When a woman is pregnant, she needs to be taken extra care: for example about what medicines to take which might be different from when she is not pregnant. How about using complementary and alternative therapies? There was a report by Stewart et al about healthcdare professional views and experiences of complementary and alternative medicine (CAM) therapies in obstetric practice in North East Scotland. They conducted a survey about the use of CAM therapies by UK healthcare professionals for pregnant women. The participants include midwives, obstetricians, and anaesthetists. 32.5% of the respondents had recommended (prescribed, referred or advised) the use of CAMs to pregnant women. The most frequently recommended CAM therapies were vitamins and minerals (excluding folic acid) 55%; massage 53%; homeopathy 50%; acupuncture 32%; yoga 32%; reflexology 26%; aromatherapy 24% and herbal medicine 21%. Midwives who had been in post for over 5 years, had received training in CAMs, were interested in CAMs and were themselves users of CAMs were more likely to recommend CAMs. Those who recommended CAMs were 8 times more likely using CAMs themselves.
Some NHS hospital hospitals provide maternity acupuncture service for paitents. Their survey of patient attitude to the maternity acupuncture service showed that 90% of patients were satisfied greatly about the maternity acupuncture service; 69% of women said that they were benefited from acupuncture and 65% said their wellbeing had significantly improved with acupuncture service; 88% said that presence of this service at the Whttington would ensure that they would preferentially re book at the Whitttington Hospital in future pregnancies rather than any other local hospital. From the back pain treatment 53% improvement in their symptoms was reported which provided pilot data for a research application and complies with the NICE recommendations for back pain. Effect of acupuncture on nausea and vomiting in pregnancy Up to 90% of pregnant women experience nausea and vomiting. Hyperemesis gravidarum is an extreme end of hyperemesis or morning sickness which is prolonged and severe nausea and vomiting in pregnancy. One of the main dangers of this condition is dehydration. Women with hyperemesis gradidarum could be constantly nausea and vomiting many times a day and it is difficult to keep fluids within the body. It could cause lot of weight loss, electrolyte imbalance and blood volume depletion. This condition is caused by hormone in pregnancy and is improved when the hormone levels go down as pregnancy turns to 13 weeks. Sometimes it could continue throughout of pregnancy. This condition is not likely to cause any harm to the baby. But there is a risk of the baby being born with a low birth weight if there is a significant weight loss during the pregnancy. Intravenous fluids and medication are used to control the vomiting and nausea. Foods in rich carbohydrates and low fat and acid are recommended. Recommended foods include Light snacks, nuts, dairy products, beans and dry and salty biscuits. Electrolyte-replacement drinks and taking nutritional supplements are beneficial for maintenance of electrolyte balance and sufficient calories. Intake of food rich in protein is recommended. Use of ginger and vitamin B6 are effective though there is limited evidence. Acupuncture was used in China to treat morning sickness. Carisson CP et al from University Hospital, Lund Sweden conducted a randomized placebo controlled trial to study the effect of acupuncture in treating morning sickness. Acupuncture treatments were given three times daily on treatment days. Each treatment lasted for 30 minutes. Acupuncture point PC6 was selected. Women in the acupuncture group had significantly quicker decrease in the amount of nausea they experienced compared with the placebo control group. There was also a significant difference in the amount of vomiting between the acupuncture and placebo groups. In acupuncture group there were fewer patients vomiting. There was no significant difference of food intake between the two groups. There were no side effects observed. The possible mechanisms for the acupuncture inhibiting nausea and vomiting include that acupuncture inhibits nociceptive transmission and autonomic reflexes; acupuncture decreases pain in the system; acupuncture has effect on gastric intestine tract; the effect of acupuncture is through somatovisceral reflexes. Acupuncture releases pain in late pregnancy without serious side effects Pain in the pelvic and low back areas during pregnancy is very common and sometimes serious. Up to about 70% of pregnant woman have pelvic and/or low back pain which often increases progressively during pregnancy. Pain is often left insufficiently treated because of fear of using pain killers during pregnancy. Acupuncture was found to reduce pelvic pain and low back pain with little side effects. Recently Nina Knoening et al from Malmo University Hospital, Malno Sweden studied the effect of acupuncture on pelvic pain and low back pain in patients in later pregnancy. 