The entire body is mapped onto the ear.

In my experience, auricular acupuncture is a low cost, non-evasive, and miraculously effective support for labour.

March 3, 2010 — Targeted acupuncture may offer women with major depression a safe and effective alternative to antidepressant medication, new research suggests.

Investigators at Stanford University School of Medicine in California found that women with major depressive disorder treated with depression-specific acupuncture had a 63% response rate after 12 sessions compared with a 44.3% response rate in 2 combined control groups who were treated with either acupuncture not known to help alleviate depressive symptoms or Swedish massage.

“Pregnancy just by its nature can bring out some underlying psychiatric and emotional issues … but treatment of depression during pregnancy is critically important so that a woman can maintain her sense of well being and take good care of herself, her fetus and, someday, her child,” study coauthor Deirdre Lyell, MD, Stanford University School of Medicine, said in a statement.

Led by Rachel Manber, PhD, the study was published in the March issue of Obstetrics & Gynecology.

Response Rates Significantly Higher

For the study, investigators randomized 150 women whose pregnancies were between 12 and 30 weeks of gestation and who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depressive disorder and who scored at least 14 on the 17-item Hamilton Rating Scale for Depression.

Of the 141 women who eventually entered the study, 52 received depression-specific acupuncture, 49 received control acupuncture, and 49 others received Swedish massage.

Treatments were provided twice a week for the first 4 weeks and then weekly thereafter for 4 additional weeks, with each session lasting about 25 minutes.

The investigators found that response rates were significantly higher in women who received depression-specific acupuncture than for either control group. Response rates in women randomized to the 2 control interventions did not differ significantly from each other at 37.5% for the control acupuncture group vs 50% for the massage group.

On the other hand, remission rates did not differ significantly between women who received depression-specific acupuncture at 34.8% and the combined control groups at 29.5%. They also did not differ between those assigned to the control acupuncture group at 27.5% or the massage group at 31.2%.

Thirty-three of the study participants discontinued treatment before the study endpoint, 30% of them for reasons related to the pregnancy. Some women in both acupuncture groups reported transient discomfort at the point of needle insertion, and 1 woman experienced bleeding at the needle site.

Significantly fewer women who received massage reported any adverse effects compared with the 2 acupuncture groups.

Clinically Meaningful

The study authors point out that the benefits observed with depression-specific acupuncture can be considered “clinically meaningful” when assessed in a broader context of depression studies.

Although there are no randomized controlled trials of antidepressants being used during pregnancy, 1 randomized controlled trial found that interpersonal psychotherapy produced a 52% reduction in Hamilton Rating Scale for Depression scores and a 19% remission rate after 16 weeks of therapy, to which the currently study compares very favorably.

According to the study, antidepressant use during pregnancy doubled between 1999 and 2003, but many women are reluctant to take these medications because of safety concerns. In fact, in this particular study, 94% of the women involved expressed reluctance to take an antidepressant because of their pregnancy.

“Because there’s this concern about medication among pregnant women and their physicians, it’s important to find an alternative,” said Dr. Manber.

Results from this study therefore suggest that this standardized acupuncture protocol could be considered a “viable treatment option” for depression during pregnancy, the investigators conclude.

Michael Thase, MD, University of Pennsylvania School of Medicine, cautions that findings from this study are preliminary, although they suggest that depression-specific acupuncture may have value in major depressive disorder in this patient population.

On the other hand, another study assessing depression-specific acupuncture in a broader population of men and women with major depressive disorder failed to find a significant effect from the modality, so evidence supporting acupuncture for the treatment of major depressive disorder is not consistent.

“Still there is reason to be cautious when prescribing antidepressants in pregnancy, and one has to weigh the pros and cons of using an antidepressant on an individual basis,” he told Medscape Psychiatry.

“If these promising findings are confirmed, it would be good to have another option to complement the focused forms of psychotherapy which are currently used for antenatal depression,” he added.

The study was funded by the Agency for Healthcare Research and Quality. The study authors and Dr. Thase have disclosed no relevant financial relationships.

