Qi Spot

I was referred a patient, three months pregnant, for management of migraine, nausea and vomiting.  (Note to skeptics, the patient was referred by her neurologist, which proves that there is definitely a way for east and west to team up.)  One can imagine the thoughts that ran through my mind, “time to review the so-called forbidden points”.

Common sense dictates that the management of a pregnant patient, using whatever medical tradition, requires special care.  Certain drugs can’t be given, certain manipulations are discouraged, etc.  Acupuncture wise, there are points that are traditionally forbidden as strong stimulation on them would cause uterine contractions.  I shan’t mention them here for fear that the less-than-holy might use these points to induce artificial abortions.  Sorry but I don’t want to advocate that.

Anyhow it got me thinking.  The points are forbidden because strong stimulation might cause contractions.  What if no stimulation is done?  This is not an exact science because I have sometimes elicited strong qi sensations from patients despite having just inserting a needle.  To be safe, avoid using aforementioned points then.

The second reason that some points are forbidden during pregnancy is because of anatomic location.  Granted, specialists in acupuncture anesthesia for cesarean sections are used to putting in six inch needles in the abdomen, but the general population, even of highly trained acupuncturists, would rather not risk having needles anywhere near a fetus.

Another school of thought is this: use the non-anatomic (first category) forbidden points, but keep the stimulation down (as mentioned before) and keep the number of needles down.  In other words, it’s not the individual point stimulation, but the sum total of all stimulations that are important to prevent premature uterine contraction.

To be safe, I keep the number of needles down, and avoid the “forbidden” points as much as possible.

And the patient’s symptoms are much improved, btw.

Firstly, I’d like to apologize for not posting for two weeks. I’ve been travelling a lot through Hong Kong and China. I will blog more on some observations I’ve made while in Hong Kong as soon as I get some of my photographs uploaded to my laptop.

Speaking of Hong Kong, I am beginning to wonder if there is some grand plot to discredit acupuncture in Hong Kong. First comes the “letter to the editor” concerning acupuncture spreading disease (http://qi-spot.com/2010/03/20/new-bashing-technique-acupuncture-causes-disease/) and now this.

“Acupuncture does not relieve childbirth pain” (http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study)

I am the first person in the world to admit where acupuncture is one big FAIL (such as in colour blindness). But I would like to call the attention of the reader to the weasel wording evident in this smear campaign of a headline.

Look at the title. “Acupuncture does not relieve childbirth pain.” What does this imply to the reader? It implies that acupuncture has no effect at all on the pain felt by mummy.

Yet the sub-title below the headline betrays a hint of the truth:

“Research suggests results from complementary therapy during labour may be placebo effect”

Now, we have no idea, based on this sub-headline if this is a single study or a meta-analysis.  As we have said before, a meta-analysis is a fancy way of saying, “let’s put different studies together just to get the numbers up.  We can always find a way to put the studies together that the sum total numbers can be made to say whatever we want.”

Secondly, it “suggests” (whatever that means) that the results may be placebo effect.  Wait.  Results?  RESULTS?  I thought that acupuncture “does not relieve” childbirth pain?  So if it is useless, why are there “results”?  That means there WAS relief of pain.

So why come up with a headline saying otherwise?  Because the results “may” be placebo effect.

Actually, I wouldn't use those points in pregnancy... but what the heck. Then again, he just might be some really fat guy...

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.

“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

The finding, which has already prompted a vigorous debate about the value of acupuncture, came from British and Korean researchers who examined previous studies of its use in labour.
“The results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture,” researchers told BJOG: An International Journal of Obstetrics and Gynaecology. The journal is owned by the Royal College of Obstetricians and Gynaecologists, which represents most of the UK’s doctors specialising in childbirth and maternity care.

So it IS a meta-analysis.  Strike one.  I wonder what points were used? Hmmm…

Prof Edzard Ernst, of the Peninsula medical school at Exeter and Plymouth Universities and co-author of the report, said: “The effects of acupuncture perceived by women are largely due to placebo. Acupuncture has many qualities that maximise placebo effects: it involves touch and is invasive and, psychologically, is attached to the mysticism of the east.”

