Acupuncture For Cynics

Acupuncture For Cynics

Have You Always Been Curious About Acupuncture, But Were Never Quite Sure Where To Stick The Needles? If you associate acupuncture with needles, pain and weird alternative medicine then you are horribly misinformed about the benefits of the world's oldest form of medicinal treatment.

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Acupuncture treatment to aid conception

Women who come for treatment and who are planning for pregnancy should start to implement preconception advice at least 3 months before trying to conceive. I prefer to treat a woman on a weekly basis according to her cycle. It is important to concentrate initially on correcting any imbalances the patient may have. A woman entering pregnancy with chronic imbalances is more likely to feel unwell during her pregnancy and certain conditions may arise as a result. I concentrate on any imbalances, using acupuncture points that will specifically help.

Adverse effects of acupuncture

On one occasion, a woman who was 33 weeks' pregnant told me that after her acupuncture treatment she had experienced strong contractions. When I questioned her about what she did after the treatment, I learnt that she had caught a train to London from Leamington, spent the whole day on her feet at an auctioneers and had not returned home until 8 p.m.

Factors to be aware of when using acupuncture in pregnancy

When treating a woman of child-bearing age for the first time with acupuncture, it is vital - and this point cannot be overstressed - never to assume or take for granted that she is not pregnant. It is far better to start with the assumption that the patient may be pregnant and try to establish the facts. For example, a woman may begin treatment because she is having problems conceiving. Her periods may be irregular or non-existent, or she may have bleeding between periods. And yet she may be pregnant without knowing it.

10Is acupuncture safe for pregnancy

Advocates of acupuncture treatment suggest that acupuncture during pregnancy is beneficial for both mother and baby. During the first trimester, acupuncture may reduce morning sickness and fatigue. During the second trimester, acupuncture can help maintain balance. In the third trimester, acupuncture can provide relief from backache and joint pain. Acupuncture is also used during labor for pain relief. However, if you are considering acupuncture during pregnancy, you should discuss it with your obstetrician.

Acupuncture treatment of heartburn

Acupuncture can give temporary relief to the symptoms of heartburn, but a further treatment may be needed after a few days. Even a couple of days' respite, however, can be a huge relief to a patient who has been suffering constantly. There are various syndromes that equate with heartburn, including Stomach Heat and retention of food in the Stomach. If the Stomach Qi is weak, the symptoms are likely to be more severe. Different acupuncture points are used depending on which week of her pregnancy the patient is in. (Note I never use abdominal points on the abdomen of a pregnant woman.) For example, at 24 weeks the fetus is at the level of the umbilicus and by 32 weeks it is between the umbilicus and the xiphisternum (see Fig. 4.6). Useful points to use prior to 32 weeks would be CV-12, 13 and 14.

Treatment with acupuncture

If the cause is stagnation of Qi, the symptoms will be a distending pain in the lower abdomen. Such women are usually very irritable and depressed, and probably suffered a lot of Liver Qi stagnation prior to getting pregnant. Use even technique on PC-6 and LR-3 together, to calm the mind and move the Qi. One woman I treated was admitted to hospital with severe abdominal pain. She was very irritable and depressed. Although given every test possible, no medical explanation could be found for her pain. I treated her with acupuncture and there was a definite improvement using the above points.

Actively managing the pain acupuncture or homeopathy

You may also be planning to use acupuncture, or homeopathy for pain relief, in which case you should use the services of a registered practitioner. The addresses for the associations of homeopaths and acupuncturists are given on p. 181.These organisations will have lists of appropriately qualified practitioners and they will be able to give you advice about what to ask.You should always ask someone about their experience and training when you are looking for a practitioner outside of the NHS. There has been in recent years some good research evidence for the effectiveness of acupuncture in managing pain, in shortening first stage labour and therefore in reducing the need for epidural. This research is still in its infancy but the signs are positive. Obviously, acupuncture is probably best suited to someone who already has experience of it and has a practitioner that is known to them.

