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Monday 12 December 2011

Acupuncture during pregnancy and labour

Dyspepsia is a pain or an uncomfortable feeling in the upper abdomen. It includes all the symptoms that expecting mothers are so familiar with – bloating, heartburn, nausea, vomiting, burping, and a burning stomach pain. Although this is a common problem, the use of medication in pregnancy is always a concern. Normally, antacids (that neutralize stomach acid) and alginates (negatively charged polysaccharide found in the cell walls of brown algae that protect the esophagus by forming a protective ‘raft’ when they come in contact with stomach acid) are used to relieve dyspepsia during pregnancy. Most of these are safe but products containing magnesium have a tendency to cause constipation and those containing aluminum may have a laxative effect. Acid suppressing drugs such as ranitidine and omeprazole are other options but if you do not prefer popping pills, you can go in for acupuncture which is a safe, drug-free treatment ideally suited to pregnancy according to the acupuncture therapists.


Lot of evidence exists about the use of acupuncture for nausea and vomiting in pregnancy, but not much is known about the efficacy of acupuncture for other dyspepsia complaints. So, researchers João Bosco Guerreiro da Silva and colleagues from Department of Internal Medicine, Rio Preto Medical College, Sao Jose do Rio Preto, Brazil, conducted a study to observe the effects of acupuncture on symptomatic dyspepsia during pregnancy and to compare this with a group of patients undergoing conventional treatment alone. This study was approved by the Research Ethics Committee of the Federal University of São Paulo, Brazil. The results appeared in Acupuncture in Medicine, scientific journal published by the BMJ group.


A total of 42 subjects in the age group of 15 to 39 years at 15 to 30 weeks of pregnancy and dyspepsia symptoms were chosen for the study. These women were randomly placed into ‘to be treated with acupuncture’ and ‘not to be treated with acupuncture’ groups. Six women dropped out - one in the acupuncture group and five in the control group. Acupuncture was performed once a week, (sometimes twice if necessary) during 8 weeks. Traditional acupuncture, using sterilized stainless steel needles of 40 mm in length and 0.2 mm diameter, was performed respecting the classical acupuncture points including depth of insertion.


During the first trimester, the focus of the treatment is to reduce the likelihood of miscarriage and address any early pregnancy symptoms such as nausea, morning sickness and fatigue.
Acupuncture during the second semester aims to maintain the balance and address many of the common complaints of pregnancy mentioned above.
Acupuncture during the third trimester prepares the body for labour and delivery by relaxing and softening ligaments, aiding cervical dilation, nourishing the body’s ‘’Qi’’ and blood, as well as relieving any muscular pain or discomfort. This is also the time where Acupuncture is used to turn breach babies.
It is recommended to start this treatment as soon as you learn that the baby is in breach position (around 33-36 weeks)
During the whole pregnancy, special attention will be given at diet and lifestyle.


Treatment for labour induction can be given any time after 39 weeks if there are no complications with the pregnancy.


Acupuncture for delayed labour has been used in China for at least 2,300 years, but Acupuncture for labour pain was rarely used because, according to Chinese culture and oriental tradition, women were expected to experience the pain of childbirth! The first occurrence in Chinese medical literature was in 1970 in ‘A barefoot doctor’s manual’ (my first book on Acupuncture),
The manual drew on the practical expertise of local health workers, often self-taught, who went from house to house to administer medical attention in the form of Acupuncture and herbal medicine.


It was around the same time the interest in Acupuncture Analgesia became the focus of much research in Europe and the western world in general.


In 1972 Christian Ehrstroem performed the first Acupuncture delivery in the west in Stockholm.


In 1974 Darras in France reported 20 electro-acupuncture deliveries by primiparea and multiparea. Since then, Acupuncture has rapidly become more popular for women in childbirth, mainly because it is a natural pain-reliever with no harmful side effects for mother or baby. Moreover, women like to feel in control during their labour and delivery, a feeling of which they may be deprived by some of the more potent conventional analgesic techniques used in today’s maternity units.


Acupuncture is also used in ‘difficult’ labour. Difficult labour can result from abnormality of the uterine contractions, cephalo-pelvic disproportion (that is imbalance between the size of the maternal pelvis and the baby’s head), or malposition and malpresentation of the baby.


Acupuncture can be of help in the first of these, but not the others. It is important to note that ‘malposition’ of the baby should not be confused with ‘malpresentation’: the latter occurs when the baby’s bottom (breach); shoulder; face or brows present first as opposed to the head - as in normal cephalic presentation. ‘Malposition’ means incorrect positioning of the head, which includes occipito-posterior position and deflection of the head. Acupuncture can help in ‘malpresentation’, but not ‘malposition!’

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