72 Pregnant women with pelvic low back pain during pregnancy weeks 24-37 were randomly allocated in acupuncture group (37 patients) and in control group (35) patients. The acupuncture points used included LR3, GV20 and local tender points initially. If the response was not enough, BL60, SI3 and BL22-26 points were selected. Acupuncture was received by the patients once or twice a week until delivery or completely recovery for acupuncture group. No acupuncture was received for control group. During the study period, the pain intensity was decreased 60% in acupuncture group which was significantly greater than that for the control group 14%. At the end of study, 43% patients in acupuncture group were less bothered by pain which was significantly greater than for the control group 9%. No serious side effects were found in the patients and no adverse effects were found in the infants. The authors suggested that acupuncture could release [elvic pain and low back pain without serious side effects in late pregnancy. Acupuncture for labour pain After months of anticipation, your baby will due. When will the labour begin, no one knows. The due date calculated is only a reference point and normal labour begins anytime between 2 weeks before the due date and 2 weeks after the due date. If you are in labour, you will be experiencing pain. The amounts of pain women are experiencing vary. Women can manage their pain wit breathing and relaxing techniques; some of them need take pain killers. Acupuncture is used to relieve pain in labour. There are many reports that show the effectiveness of acupuncture on labour and labour pain. For example, Liu YL and Jin ZG studied the effects and safety of electroacupuncture at SP6 point on labour pain. They recruited 111 cases. They found that in electroacupuncture group with acupuncture on SP6 point, the active phase of the first labour stage was shorter than that in the non treatment control group and sham acupuncture group. Ma W et al studied the effect of electroacupuncture on labour pain in women during labour. 350 women in labour in three different hospitals were randomly divided into three groups: acupuncture group, sham acupuncture group and control group. The acupuncture point was at SP6. The pain scores from women in acupuncture group were less than in the control group at needle retaining at 30 min, as well as 2 hour and 4 hour after needle withdrawal. No side effects were observed during labour process. Their concluded that acupuncture at SP6 could reduce pain in labour. Acupuncture and acupressure at acupoint LI4 relives labour pain. Peng T et al conducted a clinical study on the effect of on transcutaneous electrical nerve stimulation (TENS) reliving labour pain. They used TENS on four acupoints Hegu (LI4), Neiguan (PC6), Danshu (BL19) and WEishu (BL21) for reducing pain in labour. They found that pain in TENS group was significantly decreased compared with control group. The incidence of postpartum hemorrhage in the TENS treatment group was less than the control group. There was no side effect recorded in TENS on acupoints. Hamidzadeh A et al studied acupressure on LI4 acupoint on reducing labour pain by conducting a randomized controlled trial. There were 50 women in the acupressure group received LI4 point acupressure and 50 in controlled group received touch at LI4 acupoint without pressure. There were significant differences between the groups in labour pain score immediately and 20, 60, and 120 minutes after intervention. Active phase duration (3-4 cm dilatation to full dilatation) and second stage duration (full dilatation to birth) in labour were shorter in the acupressure group. The women in the acupressure group reported greater satisfaction. No side effect was reported. LI4 acupoint is an important acupoint for relieving labour pain. Acupuncture treatment for depression during pregnancy