Acupuncture and induction

I find that acupuncture works very well for women who are being induced (Figs 10.2, 10.3). Its main benefit is in reducing the acute pain that is often associated with induced labours (see above). Ear points such as Uterus and Shenmen are particularly effective if the needles are attached to a V-TENS machine. I have induced many women using acupuncture but I will use it only in normal, healthy, pregnant women who have had no complications in their pregnancy. I would not use it where a mother had suffered from conditions such as severe pre-eclampsia, kidney disease, a heart condition, diabetes, any bleeding, or if they had previously delivered by caesarean section.

Research on acupuncture for the induction of labour

Acupuncture for induction has been used in a number of clinical trials, including the effect on prolonged rupture of membranes and after the membranes have been ruptured (Kubista et al 1975). The relation between the force of contractions and degree of dilation of the cervix has been studied. The results of the hundreds of studies have shown that virtually any hormone neurotransmitter may affect the appropriate acupuncture stimulation. A study in Germany has shown a reduction in the length of labour of women who had received prenatal acupuncture. Tsuei & Leuizi have looked at the use of elec-troacupuncture for induction of labour. In the first study (Tsuei & Leuizi 1977), 12 women were enlisted at various stages of pregnancy between 19 and 43 weeks. These would have included induced abortions. The main points chosen were SP-6 (taken from the ancient text) and LI-4. Three of the women delivered vaginally with electroacupuncture. The time from the start of contractions to delivery...

Acupuncture in the transition phase

This is very often the most difficult part of the labour unless the mother maintains control throughout. At this stage the ear point can frequently become dislodged as the mother thrashes around. Her pain at his point will be of a different kind and as the contractions get stronger, she will want to push in response. She will experience the pain differently, so the aim of acupuncture moves from providing pain relief to calming her. Keep the mother calm and relaxed. Be firm with her if she starts to lose control.

Use of TENS machines and electroacupuncture machines

In 1967 Shealy, a prominent neurophysiologist, considered that direct stimulation by TENS of the dorsal column of the spinal cord could inhibit the transmission of pain to the higher pain perception centres of the brain (Shealy et al 1967). The discovery in 1975 of morphine-like peptides known as endorphins (Hughes et al 1975) was followed closely by the discovery of opiate receptors distributed throughout the central nervous system and the release of endogenous opioid by acupuncture (Sjolund & Eriksson 1979). When released, endorphins travel and attach themselves to these receptors this action increases pain tolerance.

Acupuncture for augmentation

The acupuncture points are exactly the same as for induction of labour (Dunn et al 1989, Kubista et al 1975), and should all be used with heavy stimulation. It is natural during the second stage for contractions to become less frequent, which allows the mother to get her second wind. However, sometimes the midwife may feel that there is too long a gap between contractions. In this case I find it useful to get the mother to stand up between her contractions and to needle the ear point for the bladder, using a quarter-inch needle in one ear and leaving it in position.

Planning for a healthy baby

Acupuncture treatment to aid conception Treatment with acupuncture during the cycle conception from the viewpoint of traditional Chinese medicine (TCM) and details the acupuncture points that can be used prior to conception and at particular stages of the menstrual cycle. Finally, it gives pointers on exercise when planning a baby.

2114 Migraini Ddications

Migraine suffering is frequently positively influenced by pregnancy. Non-drug processes such as muscle relaxation therapy, biofeedback, acupuncture and acupressure, as well as changes in lifestyle and nutrition, are preferable in the prodromal stage and in the intervals that are free from pain. The analgesic of choice is paracetamol, perhaps combined with caffeine or codeine (see Chapter 2.1.7). Ibuprofen or aspirin can also be considered, but these should not be used from the early third trimester onwards. If necessary, antiemetics like medozine or metoclo-pramide should be given prior to analgesics. To prevent dehydration, intravenous (i.v.) fluids should be given. To control nausea and pain, phenothiazines (prochlorperazine) can be administered intravenously, supplemented if necessary by i.v. narcotics (like codeine) or i.v. corticosteroids. Severe attacks can be treated with sumatriptan (preferably intranasal, s.c. or rectal) other triptanes should be used only...

Forbidden points of pregnancy

There is much debate about the points that should be used in pregnancy. Some schools of thought say that you should not treat at all during the first 3 months of pregnancy, as acupuncture may cause miscarriage. I disagree with this view and have had some wonderful results in the treatment of severe morning sickness, which can be utterly debilitating for some women. Women who have had recurrent miscarriages can also be helped greatly by acupuncture, if treatment is given to tonify Kidney weakness. The same applies to women with IVF pregnancies, who I often find suffer greatly from sickness in the first 3 months.