Ernst is a known skeptic of acupuncture and makes a living (i.e. buy his book!) by bashing it.  Then again, I make my living healing patients with it, so I guess we cancel each other out.  Still, he admits that acupuncture DOES have an effect, it’s just that he either cannot or will not recognize the evidence that acupuncture DONE PROPERLY is more than placebo. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/)

I would like to point out that even in western medicine, there exist drugs for which the mechanism of action is unknown.  Lithium is used for bipolar disorder and it is not known how it works.  Yet it is given, despite toxicity, because it has been observed to work.  I leave it to the reader to witness where the double standard lies.

Also, I find it disturbing that people will look down (albeit unintentionally) on patients’ experience just to pooh-pooh acupuncture.

Prof Philip Steer, BJOG’s editor-in-chief, said labour pain can be so intense that a women would do anything to minimise it.

Please, by that logic we can get a shaman in pyjamas to conduct ritual chants and that would work.  Yet it doesn’t, and acupuncture does.

“Acupuncture is a drug-free approach and that may explain why some women prefer its use during labour. This review shows that in a very small number of cases acupuncture may be of help, usually for short periods of time after treatment, and this may be down to psychological rather than a physiological effect. Generally the consensus is that the evidence does not support its use.”

The only benefits were 11% less pain in the first 30 minutes after receiving acupuncture and a need for less pharmacological pain relief, the authors say.

Wait wait wait.   The “only” benefits? So “they” begrudgingly admit that there are benefits!  Back to my first question: why the irresponsible headline, then?  The last part of the sentence betrays the answer:

“…a need for less pharmacological pain relief” – in english: LESS DRUGS.

Less drugs, less profit for big pharma.

I will skip to the last part:

Mike O’Farrell, chief executive of the British Acupuncture Council, said: “We’re surprised by these findings as previous trials, along with the evidence that our members see in their practices every day, suggest that acupuncture can be effective in providing pain relief in many different circumstances.”

Again, as I have said before, people not biased by big pharma can see where acupuncture works and it doesn’t.  I am happy to report, both first hand and through correspondence with other OB-Gynecologists even in the US, that acupuncture can work in reducing childbirth pain IF DONE PROPERLY.

My final thoughts: this article should have been entitled “Acupuncture apparently no better than placebo” instead of “Acupuncture doesn’t work”.  News bias, bah humbug.

Campbell, Denis.  ”Acupuncture does not relieve childbirth pain” The Guardian.  28 April 2010.  <http://www.guardian.co.uk/society/2010/apr/28/acupuncture-childbirth-pain-study> Accessed 28 April 2010

Source: http://www.dailycamera.com/health-fitness/ci_13730372 This is an interesting article.  I will reproduce it plus add my own comments to each “myth”/

Science vs. Grandma: Debunking old wives’ tales — or not
By Aimee Heckel Camera Staff Writer
Posted: 11/10/2009 09:08:16 AM MST

This must be how it all started.

Heath Croll’s 7-year-old nephew thought spinach was disgusting. But Croll, a Boulder-based youth fitness specialist, knew how to change that.

“If you want to get big and strong like you’re uncle, you’ve got to eat spinach,” Cross told him.

The boy started eating it immediately, straight out of the bag.

Croll, who has more than 13 years working with kids and fitness, admits the Popeye-spinach connection isn’t exactly a medical fact.

“It’s not that simple,” he says. Purely popping cans of spinach will obviously not inflate muscles, not without strength-training and a more comprehensive nutritional plan.

Yet it worked for Popeye, right? Just like chicken noodle soup cures a cold, and carrots improve your eyesight, and it’s bad to swim on a full stomach.

Right — Grandma?

Old wives’ tales have been around as long as, well, old wives. And despite advances in science and doctors begging us not to believe some of them, the tales — some myths, some truths — live on. Even when they defy logic, says Michelle-Nicholle Calareso, a Longmont-based birth doula and childbirth educator.

Ah yes, the old wives’ tales around pregnancy are prolific, she says with a laugh. Any rational woman knows that the patterns of a swinging necklace can’t foretell the gender of your baby, and neither does the way an expecting mom picks up a key.

Yet we still play these games, Calareso says.

“It’s part of human nature,” she says. “Pregnancy is so unknown. Science tries to take care of it, but it’s still just a lot of unknown, so people try to explain it any way they possibly know how. We don’t like the unknown.”

The same goes for trying to control nature, she says. Gardening has its own tales: Frost is coming if you don’t see many birds.

