Pregnancy

Tracey Goulding provides obstetric acupuncture throughout your pregnancy, which includes dietary and lifestyle advice. Acupuncture can help you to have a happy, healthy pregnancy, relieving many of the discomforts of pregnancy and preparing you for a good labour and recovery. Acupuncture offers a safe, effective and drug free treatment option during pregnancy.

Acupuncture has been used in China for over 3,000 years for women during pregnancy and postpartum recovery. It has been safely used in maternity wards in Europe, Australia and New Zealand and until recently in Devon (NHS cut-backs have resulted in the acupuncture service been closed – despite a huge campaign by ex-patients and midwives). Research shows that acupuncture is safe with no records of serious adverse events in the pregnancy-related systematic reviews (1,2,3).

References:

1. Cho SH et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117(8):907-20.

2. Lim CE et al. Effect of acupuncture on induction of labor. J Altern Complement Med 2009;15:1209-14.

3. Vas J et al. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol 2009;201:241-59.

Acupuncturists use very fine single-use disposable needles, the needles are as fine as a human hair and nothing like those used for an injection or to take blood. Tracey has tried many varieties of needles to find the best quality and most comfortable. When the needle is inserted you may feel a tingling sensation, pleasant dull ache or no sensation.

Most people find acupuncture relaxing and often feel very calm after a treatment. You may feel a little tired or sleepy and should take this into account if you are planning to drive after your treatment.

Rising pregnancy hormones relax ligaments and tendons throughout the body and this together with poor posture or pre-existing conditions can lead to lots of aches and pains during pregnancy. Tracey most commonly treats back pain, sciatica, pelvic (SPD) and rib pain. Her pregnant women then comment favourably how happy they are that she can also deal with their aching neck and shoulders too! Sessions may include acupuncture together with warming moxa, cupping, Kinesio Taping and home care help.

Generally the earlier acupuncture treatment begins the more effective the results.  Let us look at pelvic pain or symphysis pubis pain, as an example.  Experience has shown that if treated when symptoms initially present this can prevent the pain becoming more intense as the pregnancy progresses.  Research by Elden in 2005 (1) concluded that when compared to standard physiotherapy and specialised physiotherapy exercises, acupuncture was the treatment of choice for patients with unilateral sacroiliac pain, unilateral sacroiliac pain combined with symphysis pubis pain and bilateral sacroiliac pain.

Reference

1.  Elden H, Ladfors I, Fagevik Olsen M, Ostaard H, Hagberg H (2005) “Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial”. British Medical Journal 330:761

Iron or folate deficiency is more common around 20 weeks and in the last four week’s of pregnancy. Acupuncture, dietary advice and homecare treatment will usually be given.

Acupuncture can help with both high or low blood pressure (hypertension or hypotension). These effects can be temporary unless the underlying problem can be treated. For those with very high blood pressure, treatment is best done when you are being monitored by your midwife to ensure more serious complications do not develop, such as pre-ecampsia. Depending on how you respond, twice weekly sessions may be necessary.

During pregnancy it is thought that hormonal changes may lead to a drying out of the nasal membranes making women more prone to nasal congestion and sinusitis. Acupuncture is good for decongesting the nose and relieving pain.

For breech or other malposition presentation the ideal time to treat is before 33/34 weeks, after this the baby becomes increasingly too large to turn or move. However, even as late as 38 or 39 weeks some of these babies will go head-down, left-lying. Depending on your circumstances, either one session followed by simple self-treatment at home using a herb to warm certain acupuncture points is given; or up to three sessions over 10 days for those later in their pregnancy. This treatment is not suitable for twin or complicated pregnancies. If you are in doubt discuss with Tracey before booking your appointment. To ensure your baby is in the best position for birth, it is better to seek earlier treatment rather than wait. Research has found that the position of a baby at 20 weeks does not predict its final position at delivery, but at 30 weeks it is more likely to do so (1). Furthermore, Professor Cheng Xinnong reports that in China clinical data shows that using acupuncture (usually 3 treatments) and moxibustion (warming acupuncture points) for a malpositioned baby has a 90% success rate when applied between 28 to 32 weeks (2).

