postpartum to relieve backache and migraines. Additional acupuncture treatment may be needed after a Cesarean section to promote faster recuperation.

Note: Dietary therapy is extremely important after delivery as well. Chinese herbs are also very effective for promoting lactation.

Additional Research on Acupuncture during Pregnancy:

ACUPUNCTURE FOR PELVIC AND BACK PAIN IN PREGNANCY
In a Swedish study, 72 pregnant women (24-37 weeks) suffering pelvic or low back pain were randomly assigned to an acupuncture group or a control group. Traditional acupuncture points and ashi points were needled (with deqi elicited) in individualized treatments, once or twice a week until disappearance of symptoms or delivery in the acupuncture group. Treatment was given for at least three weeks, twice weekly for the first two weeks, then once a week. The control group received no treatment. During the study period the pain decreased in 60% of patients in the acupuncture group compared to 14% of the controls, dropping to 43% and 9% respectively at the end of the study. (Acta Obstet Gynecol Scand 2004; 83(3): 246-50).