“It makes sense, kind of,” Calareso says. “Over time, people say, ‘Hmm, yeah, I’ve seen that happen,’ and there you go. It’s your reasoning for trying to explain the world.”

And many bits of advice do seem to make sense.

Others, Calareso says, are actually true.

All of this family time with Grandma this holiday season may have you wondering: Which of her warnings hold weight? Here, we’ve pitted a variety of local experts against good ol’ Grams, to make sense of some of our favorite old wives’ tales.

1. If you carry the baby high, it’s a girl. If you carry low, it’s a boy.

Calareso: False. How a mother carries her baby is based on her physique: the length of the torso, where the baby is positioned, how it’s sitting. The gender has nothing to do with it.

“I always giggle at these myths,” she says. “Babies will sit any way they want to.”

In fact, Calareso says, there is no way to predict the gender — for sure. Darker nipples don’t mean it’s a boy. Fetal heart rate is the same for all healthy babies, regardless of gender, she says. Despite its popularity — you can even download it onto your Palm Pilot — the Chinese birth chart is bunk. Your cravings or amount of heartburn have to do with the mother and her hormones, not the baby. Even ultrasounds can be wrong.

Girls do not “steal their mom’s beauty” or cause women to have extra acne. (The amount of estrogen from a girl fetus has no real effect on the mother’s body.)

“I had skin problems, and I had two boys,” she says. “Those were my hormones. You can’t really blame it on them. You can blame other things on them, but not that.”

On the contrary, from my own experience as a physician, I find that pregnant ladies with better skin usually have girls, and that it’s the pointedness of the belly that counts, not the highness or lowness..

2. Eat chicken soup if you have a cold.

Amy Dickinson, licensed acupuncturist, of Boulder: True. Go, Grandma! Hot liquids are soothing for the throat. Onions and garlic help the lungs and have anti-microbial effects.

The Chinese version of this is hot and sour soup, which also contains vinegar, an extra “oomph” in terms of healing properties, Dickinson says.

“I am recommending this a lot at this time of year, as you can imagine,” she says. “And the cod liver oil Grandma used to force our long-suffering parents to swallow is now recommended by every medical profession I know.”

Manora Nygren, herbalist at the North Boulder Pharmaca Pharmacy: True. The minerals in the bones of the chicken help your immune system. So do the healthy fats and protein. Hot liquids can also warm up your insides if you have the shivers.

Not always, but generally yes.  But most piping hot soups… or even hot water, works in helping my patients expel phlegm.

3. Don’t go swimming on a full stomach.

Croll, youth fitness specialist: True. Overeating before an activity can make you feel sick and give you a stomach ache. It’s not seriously dangerous, though; you’re not going to be overcome by cramps and drown. This wives’ tale could have been created to keep kids from throwing up in the pool.

Joe Horwat, Boulder-based USA Olympic sports performance coach: True. Cut down on the amount of protein and fat you consume one to two hours before exercising; they digest slower and can cause cramping — with any kind of exercise. If you’re feeling hungry, instead consume a simple carbohydrate, such Vitamin Water. This fills your stomach, gives you some energy and won’t make your stomach hurt.

Debbie Steinbock, holistic health counselor with Boulder-based Whole Nourishment: True. We digest better when we aren’t diverting blood flow to other activities.

Darned right!

4. An apple a day keeps the doctor away.

Croll, youth fitness specialist: Not exactly. A variety of fruits and vegetables will help keep the doctor away.

Dickinson, acupuncturist: Sort of. Grandma was probably referring to good nutrition, in general. Chinese medicine has always treated food as therapy. Now, biomedicine is finding a “revolutionary” connection between the digestive system and the immune system.

“All the good medicine in the world cannot reverse the effects of improper diet, and indeed the most prevalent diseases of wealthy countries today — Type II diabetes, coronary artery disease, obesity — all stem from undisciplined eating,” Dickinson says. “Another point for Grandma.”

Snopes.com: Sort of. Apples have antioxidants and flavonoids that enhance the activity of vitamin C and can help reduce the risk of colon cancer, heart attack and stroke.

The problem is pesticides, and yes variety is important.  Chinese medicine teaches that if you eat the same thing over and over again you will gain too much of one flavor and that is bad too.

