Natural solution for morning sickness.
Morning sickness, a condition in pregnancy
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