Acupuncture can be used in conjunction with external manual version. Midwives have commented that in their opinion there appears to be a higher success rate in those women who have been able to have acupuncture and self-treatment for at least five days before the procedure. The New Zealand Evidence Based practice guidelines for care of women with Breech presentation (3) recommends that moxibustion may be offered to women from 33 weeks gestation. This follows research from Italy (4) that demonstrated moxibustion can have a significant effect in helping to turn breech babies. Later research has endorsed these earlier findings, concluding, “correction of a foetus in breech presentation in women at 33 weeks gestation, using Breech Version Acumoxa-Therapy on BL67, reduces the number of breech presentations at term, the number of caesarean sections and is less costly when compared to expectant management, including external cephalic version” (5). This research was based on the collation of cohort and Random Controlled Trials.

References:

1. Natural History of Breech presentation: prognostic Value of ultrasound in the Generation r study. Van den Berg, I. et al.(2010-11). Published in a collection of studies: The Contribution of Acupuncture and Moxibustion to Healthcare, an Evidence-based Approach. PhD thesis by Erasmus University of Rottendam
2. Xinnong, C. (2011) Acupuncture Therapeutics. Singing Dragon with People’s Militrary Medical Press.
3. http://www.nzgg.org.nz/guidelines/0074/caesarean
4. Cardini F, Weixin H. (1998). “Moxibustion for correction of breech presentation”. Journal American Medical Association. 280:1580-1584.
5. Ivan den Berg, I. et al (2008) Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: A systematic review. Complementary Therapies in Medicine, 2008 Apr;16(2):92-100.

Miscarriages are classified as threatened, inevitable or missed. Although the cause of miscarriage is not always known, chromosomal or genetic abnormalities in the embryo, hormonal deficiencies (such as low progesterone), an immune reaction or an infection are thought to be responsible in the majority of early miscarriages. An incompetent cervix (sorry terrible medical name), hormonal insufficiency and infection are often cited as factors in late miscarriages. Acupuncture is used to counter a threatened miscarriage, by addressing any underlying disharmonies. Experience has shown relief of lower abdominal and lumbar pain, as well as reducing stress and anxiety. If you have a history of miscarriages, then pre-conception acupuncture will be beneficial. Acupuncture can be very effective but certainly offers no guarantees that a pregnancy will continue. Given that it has been estimated that chromosomal abnormalities account for up to 70% of miscarriages, the question of whether acupuncture can interfere in a natural process to terminate a pregnancy is asked. Tracey’s opinion is that acupuncture is not a powerful enough intervention to cause the body to hold on to a pregnancy that is not viable. It does, however, offer much in terms of ensuring the woman’s mind and body is in the best possible state to avoid a threatened miscarriage where chromosomal abnormality is not the cause. If the foetus is not viable, then acupuncture here is aimed at enhancing the body’s ability to expel the dead foetus naturally and aid the mother physically and emotionally through the experience. Each case will be different but sometimes acupuncture may be necessary daily over a period of several days to enable the woman to expel the foetus. Acupuncture offers women a proactive option, rather than just waiting to see if the miscarriage occurs efficiently or whether medical intervention will be necessary. Women report that they appreciate the calming effects of acupuncture during such a stressful time.

• Many commonly used acupuncture points during in pregnancy are located on the lower arms and legs and back, so it is helpful to wear clothing that allows easy access to these areas.
• Try not to go for treatment on an empty stomach or straight after a heavy meal.
• Please bring your maternity notes with you to your appointment.

