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Pain relief to a point

Mary-Claire Mason. Nursing Standard. Harrow-on-the-Hill: Aug 27Sep 2, 2008. Vol. 22, Iss. 51; pg. 22, 2 pgs

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Acupuncture can help to relieve some of the discomfort and pain associated with pregnancy. Midwife Sarah Budd has been practising the technique for 20 years.

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Copyright RCN Publishing Company Aug 27-Sep 2, 2008

[Headnote] Acupuncture has enabled midwife Sarah Budd to treat women safely during pregnancy, reports Mary-Claire Mason SUMMARY Acupuncture can help to relieve some of the discomfort and pain associated with pregnancy. Midwife Sarah Budd has been practising the technique for 20 years. Keywords Pregnancy * Acupuncture * Moxibustion * Acupressure * Complementary and alternative medicine * Pain relief * Breech presentation

'What next?' was the question midwife Sarah Budd asked herself in the mid-1980s. She had qualified as a midwife and had been appointed to a sister's post, but did not want to go further up the management ladder. 1In those days, many women were coming to us asking for a more natural childbirth, but there was not much to offer, which I thought was sad,' she says. Ms Budd had an interest in complementary therapies. Acupuncture seemed the most obvious choice for use in pregnancy as it was fast acting and had some scientific basis. She decided to find out more about using acupuncture to relieve labour pains and spoke with the head of midwifery and one of the

consultants at Derriford Hospital, Plymouth, where she worked. Her suggestions were well received, she recalls. First she had to qualify as an acupuncturist. While continuing to work full time, she travelled to London every third weekend for training, for which she was granted study leave by her manager and given a number of bursaries to pay for tuition. After three years, Ms Budd qualified as an acupuncturist but felt that she still did not have enough experience to treat pregnant women. So she went to China for six weeks to top up her training. On her return to the UK in 1988, she began offering accupuncture as an alternative form of pain relief for women in labour. She was the first full-time midwife acupuncturist in the country Expanded service Soon midwifery colleagues started to ask whether she couid help women with problems such as backache and morning sickness, so she began to offer acupuncture for these problems too. Ms Budd was joined by two col leagues to provide the expanded service. How can acupuncture help pregnant women? Ms Budd points to the restriction on the use of medication during pregnancy. Women can suffer greatly from various problems such as hyperemesis gravidarum - the severe episodic vomiting of early pregnancy - but have little help to hand. Many women with underlying medical problems have to come off their usual medication during pregnancy. 'We can fill the gap and treat these women by offering them safe relief without going down the medication route/ Ms Buddsays. Women can refer themselves to the service, but most come via referrals from midwives, GPs and physiotherapists. The number of sessions a woman needs will depend on her problems. An improvement is often seen after three, 30-minute sessions. Morning sickness Problems treated include backache, morning sickness, pelvic pain, constipation and, after the birth, mastitis, haemorrhoids and postnatal depression. Acupuncture is used to prepare women for labour and to

induce it, as well as to provide pain relief as an alternative or alongside conventional help during labour. Breech presentations can also be treated with acupuncture, although treatment consists not of needles but of using moxibustion, ideal Iy at 34 weeks' gestation. Moxibustion for breech presentations involves heating an acupuncture point on the little toe with the herb mugwort. Women are taught how to use the treatment at home and up toten daily treatments may be needed before the baby moves to a cephalic, head-down presentation. 'We have a 60 per cent success rate using this technique, which is in line with results from other research trials/says Ms Budd. Ms Budd has carried out reviews of published research papers into the effectiveness of acupuncture for certain obstetric problems for the British Acupuncture Council. Conceding that the studies are variable in quality and design, she nonetheless has concluded that there is some evidence that acupuncture is an effective treatment for these conditions. Her own clinical experience at Derriford Hospital is that the technique is helpful, with about85 percent of women having a positive outcome. Acupuncture is safe provided certain acupuncture points are avoided during pregnancy and there are few contraindications. But safety depends on midwives being properly trained and qualified in the technique. She and her two colleagues have joined the British Acupuncture Council, the members of which have completed training courses validated by the British Acupuncture Accreditation Board. Ms Budd says shorter courses consisting of a couple of weekends, for example, are not comprehensive enough. Ms Budd is delighted that the service at Derriford Hospital is still going some 20 years after she set it up. Obstetric acupuncture is safe and effective. My dream isthat women all over the country should have access to it on the NHS,' says Ms Bu dd.