Obstet Gynecol. 2010;115:511-520.
Clinical Context

Major depressive disorder may occur in up to 14% of pregnant women, possibly in response to hormonal fluctuations or anticipated lifestyle changes. Depression during pregnancy has been associated with poor birth outcomes and postpartum depression. Untreated depression during pregnancy may harm the mother as well as the baby, particularly if the mother neglects prenatal care or engages in self-destructive behavior.

Although the use of antidepressants during pregnancy doubled between 1999 and 2003, many depressed women are unwilling to take these medications while pregnant because of safety issues. It is therefore important to find a nonpharmacologic, safe yet effective treatment option for depression during pregnancy. Previous studies have shown that acupuncture is an effective treatment of depression in the general population.
Study Highlights

* The goal of this randomized controlled trial was to estimate the efficacy of acupuncture for depression during pregnancy.
* The study sample consisted of 150 pregnant women between 12 and 30 weeks of gestation who metDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depressive disorder.
* Participants were randomly assigned to receive either depression-specific acupuncture (n = 52) or 1 of 2 active controls: control acupuncture (n = 49) or Swedish massage (n = 49).
* All treatments were standardized and lasted 8 weeks (12 sessions).
* Junior acupuncturists blinded to treatment assignment needled participants at points prescribed by senior acupuncturists.
* The main study endpoint was the Hamilton Rating Scale for Depression, performed by blinded raters at baseline and after 4 and 8 weeks of treatment.
* Response rate was defined as having at least a 50% reduction in symptoms.
* Analysis of continuous data was by intent-to-treat, with use of mixed-effects models.
* Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls (d = 0.39; 95% confidence interval [CI], −1.31 to 1.65; P < .05) or control acupuncture group alone (P < .05; Cohen's-d = 0.46; 95% CI, −1.24 to 2.31).
* In women who received depression-specific acupuncture, response rate (63.0%) was also significantly greater vs the combined controls (44.3%; P < .05; number needed to treat, 5.3; 95% CI, 2.8 - 75.0) and control acupuncture group (37.5%; P < .05; number needed to treat, 3.9; 95% CI, 2.2 - 19.8).
* The control groups were not significantly different in symptom reduction and response rates (control acupuncture, 37.5% vs massage, 50.0%).
* Rates of adverse events were not significantly different for the 3 treatment groups
* Acupuncture-related adverse effects included transient discomfort at the point of needle insertion (7 participants in the control acupuncture group and 14 in the depression-specific acupuncture group) and bleeding at the needling site (1 in the depression-specific acupuncture group).
* Massage-related adverse effects included transient discomfort in 5 participants.
* None of these adverse effects resulted in study discontinuation.
* The investigators concluded that the short acupuncture protocol tested in this study yielded symptom reduction and a response rate similar to those seen with standard depression treatments of similar length.
* Study limitations include limited generalizability of the results because of the high education and socioeconomic status, predominance of Caucasians (67%), and exclusion of comorbid mental and medical disorders.
* In addition, the massage therapy provided in this study was shorter vs standard practice.

Clinical Implications

* Depression during pregnancy is responsive to treatment with a short acupuncture protocol, which could be a viable treatment option for depressed pregnant women. Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls or control acupuncture group alone.
* Response rate (≥ 50% reduction in symptoms) was 63.0% in women who received depression-specific acupuncture, which was significantly greater vs the combined controls (44.3%) and control acupuncture alone (37.5%). Response rate with depression-specific acupuncture was similar to those seen with standard depression treatments of similar length.

CME Test

According to the randomized controlled trial by Manber and colleagues, which of the following statements about reduction in depressive symptom severity in pregnant women who received depression-specific acupuncture, control acupuncture, or Swedish massage is correct?

( )Rate of decrease in symptom severity was greater in women who received depression-specific acupuncture vs the combined controls

( )Rate of decrease in symptom severity was not greater in women who received depression-specific acupuncture vs the control acupuncture group alone

( )Acupuncture-related adverse effects led to study discontinuation in 3 patients in the depression-specific acupuncture group

( )Results are easily generalizable to women with comorbid posttraumatic stress disorder

According to the randomized controlled trial by Manber and colleagues, which of the following statements about response rate in depressed pregnant women who received depression-specific acupuncture, control acupuncture, or Swedish massage is not correct?