Hyperemesis gravidarum

She came to see me because she had heard acupuncture could help and she wanted treatment before she got pregnant again. Though I told her I could offer no guarantees, she was only too happy to give it a try. She was Kidney Yang deficient so I needled points on the Chong Mai and also lots of warming Kidney points Lauren felt terrible and was admitted to hospital twice in the first 12 weeks. But compared with her first pregnancy there was a vast improvement and, importantly, she felt that she was coping. She carried on with weekly acupuncture treatments throughout the 9 months - a good example of preventive medicine.

Acute and chronic back ache and sciatica

Sasha came to me for acupuncture at 25 weeks suffering from vulval varicose veins and varicose veins in both legs. This was Sasha's third pregnancy - she had two boys aged 12 months and 2 years - and she had suffered badly with varicose veins in each pregnancy. She presented with extreme pain which made standing and walking for any length of time unbearable. The pain was also present during the night and she was now totally exhausted. At her first appointment, I needled GV-20 and LR-5 for only 20 minutes with even technique as she was so exhausted I added BL-23. This seemed to help with the pain immediately as standing up after the treatment, Sasha commented that her legs felt lighter.

The first consultation

Women are often very wary about acupuncture and seek reassurance about the success rate of treatment. Their pain is such that they do not want to risk doing anything that may make their condition worse. Often their pain can be so severe that they can walk only with difficulty, their gait is very stiff and often they have to be transported to clinic because they are unable to drive themselves. The first thing to try to establish is whether the pain is acute or chronic (Box 6.1). Pain that is severe and stabbing, worse with rest, better with light exercise and tender to the touch is connected to stagnation of Qi and Blood. If the back ache improves with light exercise it is due to local stagnation but if it improves with rest it is due to Kidney deficiency.

Carpal tunnel syndrome

Western medicine usually treats the condition with splints or bandages. Acupuncture works very well but a daily treatment is required. I use PC-5 with the needle angled towards the carpal tunnel, and ST-36, the empirical point of the wrist. Obtain Deqi and leave the needles in with even technique.

What about raspberry tea

As discussed, the mechanisms that cause labour to begin are somewhat elusive. Although hormones will definitely bring it on, clearly, other factors also affect the beginning of labour. It seems to be common practice that women who are medically fit with their baby fine and well are given a date to come back to the hospital for induction rather than being taken in immediately. Often being told you are to be induced is closely followed by the beginnings of labour. Perhaps the baby was about to appear anyway but it is interesting to speculate on what psychological mechanisms may be at play. But what can you do if you are sitting at home waiting for that baby to arrive and feeling concerned about the possibility of being induced Many other factors are thought to help the onset of labour and other women may share with you how their labour started. Some of these are dietary the drinking of raspberry tea (available from health food shops) or eating spicy foods is suggested to help labour...

Preterm rupture of the membranes

If the woman is between 24 and 32 weeks, to help promote lung maturity in the fetus and reduce the risk of respiratory disease syndrome at birth. Different hospitals have different policies about when a women should go into hospital or not. I have never treated preterm rupture of the membranes with acupuncture because I do not believe it is appropriate to do so.

Ive done it all beforeor Oh no not again

Alternatively, a previous experience may have encouraged you to do it differently this time. You may have attended birthing classes again, chosen a home birth this time, decided to have acupuncture if you need to be induced. A distressing experience first time may galvanise you into action to prepare yourself in a different way.

The Chinese viewpoint on infertility

In Chinese medicine the menstrual cycle is divided into four phases - period, post-menstrual, mid-menstrual and premenstrual. The Kidney energy is the most vital aspect 'The treatment of infertility according to the four phases is always based principally on treating the Kidneys, because the phases are a result of the waxing and waning of Kidney-Yin and Kidney-Yang and because the Kidneys are the source of the Heavenly Gui which is the basis for reproduction' (Maciocia 1998, p. 695). Acupuncture treatment through an IVF cycle can help in many ways. There are now a number of research articles pertaining to acupuncture treatment and an increased success rate of IVF. The treatments below are only a basic starting point as each patient will present with varying patterns of disharmony, at different stages of their treatment.