5. If you swallow your gum, it’ll take seven years to digest.

Croll, youth fitness specialist: False. Otherwise every time you get an x-ray, you would see lumps of gum.

Nygren, herbalist: False. Gum resin comes from the gum tree. It’s not going to digest easily, but it’s a natural component of nature.

“It doesn’t take seven years, but I don’t think that it’s the best thing for your system,” Nygren says.

Snopes.com: False. Gum is “indigestible,” meaning the body can’t break it down. But it still can pass through the body — at the same rate as any other swallowed matter.

Why seven?

6. Eating carrots will improve your vision.

Croll, youth fitness specialist: Not exactly. The beta-carotene is healthy, but same with the apple; there’s a lot more to eye health than just eating carrots.

Steinbock, nutritionist: True. Carrots have beta-carotene (a natural form of vitamin A), which supports the health of the optic nerve.

Snopes.com: False. Eating carrots will not actually improve vision. Although carrots are a good source of vitamin A and beta-carotene, which can reduce cataracts and macular degeneration, studies show it would be difficult to eat the number of carrots necessary to make a difference. Plus, large doses of vitamin A can be toxic, and too much beta-carotene can turn your skin orange.

I suddenly remember episode 1 of House.  “You’re orange you moron”

7. Spicy foods cause ulcers.

Nygren, herbalist: False. Spicy and acidic foods can aggravate an ulcer, but the won’t cause ulcers unless you already have the predisposition. Otherwise, all people in Mexico would have ulcers.

Steinbock, nutritionist: False, although some foods (refined, spicy, fried, alcohol) can cause an increase in stomach acids and aggravate an ulcer.

The Mayo Clinic: False. The cause of most ulcers is a corkscrew-shaped bacterium called the Helicobacter pylori. Excessive alcohol consumption, stress, smoking and the regular use of pain relievers may be aggravating.

TCM wise, I’d have to say yes.  Excessive intake of spicy foods without balancing foods would lead to increase in Stomach Fire and greasiness.  Hence, one reaction would be an increase in acidity relieved by food intake, as well as increased pain relieved by food intake.  Think of it as more wood for the fire to burn or else the fire starts burning the stove…

8. Shaving will cause the hair to grow back thicker.

Jamie Gordon, cosmetician at Lafayette-based Jamie Gordon Skin Care Studio: False. You have two different types of hair: pre-pubescent hair that will come back the same no matter how you take it off, and “hormonally related” hair, which is subject to hormonal changes. It is possible to kill a hair follicle after repeatedly subjecting it to waxing over a long period of time, but that follicle might have died anyway because of hormonal changes, such as menopause.

Snopes.com: False. Cutting does not stimulate growth. If it did, bald men would be shaving their heads

I’ve heard this from my wife’s relatives.  No idea if it’s true or not.

9. You should sweat out a cold.

Dickinson, acupuncturist. Depends. Chinese medicine differentiates between the colds you get in winter and in the summer. For the common winter cold — with the chills, lack of sore throat and body aches — you will feel better if you drink hot liquids, use diaphoretic herbs, wrap yourself up in blankets and sweat out the pathogen. On the other hand, a cold with feelings of heat and rapid heart rate could get worse with sweating.

Nygren, herbalist: Depends. If you have a fever, some herbs (osha root, yarrow) can raise your temperature, help kill the bacteria and cause the fever to “break.”

“Sometimes your body needs a fever,” she says. “Breaking it can be helpful — if it’s ready to break.”

Very very true, the “it depends” part.

10. Toads give you warts.

Nygren, herbalist: False. This myth probably stems from ancient women who had knowledge of plants, who were labeled “witches.” These women used to create an ointment out of boiled skins of certain toads and rub it on their skin. The ointment had “mind-opening” (hallucinogenic) qualities. These women were often old and therefore had warts.

“It might have gotten confused that women who had warts play around with toads,” Nygren says.

The Mayo Clinic: False. Warts come from contact with the human papillomavirus.

What if the frog had HPV?  Maybe they couldn’t afford gardasil!

11. Standing on your head after sex can help you get pregnant.

Calareso, doula: False.

“I hear lots of interesting things people try: standing on your head, lying in all kinds of different positions, not eating spicy things,” she says. “They’re ridiculous things.”