( )Response rate was 63.0% in women who received depression-specific acupuncture

( )Response rate was 44.3% in the combined controls

( )The control groups were not significantly different in response rates

( )Response rate was defined as having at least a 75% reduction in symptoms

For more information, or to set up an appointment for treatments in Toronto, call Dawn at 647-209-8259 or visit www.dawnaarons.com

by Debra Betts

Debra Betts, an acupuncturist from New Zealand, has produced an excellent booklet titled, “Acupressure for Labour- promoting natural labour and partner involvement”. She has made this document available free of charge and you can download it here. Acupressure Booklet D.Betts

I recommend that couples (or women and their labour partners) print out the booklet and practice point locations and positions in advance of the labour so that you feel comfortable with the information when you need it. Debra’s suggestions are helpful and effective.

Most partners want to be actively involved in labour and are often at a loss of how to help and stay connected. Suggestions in this booklet will benefit both the labouring woman and her partner.

Thank you for Debra Betts for her clear presentation, useful information and great generosity.

Feel free to contact me at www.dawnaarons.com if you have any questions about the handout or would like more information about other labour options.

Commonly women are advised to “sleep when the baby sleeps!”. It’s great advice if you can do it. Some women find that even though they are exhausted and their little sweetie is sleeping soundly, they are unable to sleep. At first it may feel ok. There is laundry to do, people to email, thank you cards to write…but soon the new mom will be exhausted. There is nothing quite as frustrating as wanting to sleep, desperately needing to sleep, and not being able to. This is a much more common concern than most women realize.

Acupuncture can help postpartum women to sleep, heal and cope better with breastfeeding and caring for their infant. Many acupuncturists are happy to visit you in your own home for this type of treatment. In my acupuncture practice in Toronto, ON I encourage women to take advantage of housecalls and to rest as much as possible postpartum. Women benefit greatly from treatment around 3-4 days postpartum. This type of preventive care can help them to avoid later problems such as insomnia and mood swings as her breast milk comes in and helpful hormones head out.
Most women find the treatment to be relaxing and to bring immediate benefits and a sense of well being.

Who wouldn’t like to sleep like a baby?

For more details about the causes and treatment for insomnia in Chinese Medicine see http://acupuncture-pregnancy.com/2010/03/12/insomnia-in-pregnancy/

Insomnia in Chinese Medicine

It is said in Chinese Medicine, that sleep occurs when “the mind goes to rest in the heart”. For this to happen, the “heart” must be a comfortable bed. Difficulty falling asleep and/or staying asleep are signs that the heart bed is either “too hot” or “not padded enough”.

A Hot Heart

Heat in the heart reflects “yang rising” (often related to stress and/or anger) or “yin deficiency” (often seen alongside anxious exhaustion, feelings of heat and thirst). An experienced acupuncturist treats the root cause of the imbalance to bring relief of all symptoms and improved sleep.

A Hard Bed
When there is not enough “blood” or “yin” in the heart it is difficult for the mind to stay settled. These issues are addressed in Chinese Medicine with acupuncture, lifestyle adjustments, dietary therapy, and occasionally herbs.

Deep sleep is essential for the well being of mother and child. Insomnia is a common concern in pregnancy, especially when exacerbated by the need to get up to pee frequently and difficulties finding a comfortable position. I always reassure pregnant women that they have entered the zone of “guilt free napping”. Women need a lot of sleep in pregnancy and as they prepare for labour and the sleep-deprived early postpartum days ahead. In my experience, acupuncture is very effective in breaking negative sleep cycles and helping women get the rest they deserve and so greatly need.

Toronto is a hub for acupuncture styles that range from classic Traditional Chinese Medicine (TCM), Japanese Acupuncture, and western based acupuncture. If you just do a web search for “acupuncture in toronto” you will immediately see the wide world of teaching styles and types of therapists that are engaged in one of the acupuncture forms available in Toronto, Ontario.

Types of therapists include: acupuncturists who have studied at one of the TCM schools, Naturopaths, Chiropractors, Medical Doctors, Massage Therapists, Shiatsu Therapists, and other health professionals.

Any of them could be helpful. My suggestion, since it is how I was trained, is to find a good TCM acupuncturist in Toronto. My expertise is primarily with pregnancy and pregnant women, so I tend to prefer acupuncturists that have a focus or are a veteran in a particular classic style of acupuncture.