Moxibustion for turning breech babies

Much attention has been given to the turning of breech babies using moxibustion (Fig. 9.7). Moxibustion is a way of stimulating acupuncture points with heat, which can encourage the fetus to turn. The technique employs a lighted moxa stick held near the point BL-67 on the little toe. It appears that by stimulating production of maternal hormones (placental oestrogens and prostaglandin) (Budd 1992) (Fig. 9.8), it encourages the lining of the uterus to contract, which in turn stimulates fetal activity. Certainly mothers on whom I have used moxibustion invariably report that they feel the baby moving almost immediately I light the stick, even if ultimately the baby does not actually turn, although no formal survey has yet been made. The reasons for not turning a breech, listed above, also apply to moxibustion.

The role of the acupuncturist

Face, brow and shoulder presentation are all self-explanatory terms that you may hear used to describe abnormal head-first deliveries, and they are described briefly here for information. They all carry complications and are sometimes hard to diagnose when the midwife or doctor palpates. You may see these diagnoses written in the notes, or your patient may be admitted to hospital because of them. As an acupuncturist, there is little you can do to treat these conditions directly, but you can of course help to relieve any anxiety and stress they might cause to the mother. It is also important that you are familiar with the terminology so that you have a greater understanding of what is happening in a complicated labour. In all cases, even if complications are not previously diagnosed, labour would begin normally. You would therefore use the same acupuncture treatments as for a normal delivery.

When to go to hospital

Her midwife will usually be the first person to be informed of the onset of labour. The acupuncturist will have made arrangements with the mother as to when to attend. If the mother is going into hospital, the best guide as to when to go there will be the intensity, strength and duration of the contractions. Once these are lasting 60 seconds or more, the cervix will be dilating. Acupuncture treatment can be started at once.

Frequency of treatment

Treatment will usually start the uterus hardening, and contractions may get going. However, the contractions are often not sustained and repeat sessions are necessary. In practice, it is often not possible to provide treatments more than once a day, but twice or more would ensure greater success (Kubista et al 1975). The research that has been done shows that acupuncture takes from 3 to 60 hours to initiate contractions. Sharon was 10 days over her dates and due to come into hospital to be induced on day 14. She came along to me to try acupuncture. She had been feeling niggles of pain and thought she would go into labour at any time. I sat her on the bed with her feet placed on a chair, inserted the needle into BL-31 and 32 and began to manipulate them very strongly for 2-4 minutes. I then came from around the back of the bed and placed the needles in LI-4 and LR-3, and again manipulated the needles very strongly.

BL60 again tonify and take the needles out

In the hospital she was given a sedative (this practice is no longer undertaken) and slept for 4 hours. The next day I had other duties and got back to her at 2.00 p.m. She was out of bed but still labouring and struggling with the pain. At 5.00 p.m. she was allowed into the water pool as she was now 5 cm, but she was exhausted and not really coping with the pain. She came out of the water at 8.00 p.m. and felt quite refreshed but still exhausted. On examination, she was 8 cm. I stimulated ST-36, LI-4 and SP-6 but by now she did not want acupuncture. At 10.00 p.m. she was still only 8 cm and the hospital staff decided to break her waters. I was not keen on this, as I knew she would feel the pain even more, but the fetal heart was getting tired and so was she, so I understood why the decision was made. She also decided to have an epidural, which was completed at 11.00 p.m., and for the first time she was out of pain. Maddie's example illustrates the physical stresses that an OP...

Using a VTENS machine

For labour pain I use my V-TENS machine (see Fig. 12,10), setting the pulse width at 200 and the pulse rate at 2.5 Hz (Box 12.2). I use it on a continuous setting and allow the patient to set the intensity herself so that she can turn it up to a bearable level. I may use pads on the back with one set of electrodes on BL-31 and 32 (Fig. 12.11), and then with the other electrodes in the ear attached by clips to the Uterus and Shenmen acupuncture points. This setting produces the maximum endorphin release and most ease for the patient.