Acupuncture is useful in the final three to four weeks of pregnancy to prepare you and your baby for birth. A more efficient, shorter labour has been reported. There is an emphasis on preparing cervical ripening (1). Also Tracey will use acupuncture to relax muscle and tendon tension in the pelvis to allow widening of the pelvis, help descend the baby and swivel transverse or posterior babies, while reducing anxiety and increasing the body’s natural painkillers. Other pregnancy discomforts, such as pregnancy-induced-hypertension, sciatica, anxiety and others, can also be addressed. You will leave each session feeling more relaxed and emotionally stronger for birth. Research has demonstrated shorter labour times following prebirth acupuncture (2). In German hospitals a standard acupuncture protocol is now accepted practice to prepare women for labour. Acupuncture is an ideal method to help women prepare themselves to have the most efficient labour possible. Feedback from midwives suggests that acupuncture before birth offers a range of positive effects that goes beyond reducing the time spent in labour and includes a reduced rate of medical intervention, such as inductions and caesarean sections (3). It was also noted by the midwives in this study that they observed a trend in the women who received pre-birth acupuncture to either go into spontaneous labour around their term, 40-41 weeks, and these women also tended to respond well to acupuncture induction and progressed efficiently into a natural labour.

References

1. Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labour at term – a randomised controlled trail. Wien Klin Wochenschr 2001; 113 (23-24).
2. Kubista E, Kucera H. (1974). On the use of acupuncture in the preparation for delivery, Geburtshilfe Perinatol; 178(3):224-9.
3. Betts D, Lenox S ( 2006) Acupuncture For Prebirth Treatment: An Observational Study of its use in Midwifery practice. Medical Acupuncture. Vo 17 No 3.

Tracey can demonstrate acupressure to be used during labour for a variety of requirements, such as: pain relief, aid contractions, enhance dilation of the cervix and aid the baby to swivel if they are back-to-back or side-lying. Acupressure is the use of pressure on acupuncture points on the body. Acupressure can be applied by the woman and her birthing partner before and during labour. It is easy and fun to learn and can help promote an efficient labour. Research has suggested it is particularly useful for pain relief during labour (1). If you can not get to see Tracey before your labour, then she recommends this DVD: Acupressure for Natural Pain Relief in Labour DVD 
by Debra Betts and Tom Kennedy .  It is an excellent resource for women and their birth partners. It is easy to follow and comes with a booklet. There is a great version of this guide for smart phones on Google play and at the Apple App store.  Practise at home before labour starts, so you and your partner feel confident and comfortable with locating the acupressure points.

References

1. Hjelmstedt A, Shenoy ST, Stener-Victorin E, Lekander M, Bhat M, Balakumaran L, Waldenström U. Acupressure to reduce labor pain. Acta Obstet Gynecol Scand. 2010 Nov;89(11):1453-9.

Weekly acupuncture sessions prior to your labour will help prepare your body for birth. Acupuncture for birth should be started at week 36 or 37. However, even if labour is imminent, just one session will be beneficial. Acupuncture “induction” can be done after your due date has passed starting at about 41 weeks.

Acupuncture has been used in China for over 3,000 years for women during pregnancy and postpartum recovery. It has been safely used in maternity wards in Europe, Australia and New Zealand and not too long ago in Devon (NHS cut-backs have resulted in the acupuncture service been closed – despite a huge campaign by ex-patients and midwives). Research shows that acupuncture is safe with no records of serious adverse events in the pregnancy-related systematic reviews (1,2,3).

References:

1. Cho SH et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117(8):907-20.

2. Lim CE et al. Effect of acupuncture on induction of labor. J Altern Complement Med 2009;15:1209-14.

3. Vas J et al. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol 2009;201:241-59.

Acupuncturists use very fine single-use disposable needles, the needles are as fine as a human hair and nothing like those used for an injection or to take blood. Tracey has tried many varieties of needles to find the best quality and most comfortable. When the needle is inserted you may feel a tingling sensation, pleasant dull ache or no sensation.

Most people find acupuncture relaxing and often feel very calm after a treatment. You may feel a little tired or sleepy and should take this into account if you are planning to drive after your treatment.

• Many commonly used acupuncture points during in pregnancy are located on the lower arms and legs and back, so it is helpful to wear clothing that allows easy access to these areas.
• Try not to go for treatment on an empty stomach or straight after a heavy meal.
• Please bring your maternity notes with you to your appointment.