Whereas the position does not matter, men should be careful not to overheat their scrotum, which can slow down the mobility of the sperm.

Parents Magazine: False. It doesn’t matter to the sperm and egg what position you use.

Didn’t work for me!

12. Drinking two glasses of Gatorade will relieve a headache.

Croll, youth fitness specialist: Depends on why you have a headache. If you’re dehydrated with low energy, the electrolytes in Gatorade can help relieve some symptoms. It won’t help a migraine, though.

Horwat, personal trainer: Depends. If you have a headache after a big training day, it could be due to lack of sugars, liquids and carbs in your diet. Gatorade could help, although it’s basically sugar water.

Steinbock, nutritionist: Depends. Hydration can help some headaches, but the excess sugar and food coloring in Gatorade can make a headache worse. Stick with water.

And will make you fat.

13. Put toothpaste on a burn or acne.

Nygren, herbalist: Maybe. If the toothpaste contains baking soda, it could help balance out the pH of your skin. I wouldn’t put baking soda directly on a burn, but toothpaste could help soothe and cool a small burn temporarily.

Gordon, cosmetician: Maybe. Baking soda can be anti-inflammatory, it helps absorb oils, exfoliates and draws out toxins, so it makes sense. But remember: Toothpaste has been so reformulated since this myth probably originated. Much of today’s toothpaste also contains dyes, whitening agents and all kinds of ingredients.

Instead, put Vaseline on a burn to temporarily relieve pain. It seals out the air.

What my wife does is put Watermelon frost powder on toothpaste and THEN use it on a burn.

14. Put honey on a blemish and cover with a Band-Aid overnight.

Nygren, herbalist: Probably. Raw honey has strong antibacterial components to it — “although I’ve never actually done it or heard or anyone doing it,” she says.

Gordon, cosmetician: True. Raw honey is often used in face masks. She references the “Beauty by Nature” book by Boulder herbalist Brigitte Mars: Honey is mildly antiseptic and holds water; helps draw impurities out of the skin; and can soothe, heal and nourish the skin.

TCM wise, I agree with Mars.

Breech births are difficult.  Instead of the baby’s head at the bottom, ready to charge through at the proper time, it is the feet which are “presented” to the doctor.  A viewing of the movie “Red Cliff” showed Zhuge Liang (played by Takeshi Kaneshiro) successfully solve the problem of breech birth in a horse.  However, traditionally the use of moxibustion on acupoint Zhiyin (BL-67, or the 67th point of the Bladder channel).  However, a recent article <http://www.reuters.com/article/healthNews/idUSTRE59S41C20091029?pageNumber=1&virtualBrandChannel=10522> says that the “Chinese Medicine Tactic doesn’t turn breech babies”

Before I examine the article in depth, I’d like to point out how this “tactic” is supposed to work.

Using a Moxibustion "cigar"

Peter Deadman describes the procedure as such:

The principal application of Zhiyin BL-67 is the treatment of malposition of the foetus, for which it is renowned.  For this purpose it is treated by stick moxibustion for fifteen to twenty minutes bilaterally, or by moxa cones (five to ten cones at each point) once or twice a day.  the woman should loosen her clothes and sit in a comfortable semi-reclining position.  It is common practice in China to demonstrate this method to the pregnant woman who is then supplied with moxa sticks for self-treatment at home.  Best results are achieved if this treatment is started in the 34th week.

That’s what Peter Deadman says in his encyclopedic work, A Manual of Acupuncture which is actually more huge textbook than manual.  Other texts describe the procedure differently:

Chinese Therapeutic Methods of Acupoints published by Hunan Science and Technology Press elaborates:

Let the patient loosen her clothing and evacuate the urine from her bladder.  She should lie supine in bed.  then, hold two moxa sticks respectively 2-3 cm bilaterally to Zhiyin (BL-47).  Ignite them for moxibustion for 15-20 minutes causing local congestion.  The treatment is given once a day.

What strikes me in this description is the need to perform moxibustion on both sides (two points, both BL-67) simultaneously.

So how did the study do it?  You know the drill by know, folks: we quote the study and critique it.

NEW YORK (Reuters Health) – A traditional Chinese therapy used for turning babies out of the breech position before birth may not be effective, a new study finds.

The study, reported in the journal Obstetrics & Gynecology, tested a tactic known as moxibustion, which uses heat to stimulate a particular acupuncture point in an effort to turn a breech fetus to the head-down position before birth.