Box 121 Comparison of the two methods of TENS

Acupuncture-like TENS endorphins Non-segmental and segmental effects small fibres act on three sites spine, brainstem and pituitary High intensity of some TENS devices activates small muscle (type III) nerves producing Deqi Pads placed on acupuncture points as these are over small-diameter afferent nerves (type III) in muscle Low frequency (1-4 Hz) produces no muscle spasm at high intensity and hence allows strong stimulation needed for Deqi Pulse trains cause muscle spasms at high intensity and do not permit adequate intensities for Deqi Analgesia has slow onset and long duration needs only 30 minutes of therapy for prolonged effects No tolerance from short, 30-minute treatments

Box 122 Frequency windows

0.5-3 Hz (delta) this band is associated with deep sleep, meditative and subconscious states analgesia produced using these frequencies appears to be blocked by naloxone, implicating beta-endorphin production. Virtually any frequency within this band is capable of producing fast relaxation, treating insomnia and providing good pain relief. This band is recommended for high-intensity electroacupuncture, neuroelectric acupuncture or acupuncture-like TENS.

Diagnosis of the true cause

So if it is true that the cause can come from any of these stages, what does this mean exactly Do we mean the cause originates at a particular phase of the pregnancy and is then experienced after the birth This could be true but to understand the method of diagnosis fully, we have to look at the theory of classical Five Element acupuncture, not just in the context of pregnancy or postnatal depression but in the general concept of an underlying causative factor that will lead to illness or disharmony in any individual. The theory of the 'causative factor' as taught in Five Element acupuncture simply states that within every person's energetic make-up there is a weakness, or a part that is weaker than the rest, and if disease is going to enter this person's body, mind or spirit it will be through this window of weakness. Why this weakness exists is of no consequence as we simply need to be able to make a diagnosis in order to treat and support it. This underlying weakness is not...

Use moxa on SP1 and encourage the patient to continue use at home

Celia had had three pregnancies, all the result of IVF, but all had ended in miscarriage. In one pregnancy she sadly lost the baby at 24 weeks. She came to me for acupuncture in desperate hope, prior to her fourth IVF attempt. The same thing happened again every 2-3 weeks. She was understandably very fearful and refused a scan, as she was worried about the effect of the ultrasound and did not feel the benefits were worth the risk. She kept up the acupuncture treatments and the bleeding continued at intervals with no known cause until she was 20 weeks. She went on to deliver a healthy boy at 39 weeks.

Foreword to the first edition

Since 1949 the combination of Western and Chinese Medicine has been emphasised and many innovative treatments in obstetrics have been devised. For example, ectopic pregnancy is often treated with acupuncture and Chinese herbs without recourse to surgery acupuncture is used in breech presentation of the fetus Chinese herbs are used in the treatment of postnatal depression. Ms West is an acupuncturist and a midwife with 15 years' experience and therefore is uniquely placed to write about obstetrics. Her book is a lucid, coherent and practical guide to the care of pregnant women for acupuncturists. The book combines a comprehensive discussion of the acupuncture treatment of the pregnant mother before, during and after childbirth with possibly the most rigorous and detailed guidelines for administering acupuncture in childbirth ever published in the English language. The extensive chapters on the physiology and pathology of labour will give any acupuncturist complete confidence in...

Reface

Years of working as a midwife and acupuncturist have proved to me that the majority of pregnancy ailments can be treated successfully with acupuncture yet these conditions are generally considered 'par for the course' because they are hard to alleviate conventionally. Pregnant women are understandably reluctant to take drugs unless it is absolutely essential and they therefore have no choice. Many would be happy to seek safe alternatives. My first introduction to acupuncture came after the birth of my second child, when I was suffering from postnatal depression. The success of the treatment I received inspired me to study the subject further, and four years later I graduated from the College of Traditional Chinese Medicine in Leamington Spa. Having been a practising midwife for many years, and having had two children of my own, I understood the reluctance of pregnant women to take pharmaceutical remedies for their ailments. Acupuncture treatment, used in conjunction with conventional...