Acupuncture is best used well in advance of medical intervention. Usually treatment should start at about 41 weeks and can be done daily if necessary.  Acupuncture can provide a gentle inducement to labour if the baby is overdue and can be an effective alternative to a medical induction.  If your induction date is before 41 or even 40 weeks due to complications these sessions can be done earlier with the approval of your obstetrician/midwife.  Research from Norway (1) on the use of acupuncture for women with premature rupture of membranes (PROM) concluded that:

“Ideally acupuncture treatment should be offered to all women with PROM and other women who wish to use this method to facilitate their birth and keep it normal”.

Reference

1. 
 Gaudernack L, Forbord S, Hole E. (2007) Acupuncture administered after spontaneous rupture of membranes at term significantly reduces the length of birth and use of oxytocin . A randomised controlled trial. Midirs Midwifery Digest. Vol 17, No 2.


Acupuncture has been used in China for over 3,000 years for women during pregnancy and postpartum recovery. It has been safely used in maternity wards in Europe, Australia and New Zealand and until recently in Devon (NHS cut-backs have resulted in the acupuncture service been closed – despite a huge campaign by ex-patients and midwives). Research shows that acupuncture is safe with no records of serious adverse events in the pregnancy-related systematic reviews (1,2,3).

References:

1. Cho SH et al. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117(8):907-20.

2. Lim CE et al. Effect of acupuncture on induction of labor. J Altern Complement Med 2009;15:1209-14.

3. Vas J et al. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol 2009;201:241-59.

Acupuncturists use very fine single-use disposable needles, the needles are as fine as a human hair and nothing like those used for an injection or to take blood. Tracey has tried many varieties of needles to find the best quality and most comfortable. When the needle is inserted you may feel a tingling sensation, pleasant dull ache or no sensation.

Most people find acupuncture relaxing and often feel very calm after a treatment. You may feel a little tired or sleepy and should take this into account if you are planning to drive after your treatment.

Usually the woman will receive her acupuncture in a seated position for encouraging labour. This allows better access to points and better positioning for birth.

Treatment may be required daily or on alternate days depending on your circumstances and reaction to treatment. The number of treatments required varies and one may be sufficient, although an average of three or more may be required. Home visits may be possible.

• Many commonly used acupuncture points during in pregnancy are located on the lower arms and legs and back, so it is helpful to wear clothing that allows easy access to these areas.
• Try not to go for treatment on an empty stomach or straight after a heavy meal.
• Please bring your maternity notes with you to your appointment.

Alison came to see me when she was 19 week’s pregnant. She was experiencing intermittent sharp lower back pain with continuous aching. She had a history of back problems since a whiplash injury 14 years ago, including very painful sciatica during her last pregnancy. She was also having shooting calf leg cramps occurring mainly at night. Following examination of the lower back, I used cupping (a kind of deep tissue massage) over the affected muscles then needling. I gave her my Advice Note on leg cramps. Two weeks later she returned and said that she was:

“amazed that just one treatment could make should a big difference to my back pain”.

She reported only the occasional twinge towards the end of the day or after lifting her daughter. Her leg cramps were much reduced too.

Angela was extremely anxious about going into her second labour. Her first had been traumatic ending in a caesarean section. We managed to fit in 4 treatments to prepare her cervix and reduce her anxiety. During in these weeks she felt much calmer at the prospect of giving birth. Her labour lasted 4 hours and she delivered a healthy boy. She reported back to me that the midwife commented favourably on how quickly her cervix dilated.

Katy had been prescribed antiemetics, but found them not to be effective. She described a feeling of overwhelming tiredness. I gave her two acupuncture treatments within a few days of each other and also supplied her with press tacks so she could use acupressure at home. I also gave her my guidance note on self-help remedies to help treat morning sickness. After the first treatment she noticed less nausea and after the second the vomiting stopped. Within days she was able to return to work, do exercise and eat properly, so her bowel movements and energy levels improved too.

Geraldine had been suffering from severe migraines occurring 1 to 2 times a month for 5 years. Being 7 weeks pregnant she could only take paracetamol which was not enough to reduce her pain. I gave her 8 treatments in which time the migraines were reduced one month and then returned. However, following the end of the treatment course they disappeared and she emailed me saying that she:

“felt like a new woman”.

A year later she still reported no recurrence of her migraine.