Women’s Health Issues: Pregnancy and Menopause

Early on in my acupuncture career, I found an affinity with treating women’s health issues including menopause and right now my practice is almost exclusively focused on pregnant women.

I find that pregnancy is a wonderful and exciting time! It is a magical time. Alas, it can also be a difficult time. Women are often discouraged when the challenges of pregnancy feel overwhelming. And although it may be reassuring to be told that one’s aches and pains (for example, morning sickness, or sciatica, carpel tunnel syndrome, pelvic pain, back pain, insomnia, exhaustion or anxiety) is “normal”, that doesn’t bring relief.

Many women are told that there is nothing they can do to help themselves feel better. Their experience is often ignored or at best, belittled.

There are “new” options that are actually thousands of years old. Traditional acupuncture offers safe and effective relief. Thousands of women are enjoying relief they didn’t realize was possible. When performed by a knowledgeable professional, acupuncture really works!

Please contact Dawn Aarons by email at dawn@dawnaarons.com or visit her website at www.dawnaarons.com

Hypertension In Pregnancy – Wellness Guide

If you have been diagnosed with hypertension during your pregnancy, or even if you are looking for preventative measures to keep your blood pressure down, here are a number of recommendations to help keep you “calm and collected”.

1. Water. Water. Water. Drink some water. Then drink some more and then some more. At least 8 cups a day or more if you can. You’ll get to know the washrooms all about town.

2. Exercise and Stretching. Active women are less likely to suffer from high blood pressure. For those who are dealing with hypertension already, walking, yoga, tai chi and gentle stretching are beneficial to keep your blood circulating and heart pumping.

3. A Healthy Diet. A diet that includes plenty of fresh organic fruits and vegetables will help you feel good about how you are caring for yourself and for your baby. Some special considerations to help alleviate or prevent hypertension include:
a) Load up on the protein. Up your protein intake to 80-100 grams per day. So we are taking about eating A LOT of protein. There are roughly 25 grams of protein in three cups of milk, or four eggs, or two cups of cooked beans, or two ounces of nuts, or four ounces of fish, meat or cheese. (Susan Weed, Wise Woman Herbal for the Childbearing Year, 1986).
b) Calcium is your friend! 1,000 grams of calcium daily during pregnancy is recommended. `The best source of calcium is seaweed! Other calcium-rich foods include fish, dairy products, almonds, broccoli, bok choy, brazil nuts, collard greens, dandelion greens, eggs, kale, blackstrap molasses, sesame tahini, soybeans, tofu, and sunflower seeds.
c) Potassium. Potato peels and fresh bananas are exceptionally rich in potassium. A banana a day keeps the cramps away.
d) A cucumber a day. Cucumbers are the food most renowned for lowering blood pressure. A whole cucumber per day will also relieve constipation and benefit your kidneys.
e) Other dietary recommendations include taking fish oil, eating large quantities of garlic, and avoiding stimulants such as spicy or peppery foods, black tea, cola drinks, coffee, and nicotine.

4. Tea for two. Drink nettle or raspberry leaf infusions daily. Other helpful herbal teas (to be taken under the direction of a herbalist) include hops, passionflower, skullcap, and Hawthorn berries
Making an Herbal Infusion: Use a jar that has a lid and holds at least 4 cups of water. Put one handful of loose leaves (or roots in the case of ginger) and pour boiling water into the jar. Leave for 4 hours or more It’s easy to prepare this before bed and have it ready at room temperature in the morning.
Long steeping extracts all the chlorophyll, as well as the vitamins and minerals. Drink your tea over the course of the day.
If you want to steep a fresh hot cup of tea, leave a teaspoon of herbs in a cup of water for at least 15 minutes.

5. Enjoy regular baths. Adding Epsom salts to your bath allows for magnesium absorption and this often aids in pain relief. Daily swimming in a pool is also recommended.

6. Express Yourself! Emotional stress can raise blood pressure. It is important to express difficult emotions as they arise, as opposed to holding them in. Talk openly to family and friends. Find non-verbal forms of expression (in art, movement, and singing).

7. Relaxation/Meditation/Visualization. Nothing is as centering and healing as a deep mindful breath. Search out activities or classes that resonate with you, be they prenatal yoga, or mindfulness meditation. Enjoy the journey with an open heart and smile on your face.