Acknowledgements

I would like to thank Lyndsey Isaacs, Sharon Baylis and my husband, Robert, for their hard work and invaluable input I could not have written the book without them my teachers, Professor J R Worsley, Angela Hicks, Allegra Wint and Nikki Bilton Sarah Budd, for her help in setting up the acupuncture clinic at Warwick Hospital John Hughes, Hugh Begg, Robert Jackson, Karl Olah and Mike Pearson, consultants at Warwick Hospital, for their support in helping to provide an acupuncture service on the NHS Nancy Hempstead, Chris Sidgwick, Annette Gough and Susan Ensor, for their help and support Gerad Kite, for his invaluable contribution (Chapter 16) Gordon Gatesby, for his help in understanding electroacu-puncture all of my patients and the GPs and midwives who have supported me over the years.

Pregnancy

Acupuncture use during pregnancy 31 Adverse effects of acupuncture 33 acupuncture in pregnancy 33 Pregnancy is, after all, a natural physiological life event and not an illness. I find that women much prefer to be treated holistically, as a whole and individual person, rather than just a womb and a collection of symptoms. They appreciate the chance to get in tune with the changes happening within them and to work in harmony with their body's natural rhythms. Treatment with acupuncture is warmly welcomed by many women who may never previously have considered its benefits. And the benefits for the pregnant woman are many and great. It is important for the acupuncturist to liaise closely with the woman's midwife or GP, particularly if there are any medical problems. Women should be encouraged to tell their midwives and GPs what they are being treated for, as most midwives and doctors are unaware of all the conditions that acupuncture can help with in pregnancy. Safety in treatment is...

Recent research

In 2002, Smith et al presented two papers on the outcome of a randomised controlled trial on 593 pregnant women who were less than 14 weeks pregnant and complaining of morning sickness. One article (Smith et al 2002a) reviewed the efficacy of acupuncture and the other the safety of acupuncture as a treatment for morning sickness (Smith et al 2002b). The women were split into four groups. Traditional acupuncture treatments pattern differentiations used were Liver Qi stagnation, Stomach or Spleen deficiency, Stomach Heat, Phlegm, Heart Qi deficiency and Heart Fire. Acupuncture at PC-6 only. Sham acupuncture points needled close to but not on acupuncture points. No acupuncture.

Results

The outcome was that all the treatment groups showed less nausea than those women who had no treatment. The traditional acupuncture groups showed less nausea in the first week of treatment, and the PC-6 only group from the second week of treatment. By the third week the sham acupuncture group showed less nausea. Perinatal outcome showed no difference in all four study groups so it was deemed that acupuncture in early pregnancy was thought to be a safe and effective treatment for nausea. A more recent pilot study on acupuncture and acupressure at PC-6 in the treatment of hyperemesis gravidarum (HG) showed positive results (Habek et al 2004). However, this was a small study and HG is a serious complication and care must be taken in the treatment of these women.

Chinese treatment

In Chinese terms, the syndrome that usually corresponds to varicose veins is stagnant Qi and Blood with deficient Spleen and Qi sinking. The success of acupuncture depends on the severity of the varicose veins. In many cases improvement is minimal and treatment may seem ineffectual, but some women feel that it helps with the throbbing sensation and opt to continue with treatment, regardless of the success. Acupuncture in combination with a TENS (transcutaneous electrical nerve stimulation) machine appears to be the most effective in relieving the heaviness and pain. Needling will depend on where the veins are and whether or not it is possible to needle. Some women have very bad veins around the site of the acupuncture points, making it impossible to needle.

Chapter outline

Acupuncture for urinary tract infections This chapter is intended as a reference guide for the acupuncturist. When giving acupuncture to women who are considered a high risk medically, it is as well to have a background knowledge of the possible complications. It is my strong opinion that any woman with complications should always be treated in conjunction with her midwife and doctor.

Transfer phase

Recent studies from Germany and Denmark have shown a remarkable, almost 50 increase in success rates in women who had acupuncture 25 minutes before and after embryo transfer. The studies used the same acupuncture points which, according to TCM (traditional Chinese medicine) principles, would increase blood circulation and energy to the uterus as well as relax the patient (Paulus et al 2002, Westergaard et al 2006). the Du Mai is responsible, thus maturing the follicle to release the egg and the thickening of the corpus luteum. Therefore in acupuncture treatment during an IVF cycle, it would be appropriate to use these channels.