Moxibustion is MORE than just heat.  It is also exposing the acupoint to the essential oils released when the mugwort plant (mogusa in Japanese, hence the name “moxa”) is burned.

Some research has suggested moxibustion might be effective; a trial in China, for example, found that the method increased the chances of the fetus turning to the head-down position.

However, some other studies have been unable to replicate that success, and moxibustion remains “controversial” outside of Chinese medicine, according to the researchers on the new study, led by Marie-Julia Guittier of the Geneva University Hospitals in Switzerland.

Uh… I love it when people seem to imply that only Chinese studies prove efficacy.  What about the following:

Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.  – Neri I – J Matern Fetal Neonatal Med – 01-APR-2004; 15(4): 247-52

OBJECTIVE: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. METHODS: A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupoint (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). CONCLUSIONS: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.

That was not just moxibustion however: it was acupuncture AND moxibustion.

Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: A systematic review – van der Berg et al, Complementary Therapies in Medicine Volume 16, Issue 2, April 2008, Pages 92-100 Online March 18, 2008 Accessed 30 october 2009 (http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WCS-4S0356K-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=c619612fbda948f84d4d532350dfd306>

Objective

A systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials.

Data sources

Articles published from 1980 to May 2007 in databases of Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, NCCAM, Midirs and reference lists.

Study selection

Studies included were original articles; randomised controlled trials (RCT) or controlled cohort studies; acupuncture-type intervention on BL 67 compared with expectant management; ultrasound confirmed breech presentation and position of the fetus after treatment confirmed with ultrasound, position at delivery, and/or the proportion of caesarean sections reported.

Data extraction

Three reviewers independently extracted data. Disagreements were resolved by consensus.

Data synthesis

Of 65 retrieved citations, six RCT’s and three cohort studies fulfilled the inclusion criteria. Data were pooled using random-effects models. In the RCT’s the pooled proportion of breech presentations was 34% (95% CI: 20–49%) following treatment versus 66% (95% CI: 55–77%) in the control group (OR 0.25 95% CI: 0.11–0.58). The pooled proportion in the cohort studies was 15% (95% CI: 1–28%) versus 36% (95% CI: 14–58%), (OR 0.29, 95% CI: 0.19–0.43). Including all studies the pooled proportion was 28% (95% CI: 16–40%) versus 56% (95% CI: 43–70%) (OR 0.27, 95% CI: 0.15–0.46).

Conclusions

Our results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. Some studies were of inferior quality to others and further RCT’s of improved quality are necessary to adequately answer the research question.

Breech Pregnancies - treated by moxibustion?

Habek D, Habek J and Jagust. “Acupuncture Conversion of Fetal Breech Presentation” Fetal Diagn Ther 2003;18:418-421 (DOI: 10.1159/000073135)  Accessed 30 October 2009<http://content.karger.com/ProdukteDB/produkte.asp?Doi=73135>

Abstract

Aim: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation. Patients and Methods: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. Results: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p < 0.001). Conclusions: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.

So… a study in Croatia suggests that not only is it effective, but that it improves fetal health as well.

But anyway back to our article of the day:

For their study, the researchers followed 212 women who had a fetus in the breech position between the 34th and 36th week of pregnancy.

Half of the women were randomly assigned to have moxibustion therapy; a midwife trained in acupuncture performed it three times weekly in the hospital, and the women were encouraged to do it at home on all other days. The rest of the women received no therapy and served as control group.

All study participants, however, had the option of undergoing an ECV at the 37th week of pregnancy.

In the end, Guittier’s team found, 18 percent of fetuses in the moxibustion group had turned to the head-down position by the time of delivery or a scheduled ECV. In the control group, 16 percent of fetuses had spontaneously turned — a difference that was not statistically significant.

I am very much looking forward to obtaining a copy of this study because I want to see the following answered:

a) what BRAND of moxibustion was used? (some brands are great, some suck big time… like comparing cheap china watches to rolexes)

b) how COMPLIANT were the mothers-to-be in terms of using the moxa at home?

c) what MANIPULATION was used? You don’t just wave the stick at the toe, there are various techniques to it.