For information on using acupuncture as a support to self care, see Dawn’s blog post, Acupuncture for the management of Pregnancy Induced Hypertension.

Women can also enter pregnancy with pre-existing high blood pressure (essential hypertension).

In both cases, blood pressure is monitored on an ongoing basis. The systolic (the top figure) and the diastolic pressure (the bottom reading) are monitored. Concern will arise if either the systolic or diastolic pressure rises significantly above the woman’s original blood pressure (baseline). A diastolic pressure of over 90-95 is usually considered a cause for concern, particularly if accompanied by upper body edema, protein in the urine, severe headaches, nausea or vomiting, and/or visual disturbances.

Pregnancy Induced Hypertension (PIH) affects 2.5-3% of pregnant women (Redman C, Sargent 2005. Latest Advances in Understanding Preeclampsia. Science 308: 1592-4.) PIH is more commonly experienced by first-time mothers, especially those under 19 and over 40 years old, and those who are obese.

Acupuncture for High Blood Pressure

Acupuncture is the most commonly used method to treat hypertension during pregnancy in our Toronto Acupuncture clinic. Acupuncture is used to balance and relax the body, and is most successful in combination with lifestyle adjustments – especially regular exercise, stress relief, and a healthy diet.

From a Chinese Medicine perspective, the appropriate treatment depends on the underlying imbalance that is causing the hypertension. Different imbalances will show different combinations of signs and symptoms in addition to the high blood pressure. An experienced acupuncturist will determine a woman’s pattern of imbalance (in this case some possibilities include Liver Blood deficiency, Liver and Kidney yin deficiency, Spleen Yang Deficiency, Liver Yang Rising) and treat her specific condition. In her book, Acupuncture and Pregancy in Labour, Debra Betts writes, “positive changes are clearly achievable with acupuncture, indicating that it can help the body to normalize and allow women to progress naturally through their pregnancy. These changes include reduction in uric acid to normal levels and stabilization of liver enzymes, as well as the more obvious signs of blood pressure readings remaining within acceptable medical limits”(p.110)

Research on Hypertension

Research on Hypertension supports calcium supplementation and regular exercise.

The Journal of the American Medical Association (JAMA) published a study that reported that consuming sufficient calcium during pregnancy can reduce the risk of PIH and preeclampsia. The researchers found that 1500 – 2000 mg daily of calcium supplementation can lower the risk of PIH by 70% and the risk of preeclampsia by over 60%.

A study on exercise and gestational hypertension concluded that the most active women were 43% less likely to develop preeclampsia than sedentary women. (Marcoux, S., J. Brisson, and J. Fabia. The effect of leisure time physical activity on the risk of preeclampsia and gestational hypertension. J. Epidemiol. Community Health 43:147-152, 1989.)

See Self-Care Guide for Pregnancy Hypertension for information on things you can do to help yourself. Consider using acupuncture as part of the overall care plan you arrange in consultation with your primary health care provider.

Gestational Hypertension and Preeclampsia

A recent study of the effectiveness of acupuncture for treating depression during pregnancy published reassuring findings.

“The results of our study show that the acupuncture protocol we tested could be a viable treatment option for depression during pregnancy,” Rosa Schnyer of the College of Pharmacy at the University of Texas at Austin said in a statement.

Schnyer and colleagues conducted an evaluator-blinded randomized trial in which 150 pregnant women who met the criteria of major depressive disorder received either eight weeks of acupuncture specific for depression or one of two active controls — control acupuncture or massage. Women receiving acupuncture specific for depression experienced a significantly greater decrease in depression severity compared to the controls.”
UPI.com United Press International (Feb 8, 2010)

In my acupuncture practice in Toronto I have worked successfully with pregnant women suffering from depression.

Acupuncture in pregnancy does not pose risks to the fetus. As well as improving mood, acupuncture can simultaneously be used to relieve aches and pains associated with pregnancy as well as discomforts such as nausea, heartburn and swelling.

As a modality of Chinese Medicine, acupuncture balances the woman’s whole body and mind; relieving symptoms, energizing and inviting a general sense of well being.

Click here for a detailed report on this study from the The American College of Obstetricians and Gynecologists