In 2004, she produced a document, Implementing a Maternity Acupuncture Service Information for Managers, that was sent to the heads of more than 300 midwifery services. The feedback was positive, but the reality in 2008 is that services have not sprung up all over the UK. Ms Budd says this is probably down to the demands of the three-year train ing course The answer may be to have an acupuncture course specifically tailored to midwives' needs, such as that set Lip in New Zealand by nurse acupuncturist Debra Betts. It involves a series of six weekend workshops that take place over eight months to a year. The course has been recognised by the qualification authorities in New Zealand. A similar course here could be the way forward, but first Ms Budd wants to see the government's forthcoming plans for regulating complementary therapies. Meanwhile, there is an exciting pilot project at Derriford Hospital assessing the use of accupressure for pain relief during labour. Women and their partners are taught how to apply pressure to relevant points. The hope is that midwives can be trained how to use these too
[Sidebar] 'MY DREAM IS THAT WOMEN ALL OVER THE COUNTRY SHOULD HAVE ACCESS TO ACUPUNCTURE ON THE NHS'

[Sidebar] About acupuncture * Stimulating specific acupuncture points may affect the functioning of certain organs but these points may not be close to the organ's anatomical position. * There are around 500 acupuncture points around the body. * A selection of around ten or 12 points are used for each treatment. * Different points may be selected as the condition changes during a course of treatment. Source: British Acupuncture Council - www.aaipuncture.org.uk

[Sidebar] For more information about the New Zealand training course and a booklet

about acupressure and pregnancy visit www.acupunctLtre.rhizome.net.nz The Maternity Acupuncture Service at Derriford Hospital can be contacted on 01752 763689. Ms Budd can be contacted at sarah.budd@phnt.swest.nhs.uk

[Author Affiliation] Mary-Claire Mason is a freelance health journalist

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MeSH subjects: Acupuncture (major), Female, Great Britain, Health Services Accessibility, Humans, Labor Pain -therapy(major), Morning Sickness -- therapy, Nurse Midwives (major), Pregnancy, State Medicine Mary-Claire Mason Mary-Claire Mason is a freelance health journalist Nursing Standard. Harrow-on-the-Hill: Aug 27-Sep 2, 2008. Vol. 22, Iss. 51; pg. 22, 2 pgs 00296570

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Sarah Budd, midwifery sister/acupuncturist at Derriford Hospital, Plymouth, is one of a team of three midwives who have been using acupuncture since 1988 Acupuncture is part of traditional Chinese medicine, based on the

principle that energy (qi) flows through the body along invisible channels called meridians. Needles are inserted into acupoints, specific areas of the body that correspond with a particular organ. Acupuncture in labour works on the endocrine system, which is responsible for producing hormones, including oxytocin the hormone that makes the uterus contract and also helps with relaxation and pain relief, says Sarah. Half-inch needles are inserted in points in the upper and lower limbs and on the ear during labour. These points correspond to the pelvis and endocrine system, producing the hormones needed for pain relief, relaxation and contractions. A Swedish study found that 58% of women who had acupuncture managed their deliveries without any other pain relief, compared to only 13% of those who didnt have acupuncture. Sarahs self-help tips Only a tiny number of NHS midwives are trained in acupuncture, and you cant administer it yourself. If you cant afford to hire your own private acupuncturist for labour try some acupressure techniques instead: The hand points (along the crease of the hands where the fingers join the palm) are thought to help release endorphins your bodys natural painkillers. Try, gripping a small comb to apply pressure to this point as a contraction builds. For
Sarah Budd has a background as a Midwifery Sister and subsequently trained as an acupuncturist in London and China.

She set up an acupuncture service in Plymouth Maternity Unit in 1988, then completed a degree in Complementary Health Studies at Exeter University. In 1991, where she won a Churchill Fellowship, and then went to China again to study acupuncture anaesthesia. She was given the first and only full time post as acupuncturist midwife in the UK, then had a family, and now works one day per week in Plymouth, and privately at home. Over 6,000 pregnant women have been treated with acupuncture on the NHS in Plymouth, and the service was joint winner of the Prince of Wales' Foundation for Integrated Health Award in 2001. Sarah co-authored a report for the Department of Health with Simon Mills, "Professional Organisation of Complementary and Alternative Medicine in the United Kingdom 2000" and worked as a Research Assistant on the Regulation of Complementary Medicine, and in the Acupuncture Research Resource Centre. Over the years, Sarah has contributed to text books and journals and continues to teach in acupuncture colleges / universities. It is a joy to offer help to women struggling in pregnancy, who would not otherwise be able to afford treatment. Sarah Budd. Acupuncture in pregnancy Antenatal acupuncture can help you to have a happy, healthy pregnancy, relieving many of the discomforts of pregnancy and preparing you for a good labour. Symptoms that Antenatal Acupuncture can treat
Many of the 'minor' discomforts of pregnancy can be very effectively treated using acupuncture, without any unwanted side affects for wither mother or baby

Moxa treatment for breech position babies Moxa is a gentle and safe treatment understood to have an effect on the tone of the muscles of the womb, encouraging the baby into a head down position. Preparing for labour and pre-labour acupuncture Acupuncture treatment before your labour can give you the strength to sustain your labour and therefore require less intervention. Acupuncture to induce labour

If your baby is overdue, acupuncture can be successful in promoting the induction of labour, or help your body to cope better if a hospital induction is required. Acupuncture during labour Acupuncture during labour is not just about pain relief! It can also help with a number of problems during labour, and give you an extra level of support.