Manber et al in Stanford University in USA conducted a randomized controlled trial to investigate the efficacy of acupuncture in treating depression during pregnancy. 15 pregnant women who were diagnosed depression. The diagnosis met the criteria “Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) critieria for major depressive disorder. They were divided into three groups: specific acupuncture for depression group (52 patients), control non specific acupuncture group (49 patients) and massage group (49 patients). The treatments lasted 8 weeks with 12 sessions. Result showed that women who received acupuncture specific for depression had a greater rate of decrease in symptom severity and a greater response rate compared with the control groups (nonspecific acupuncture and massage groups). There was no significant difference between non specific acupuncture and massage groups. Their conclusion is that the short acupuncture in symptom reduction and a response rate for depression is comparable to those observed in standard depression treatments of similar length and could be a viable treatment option for depression during pregnancy. Turn foetus around
Babies born in a breech position, the unfavoured position have an increased risk of birth complications. To minimise these risks, caesarean section deliveries have increased which results in health risks to the mother and baby and increased costs to health services. Strategies to promote normal birth are encouraged. Acupuncture and moxubustion at acupuncture points were used as one of the methods to correct foetal breech position. Recently Vas J et al reported a clinical trial of correcting foetal breech position to evaluate the conventional acupuncture point BL67 compared with SP1. There were 406 low-risk pregnant women with a fetus in breech presentation confirmed by ultrasound. The gestational age was range 33-35 weeks. These women were allocated into three groups: moxibustion at point BL67 plus usual care, moxibustion at SP1-a non specific acupuncture point plus usual care and usual care group alone. The results showed that 58.1% of the full-term presentations were cephalic (the correct position of birth) in moxibustion at point BL67 group, the highest in the three groups. There were no severe adverse effects found during the treatments. From this study, the authors concluded that moxibustion at acupuncture point BL67 is effective and safe approach to correct foetal breech position used between 33-35 weeks of pregnancy.Reducing obesity is beneficial for pregnancy
Obesity is a major health problem. A recent survey showed that about a fourth of population is obese. About 50% of women in reproductive age are either overweight or obese. Obesity increases risk of maternal and fetal complications. About 20-40% women gain excessive weight during pregnancy. The maternal complications linked to obesity include miscarriage, hypertension, gestational diabetes, infection, caesarean section, instrumental and traumatic deliveries, wound infection and endometriosis. The fetal risks related to maternal obesity include stillbirths, neonatal deaths, preterm birth, congenital abnormalities and childhood obesity etc. Weight management during pregnancy need to have extra care, because reduction in weight gain or weight loss may be beneficial, but the weight loss itself or the interventions may potentially harm to the mother or bay. To evaluate the effectiveness of dietary and lifestyle interventions in reducing or preventing obesity in pregnancy and assess the beneficial and adverse effects of the interventions on obstetric, fetal and neonatal outcomes, Thagaratinam S et al did a systematic review. They searched database from 1950 to March 2011. There were 88 studies involving 182139 women. They found that weight management interventions in pregnancy significantly reduced hypertension during pregnancy and gestational diabetes. It also reduced preterm birth and should dystocia. Adverse effects were low. They concluded that weight management reduced weight gain during pregnancy. Dietary interventions were the most effective way to reduce weight gain in pregnancy and the risk of gestational hypertension and diabetes and shoulder dystocia. There were no adverse effects from dietary management. References Thangaratinam S et al Health Technol Assess (2012) 16:1-192 Nina Knoening et al Ata Obstet Gynecol Scand (2004) 83:246-250 Carisson et al J Pain Symptom Manage (2000) 20:273-9 Peng T et al Chin J Integr Med (2010) 16:234-8 Hamidzadeh A et al J Midwifery Womens Health (2012) 57:133-8 Liu YL and Jin ZG Zhongguo Zhen Jiu (2012) 32:409-12 Ma W et al Complement Ther Med (2011) 19 Suppl 1:S13-8 Manber R et al Obstet Gynecol (2010) 115:511-20 Vas J et al Acupunct Med (2013) 31:31-8 BJOG (2014) Feb11 doi:10.1111/1471-0528.12618 http://www.whittington.nhs.uk/default.asp?c=4243