Also, the study was done with MIDWIVES TRAINED IN ACUPUNCTURE.  Note, MIDWIVES TRAINED IN ACUPUNCTURE.  Not fully trained acupuncturists.  Maybe they think this is simple enough, waving weed on a toe.

“To say the least, moxibustion was not as effective as suggested in (the) earlier trial that was conducted in China,” co-researcher Dr. Michel Boulvain, also with the Geneva University Hospitals, told Reuters Health in an email. The reasons for the differences in the trials, he added, are unclear.

Yes, the study says it was not as effective as the earlier trial conducted in China AND the one in Italy AND the one in Croatia AND the one… etc.

It’s also unclear whether moxibustion has any physiological effects that would help turn a breech fetus.

Boulvain said that some researchers have reported increases in fetal movement during moxibustion sessions, which in theory could be beneficial. But he added that there are no known reasons, based on “traditional physiology,” for why moxibustion would work in this context.

Based on the existing evidence, Boulvain said, “the decision in our hospital is to not implement or recommend moxibustion for these women.

I agree, conventional physiology cannot explain acupuncture 100%, which is why I cringe when some MDs try to force acupuncture to fit into western concepts.  Acupuncture and Moxibustion developed using CHINESE philosophy, CHINESE experience and CHINESE vocabulary.

And he has the guts to say “based on the existing evidence…” Well based on YOUR evidence maybe, not based on the kaboodles of others, “…the decision in our hospital is not to implement or recommend moxibustion for these women.” I agree, especially if the treatment is not done by professionals.

Acupuncture can reduce the need for cesarean sections

Deborah Mitchell writes in Emaxhealth (link) that Acupuncture during pregnancy reduces the chances of necessitating a cesarean birth.  Now in my opinion, cesarean births are to be avoided as much as possible because the operation itself slices through important meridians.  In the classical C-section, where a line is cut from below the navel downwards, only the conception vessel is affected.

These days, however, the lower section c-section is more popular, ostensibly to preserve the bikini line.  It should be noted though, that being a transverse (side to side) cut, it can cut through the Kidney and Stomach meridians as well.  Anyway the point is, less slicing, the better.

Except for pizza.

In 1965, the rate of cesarean births in the United States was 4.5 percent. Yet in December 2007, the National Center for Health Statistics reported that the cesarean delivery rate in the United States for 2006 was 31.1 percent. This rate exceeds the rate in Canada, which reports that nearly 28 percent of the infants born in that country in 2007 and 2008 were by cesarean.

Uh oh.  That means almost 1/3 of women will have problems later on.  But let’s see the good news with acupuncture

For example, in a randomized, controlled trial of acupuncture in first-time mothers, researchers evaluated 56 women who were randomly assigned to either a control group (no acupuncture) or three outpatient acupuncture treatments during pregnancy. Compared with the control group, women in the acupuncture group were more likely to labor spontaneously (70% vs 50%) and less likely to have a cesarean birth (39% vs 17%).

Now, I wish she mentioned precisely what these ladies were getting acupuncture treatments for.  My first guess is that they were getting treated for controlling breech pregnancies?  Anyway I will skip to the end of the article plus the sources she quotes.

According to Debra Betts, an international expert on acupuncture and author of Essential Acupuncture for Pregnancy and Childbirth, acupuncture delivered during pregnancy can reduce nausea, high blood pressure, and back pain, and can naturally induce labor, thus reducing cesarean births. Betts is presenting the workshop on acupuncture and cesarean births and related information in Vancouver.

SOURCES:
Cunningham FG et al. “Cesarean delivery and peripartum hysterectomy. In Williams, Obstetrics 22nd ed. 2005
Harper TC et al. Journal of Maternal Fetal Neonatal Medicine 2006 Aug; 19(8): 465-70
Kolas T et al. American Journal of Obstetrics and Gynecology 2006; 195(6): 1538-43.
News-Medical.net October 9, 2009
Taffel SM et al. American Journal of Public Health 1987; 77:955-59

So there you have it, acupuncture recommended to cut down the need for cesarean deliveries.  I only with we had more details though.

SOURCES

Mitchell, Deborah.  “Acupuncture May Help Prevent Cesarean Births” Emaxhealth.com 11 October 2009.  12 October 2009 <http://www.emaxhealth.com/1275/84/34080/acupuncture-may-help-prevent-cesarean-births.html>