Acupuncture has been used for thousands of years as a specialised therapy for helping to maintain a healthy pregnancy and birth with excellent recovery. Pregnancy, childbirth and postnatal recovery are viewed in TCM as a window of opportunity to enhance the woman’s well being. Value is therefore placed on promoting preventative care to strengthen the mother and baby as well as dealing with problems as they occur during pregnancy, thus preventing long term problems. Acupuncture in pregnancy is becoming increasingly valued in New Zealand, as it is in England, Germany and France, where acupuncture is available in specialised antenatal clinics and maternity hospitals. There is now emerging positive studies that show acupuncture is an effective treatment for the many conditions in pregnancy.
What to expect? Everyone is unique and treatment is based on a thorough TCM consultation and diagnosis. The first appointment can take up to 90 minutes and follow up ones are usually 60 minutes. The needles are inserted and left to work for a period of time while relaxing to music. Many people are pleasantly surprised to find acupuncture so calming they fall asleep. It may take a series of weekly appointments that build on each other. Nourishing treatments can be offered at prescribed time points intermittently throughout pregnancy to build blood health and Qi(energy)
It is estimated that this happens in about 20% of all pregnancies although if all were recorded it could be as high as 40%. There are many reasons for a miscarriage, chromosomal abnormalities in the embryo, hormonal deficiencies, an immune reaction against the embryo, infections, coeliac disease, uterine malformation or incomplete cervix, stress or trauma, and fibroids.
It is worth mentioning that not all vaginal bleeding will indicate a miscarriage. In early pregnancy it is common for a small amount of bleeding to occur as the embryo is embedding into the uterine wall. From a Chinese Medicine viewpoint, a miscarriage suggests disharmony in the conception and penetrating vessels which is responsible for gathering the blood and nourishing the foetus. This comes about due to Kidney yang or yin deficiency, qi and blood deficiency, spleen qi sinking or blood heat. There are many treatment options depending on what the individual Chinese diagnosis is. The sooner the treatment begins the better the outcome. If a woman has experienced more than one miscarriage, we would suggest treatment for the months leading up to conception to build strong kidney qi to prevent further miscarriages. We would also address diet and lifestyle factors that may be contributing to such deficiencies.
Although there is no way of knowing the causative factors at the time of a threatened miscarriage there remains potential for early pregnancy support using Acupuncture to reduce stress. This is done by nourishing qi and blood. This is thought to have a positive effect on progesterone production, stress hormones, immune function, qi and blood. Acupuncture has been used historically to prevent miscarriage and is recommended in traditional teachings.
Birch, S & Lewith, G 2008,Acupuncture research: the story so far. In:Macpherson, H, Hammerschlag, R, Lewith, G & Schnyer, RN (eds.) Acupuncture research: strategies for establishing an evidence base.Edinburgh, Elsevier.
Deadman, P, Al-Khafaji, M & Baker, K 2001,A manual of acupuncture.Hove, London Journal of Chinese Medicine Publications.
Lyttleton, J 2004,Treatment of infertility with Chinese medicine.Edinburgh,Churchill Livingston.
Maciocia, G 1998,Obstetrics & gynecology in Chinese medicine, New York, Churchill Livingstone.
West, Z 2001,Acupuncture in pregnancy and childbirth.Edinburgh, Churchill Livingstone.
Nausea and Vomiting (Morning Sickness)
This occurs in about half of pregnancies and can happen at any time of the day and sometimes reoccurs throughout the pregnancy. It can range from mild nausea to severe vomiting (hyperemesis gravidarum) that needs medical assistance. The cause is thought to be related to high hormone levels such as HCG and oestrogen which overwhelms the woman’s system. It is understood in Chinese Medicine that this creates a disordered function of the Penetrating vessel which interferes with the descending action of the Stomach qi leading rebellious qi which presents itself as nausea and vomiting. There are several patterns here that Acupuncture can help to correct. While having treatment Nicky and Elaine will also discuss triggers of nausea, dietary and lifestyle changes that is known to help. When treating morning sickness, a woman may require more frequent treatments depending on the severity of her symptoms. It is our clinical experience and data that is showing us that treatment using Acupuncture for nausea and vomiting is very beneficial.