Still birth

It is usually the result of some congenital abnormality or fetal anoxia. Fetal anoxia is starvation of oxygen, which can occur because of cord prolapse, the placenta not functioning properly, the placenta coming away from the uterine wall, medical conditions such as diabetes, intrauterine infection or a traumatic delivery. Acupuncture after a still birth can be of benefit to the mother and can do a great deal to restore the spirit.

Research on breech

Cardini & Weixin (1998) carried out a randomised controlled trial in Italy. Their patients were 260 primigravidas in the 33rd week of pregnancy, all with normal pregnancies and diagnosed as breech position by ultrasound 130 of the women were randomised to the intervention group and received stimulation to the acupuncture point BL-67 with moxa for 7 days. They were given treatment for a further 7 days if the fetus was still in the breech position. The other 130 were randomised to the control group and received routine care but no intervention. Subjects with persistent breech (after 32 weeks) could undergo external cephalic version any time between 35 weeks and delivery.

Labour

Acupuncture treatment in labour One of the most important considerations in labour should always be to reduce the mother's fear and to reassure her. If you are guided by her natural behaviour patterns, everything should in most cases progress well. A basic understanding of how hormones affect pain in labour and the role of the pelvis will also help your acupuncture treatments. This chapter covers general uses of acupuncture in labour.

Case Study 121

When given a vaginal examination by the night staff, she was found to be 2-3 cm dilated. Her membranes were present (or intact, as the midwife would say) and the baby was lying in the favourable OA position. Mandy was placed on a fetal monitor for 20 minutes to measure the strength of her contractions and to check the fetal heart. After breakfast, if nothing was happening, she was going to decide whether or not to go home. At 8.30 a.m. I asked her if she was interested in having some acupuncture, to see whether we could get the contractions going again. She agreed. With her sitting upright on the bed, I began by using four plain 11 2-inch (3.8 cm) needles in BL-31 and 32, and really stimulated them. Then I put needles bilaterally in LI-4 and SP-6, and kept that up for about 40 minutes. The contractions definitely started to become stronger and more regular. By 3.30 p.m., she was on the bed and using the Entonox. The needles had now fallen out so I let them be and used no more...

Case Study 151

During her second pregnancy, Mary was convinced her baby was not lying correctly. Despite reassurance from the medical staff that everything was OK, she felt all the way through her pregnancy that something was wrong. A very long labour ended in an emergency caesarean section - because the baby was not lying the correct way. She was haunted by this after delivery, became very depressed and was finally diagnosed as having posttraumatic stress syndrome. When she became pregnant again, she continued anxious and depressed, finally coming for acupuncture during her third trimester. She went on to have a normal delivery.

Case Study 152

Anne came to me for treatment for anxiety during her second pregnancy. During her first labour she had needed an epidural, a process during which the patient is gently held by the midwife as the anaesthetist inserts the needle into her back. However, this experience had unlocked for Anne repressed memories of being raped at the age of 6. She became hysterical when she felt she was being forced down and had to be restrained. She subsequently received counselling but when she came to me for acupuncture, she was full of fear and anxiety about what would happen in her next labour. Together, we wrote a long letter to explain to the midwifery staff what had happened to her and why it had happened, asking that she be treated with care and understanding. This letter was put in an envelope and placed in her hospital notes so that only the medical staff would see it. (This can be done on behalf of any patient.) The staff were very understanding and Anne went on to have a normal delivery with no...

Gerad Kite

Classical Five Element acupuncture seeks to isolate the true source of the problem and eradicate it for all time, rather than simply dealing with a presenting symptom and clearing the problem for that moment. I am not suggesting that all postnatal depression is old, deep-rooted psychological baggage rising to the surface rather that any extreme experience in life, be it good or bad, can throw us off our natural cycle, and the apparent cause (childbirth in this case) may not actually be the cause but simply the trigger.

Needle techniques

From personal experience, I believe the body adapts to whatever needle technique you use. Before my TCM training (at the College of Integrated Medicine), I studied Five Element acupuncture, so my techniques may be considered different from those of classically trained TCM practitioners. When I began training, I soon came to realise through observation that all practitioners develop their own personal needle technique. The following recommendations are therefore based on my own preferences.