As the pregnancy is advancing there are several musculoskeletal pain conditions that can arise as the woman’s body adjust to extra weight distribution and the hormones of pregnancy are influencing the ligaments. This includes sciatica, carpal tunnel, leg cramps, backache, rib, hip and pelvic pain, and joint pain. The growing baby can put pressure on the ribs and pelvis leaving those areas very tender. As the pregnancy advances a woman’s centre of gravity is altered which can lead to neck, shoulder, and back problems. In Chinese Medicine this type of pain is seen as a disruption in the flow of qi that flows through the channels of the affected area. The qi is stagnating. This comes about from over strain, trauma, or from pathogenic factor from cold, damp, heat or wind that has invaded the channels disrupting its flow. In the event of carpel tunnel syndrome this has occurred due to the increased oedema in the cells which has put pressure on the nerves that flow through this tunnel. There is usually an underlying deficiency of Kidney qi that has left the body vulnerable. Treatment will involve nourishing the qi and moving the stagnation gently. If oedema is present acupuncture is used to relieve some of the oedema. TCM dietary advice will be included in the treatment.
Headaches in pregnancy can be common. The body’s blood volume increases substantially, and the increase levels of hormones are thought to be the main influence. The Chinese Medicine viewpoint is that there the conception and penetrating vessel is flushed with an abundance of qi and blood that is directed towards the developing baby to nourish its rapid development. The blood supply to the head is reduced leaving it vulnerable to stagnation of qi and blood which presents as a headache of varying intensity. When the head is undernourished this leads to an imbalance between the yin and yang giving rise to yang hyperactivity. When undernourished is open to attack by pathogens which can enter the head via its orifices. Other triggers could be from foods such as chocolate or gluten, vitamin and mineral deficiency or stress and insomnia. There is very little research on using Acupuncture to treat headaches in pregnancy. However historically is has been used successfully with good outcomes. Clinically we witness very positive results in our clinic.
During pregnancy there is an increase in circulating blood volume and increasing estrogen levels. This can have a direct impact on the nasal mucosa leading to inflammation and increased gland activity. This can leave women vulnerable to sinus infections or aggravate a pre-existing Sino nasal condition. Leaving the person with blocked nasal passages, postnasal drip, localised pain, headaches, and purulent nasal discharge. When treating pregnant women with this condition we have seen good results using acupuncture. In Chinese Medicine it is understood that an acute attack is due to invasion of wind-heat that impairs the descending function of the Lung qi. In a chronic condition it is due to Spleen qi deficiency allowing dampness to accumulate. Often eating an abundance of damp forming foods such as dairy, sugar or an excess amount of cold foods with exacerbate this condition.
Heartburn is a very common complaint in pregnancy with most woman experiencing it at some point during pregnancy. The stomach qi has a descending action on the contents, facilitating its passage to the next stage of the digestion tract. The Spleen qi focuses on transforming and transporting the contents. The two work synergistically together. As the pregnancy advances, the growing baby pushes up under the stomach, compromising the upper sphincter, resulting in an upward movement of qi creating a painful burning sensation. Acupuncture is helpful in nourishing the spleen qi. There are certain points used that have a descending action on the stomach qi, calming and dispersing the discomfort/stagnation. Dietary advice and stress managment are also part of the treatment plan.
It is understood that when pregnant the digestive function slows somewhat under the influence of estrogen and progesterone in order for more absoption of nutrients to take place. The intestines are also grossley displaced to make way for the devoloping baby. This contributes to an increased susceptability to constipation and discomfort. Furthermore in early pregnancy women may be suffering from nausea or vommiting leading to dehydration and a low fibre diet which exascerbates the situation. If a woman is taking iron tablets she maybe experiencing the side effects of constipation form these. According to Chinese Medicine there are a number of underlying patterns that can contribute to this disfunction of the bowel. Acupuncture, dietary advice and exercises can result in more regular soft bowel function.
Sleep disturbances in pregnancy are very common. There are a variety of reasons for this. In the first trimester there are rapid changes taking place within the woman’s body that is influence by the high levels of circulating pregnancy hormones such as estrogen and progesterone. In early pregnancy many women suffer from nausea that disrupts their sleep, increase urinary frequency occurs as the uterus and developing baby is moving up out of the pelvis, breathing difficulty from congested sinuses, sleep apnea and mood disorders. Later in pregnancy it is related to discomfort from the developing baby putting pressure on the woman’s pelvis, back or ribs; heartburn, increased urination from pressure applied on the bladder as the baby then begins to descend into the pelvis, oedema, stress and anxiety.
Acupuncture is very effective in treating insomnia with many clients falling asleep during treatment.
Treatment may involve the recommendation of supplements, stress management, diet, and lifestyle changes.
Pregnancy Wellness Program
Today we are caring for woman who enter pregnancy with more complex health concerns. Many are obese yet undernourished. We are experiencing a level of health complications never seen before. If the mother’s system is under stress in any way, then her baby is to a certain degree as well. This situation has longer consequences on both the mother and baby’s health and the outcome of the pregnancy. At the end of each pregnancy the goal for all involved is to have a healthy Mum and baby that progresses into a gentle vaginal birth allowing the mother to recover well and be ready to nurture her baby. This is very difficult to achieve if the mother’s body is suffering from stress, disease, or deficiency in any way. A mother’s health in pregnancy has a profound effect on the health and wellbeing of the child throughout its life. Hence it is of the utmost importance to create the most ideal environment for the baby to develop in to provide good amounts of qi and blood for it to have a healthy start to life following birth. The Chinese medicine viewpoint on pregnancy is that it is a time in a woman’s life that she should take time to rest to allow the pregnancy to establish strongly. To nourish herself well every day. To have time to get gentle exercise and to stretch out tension as her body changes and accommodates extra weight from the baby. It is a time when a woman’s body is building significant qi and blood to support the development of the baby and to avoid complications. This means that the mother needs not only to be on the healthiest of diets and have a healthy lifestyle, but she also needs to be aware of the impact of environmental stresses on the baby. (See more. Click here for our Pregnancy Wellness Program page)
A numbness and tingling in the hand and arm caused by a pinched nerve in the wrist.
Oedema is an accumulation of an excessive amount of fluids within the body tissues. This can range from mild to excessive. Mild oedema will resolve overnight while resting. Once it starts accumulating beyond this then special attention is given to the woman’s blood pressure and urinalysis. If this is moving out of the normal range, then close monitoring will be done by her Lead Maternity Carer.
The Chinese medicine understanding of this is that the spleen is failing to transform and transport the fluids of the body. When we refer to the spleen function, we include the stomach as well. Combined they carry out the role of transforming and transporting the contents that is put into it whether that be solid food or liquids. This process is helped by the other organs particularly the Kidney which provides the yang energy to heat the contents. They co-exist in this function. If a woman’s body is deficient in this type of qi she is more likely to experience more oedema and become symptomatic. She may experience such symptoms of swelling of the limbs, heaviness of limbs, tightness to her skin and difficulty in attempting to squat, cold limbs, she may have carpel tunnel syndrome. During pregnancy woman are particularly vulnerable to spleen qi deficiency as the function of their digestive organs slows down a bit to allow for more absorption of nutrients needed for the developing baby
Acupuncture is given to nourish her Spleen qi, Kidney yang qi and clearing the damp accumulation. There will be a discussion around diet and the known damp forming foods to be removed from her diet. She will be shown how to moxa certain points so she can continue supporting the treatment each day at home.
Breech and Posterior Presentation
The safest position for a baby to be in prior to birth is cephalic anterior position with a well flexed head. Most babies have achieved this by 32 weeks gestation with only 4% remaining in a breech presentation at term (Cruikshank 1986). The cause of a baby presenting in a breech position is unknown but may result from placenta praevia , uterine abnormalities, multiple gestation giving way to poor uterine tone, prematurity, babies small for their gestational age, older mothers, there is a higher rate seen in female babies and primigravidae.
In Chinese Medicine it is understood that the root cause of breech presentation is the result of Kidney qi (energy) deficiency. Deadman (2007) describes the kidneys role is to nourish and control the development of the baby throughout the months of pregnancy. As the mother approaches the third trimester of her pregnancy yin reaches its peak (yin energy is needed to facilitate the rapid development of the baby), then as the mother enters the third trimester, yang must begin to mature in order to facilitate the turning of the baby into a cephalic anterior position preparing for the birth. If there is insufficient yang energy then there is a greater chance that the baby will settle into a breech position. If it is deficient or stagnant then yang must be stimulated. The most powerful point to do this is Zhiyin bladder 67 on the yang bladder channel especially when using the yang heat of moxibustion (specially prepared herb Artemis vulgaris). It is important to note that this channel is coupled with the yin Kidney channel at its terminal point. Cardini (1998) hypothesised that moxa to BL67 may stimulate the adrenals which heightens the sensitivity of the miometrium. This in turn alters the relationship between the F and E prostoglandins and increases the contractility of the uterine muscle. This would stimulate foetal movements and the likelihood of the baby turning.
Using Acupuncture to turn breech presentations is a non–invasive method that originates from Traditional Chinese Medicine. It involves the use of moxibustion to stimulate Zhiyin BL67 an acupuncture point of the bladder channel. This point is located on the outer corner of the fifth toenail.
The data that we are collecting in our clinic on such cases is indicating a success rate of 90% for cases that present prior to 36 weeks and 85% for cases that present after 36 weeks. We have even had cases that turn at 39 weeks. As soon as you learn that your baby is in the breech position you should seek treatment. This treatment requires an initial appointment for assessment and treatment which will involve acupuncture and training on how to use moxa each day over certain points, then a follow up assessment and treatment is given 2 weeks later.
An occipital position is when the baby has its back turned towards the mothers back. This can cause lower back ache for the mother. This position is more commonly seen in mothers who have a sedentary lifestyle whereby her pelvis has been held mostly in a backward tilt encouraging baby to settle in a posterior position. It could also be the shape of a woman’s pelvis that has contributed to this position as well. A baby presenting in this position when going into labour is known to attribute to increase length of labour, a prolonged latent phase (trying to establish labour), more intense pain while in labour as the baby tries to makes its way down the birth canal which often results in an instrumental birth. When a baby enters the birth canal in an occiput position it finds it more difficult to tuck its chin onto its chest allowing for the smallest diameter of the head (the crown) to present first. Instead its head presents in a more deflexed position, being the larger diameter presenting first making it more difficult to birth vaginally. The TCM treatment principle is like that of a breech presentation, nourish kidney yang to facilitate the shift into a more anterior position. There will be a focus on pelvic position as well to give the baby the space to do this.
Deadman P, Al-Khafaji M, Baker K; 2007, A Manual of Acupuncture.
Birth prep acupuncture is a treatment we offer in the final weeks of pregnancy to help strengthen kidney yang qi and to nourish blood to prepare for childbirth. Research has shown that women who have pre birth acupuncture experience a shorter labour, use less pharmacological pain relief, and recover faster. Our data that we are collecting has demonstrated this to be the case. This is a safe and effective treatment that promotes natural childbirth. Treatment can be tailored to the woman’s needs incorporating points for specific ailments as pregnancy advances. Feedback from woman in regard to this treatment has been very positive.
In order for a woman to go into labour around her due time according to Chinese Medicine there are three factors that need to occur; yang qi needs to strengthen and mature, a woman’s qi and blood needs to flow freely and the door of the uterus (the cervix) needs to open.
There are many factors involved as pregnancy matures and readies for childbirth. There is the length of pregnancy, age of placenta, hormones, position of the baby, stress, health of both mother and baby, emotions such as fear, frustration, and anxiety. Any of these things can disrupt the woman’s body from going into labour smoothly. There are many acupuncture points that have been used traditional to facilitate the free flow of qi and blood, nourish qi and blood, sooth a woman’s emotions and help correct the position of the baby. Even if an induction is planned acupuncture may facilitate a more efficient labour. The feedback that we have received from woman is that it helped them cope better and reduced the intervention rates.
Pregnancy is a time when a woman’s body developing large amounts of qi and blood to support the pregnancy and developing baby. Haemoglobin is the red blood cell that carries oxygen to every cell of her body. The haem component of this cell contains the iron. If this gets depleted this is known as iron deficiency anaemia. The symptoms of this are excessive fatigue, breathlessness, pallor, heart palpitations and poor resistance to infections. A woman may begin her pregnancy already deficient due a poor diet or other health condition. At the beginning of her pregnancy she will have her iron levels checked. This will give a baseline of her iron stores (ferritin) and the state of her haemoglobin. At around 26-28 weeks another blood test is offered to check this status. By this stage, her blood volume has increased providing further information about how well her system is managing with the demands of the pregnancy and developing baby. It is common at this stage for woman to require extra supplementation for iron. It is around this time that the baby starts to call on more iron from the mother’s system as it starts developing more of its own haemoglobin. The mother requires enough iron in her diet to support both herself and baby without leaving either one vulnerable. At 36 weeks a blood test will be offered to check her iron stores and haemoglobin. This will declare the state of her iron studies and whether her system will require more iron support prior to going into labour to minimise the risk of haemorrhaging following birth and to prevent premature labour. Some women appear more at risk of iron deficiency anaemia that others. They are ones on a poor diet, unable to absorb iron efficiently, poorly managed vegans or vegetarians, multiple pregnancies, woman who have had their children close together, or woman who have had recurrent miscarriages prior to the current pregnancy.
Chinese medicine views anaemia as qi and blood deficiency. The treatment of acupuncture for this condition focuses on building good amounts of qi and blood. This is best started as soon as the woman becomes symptomatic or is aware of her low iron levels. When a woman presents in clinic a full history will be taken, a TCM diagnoses made and a treatment plan put in place. She will be shown how she can support this at home each day with her diet, appropriate supplementation, and the use of moxa on certain points.