Pregnancy, Birth and Beyond

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Is Chinese Medicine Safe During Pregnancy?

Is Chinese medicine safe in pregnancy? is one of the most commonly asked questions of TCM practitioners by pregnant women. In short, the answer is both ‘Yes’ and ‘No’. There are a number of acupuncture points and herbal ingredients that are either cautioned or contraindicated for use during pregnancy.

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Chinese Medicine

The question of  "Is Chinese medicine safe in pregnancy?" is one of the most commonly asked questions of TCM practitioners by pregnant women. In short, the answer is both ‘Yes’ and ‘No’. There are a number of acupuncture points and herbal ingredients that are either cautioned or contraindicated for use during pregnancy. Women can rest assured, however, that all Chinese Medicine professionals registered with the Chinese Medicine Registration Board of Victoria (CMRB*) will know how to safely modify cautioned treatment and will avoid hose contraindicated when treating pregnant women.

Through this article we hope to allay fears, dispel misnomers and present accurate information on the use of Chinese Medicine during pregnancy so women feel empowered to make safe, informed treatment choices for themselves and their babies.

Wisdom of the ages

With a written history dating back 2500 years and further evidence to suggest that it originated over 5000 years ago. Chinese Medicine is an ancient yet evolving system of medicine. It has a long history of treating women’s health issues dating back to 1500–1000 BC, when inscriptions on tortoise shells recovered from archaeological diggings recorded problems during childbirth.

Ancient Chinese Medicine knowledge and wisdom was cultivated and passed down from master to student via a rich oral tradition. It evolved simply because experienced practitioners discovered what worked and when their students applied the theory in practice they had the same results – no need for double-blind randomised controlled trials, the benchmark of Western biomedical science. Over the centuries, countless ancient Chinese medical texts were destroyed as a result of wars and foreign invasion, so the contents of these classical texts were preserved only through reference in surviving books.

The Treasure of Obstetrics by Jing Xiao Chan Bao, written during the Tang Dynasty (618-907 AD) is the first surviving text dedicated entirely to obstetrics. This book contains 12 chapters on diseases during pregnancy, 4 on difficult labour and 25 on post-partum disease [1].

Formalised medical training colleges were established during the Song Dynasty (960-1279 AD). These colleges had specialist medical departments and one branch was obstetrics and gynaecology. Since the mid-1940s, China has endeavoured to integrate Traditional Chinese Medicine and Western Medicine across all specialty areas and continues to evolve innovative treatment techniques utilising the strengths and benefits of both.

In Australia we are engaged in a process of learning how best to explain, adapt and apply this ancient medicine within the context of our contemporary health care system.

What level of care is appropriate?

Individual Chinese Medicine practitioners will have their preference in advising women regarding treatment during pregnancy. Our approach tends to be that unless there are presenting signs and symptoms that indicate intervention is necessary it is better to leave nature alone. Some women, however, will have constitutional weaknesses that predispose them to niggling pregnancy-related symptoms, ranging from mildly uncomfortable to potentially life-threatening. Sometimes Chinese Medicine treatment will be used independently as a stand-alone treatment option, other times in conjunction with conventional obstetric care.'

Acupuncture

The usual precautions around infection control and needling dangerous points* apply when treating pregnant women. Special consideration is given to ensure women are safely and comfortably positioned during treatment to reduce potential adverse reactions such as needle shock* and phobia.

In general, acupuncturists will opt for gentle needling techniques during pregnancy being careful to consolidate a woman’s energy and not to overstimulate or disturb the integrity of the pregnancy. More specifically, there is a list of traditionally forbidden acupuncture points considered too dangerous for use during pregnancy, not because they pose any health risk to mother or baby, but because of their oxytocic effect. They are known to induce labour by stimulating the contraction of the uterine muscles and thus cause miscarriage or abortion.

This list has evolved as the result of centuries of empirical observation by Chinese Medicine doctors who recorded both the adverse reactions of unintended treatment outcomes as well as techniques developed to intentionally induce abortion in unwanted pregnancy. These contraindicated points will routinely appear in acupuncture treatments to induce labour in post-date pregnancy. Once a woman is past her due date, she is no longer deemed to be pregnant and these points can be safely used to promote labour. Cautioned points have a less potent effect and usually need to be combined with other labour-inducing points and strong stimulation applied in order to induce miscarriage; they can be used if treatment is modified.

Herbal medicine

In our experience, women tend to be more reluctant to take herbal medicine during pregnancy. This caution is unnecessary. Chinese medicine uses mainly whole plant, animal (for non-vegetarians) and mineral products that look very much like food to the body. The power of the medicine is not in the individual herb but in how the herbs are combined.

To understand how herbal medicine works one might imagine that each herb has a unique ‘personality’. These ‘personalities’ have been carefully studied and categorised according to how they behave individually and collectively: some will be hot in nature, some cold, some mild, and some harsh. They might also have an astringing, dispersing, ascending, descending, stimulating, moving or slowing, sedating action.

When individual herbs are combined into formulas they create a unique energetic matrix. If a practitioner wants a cooler, more sedate effect, they will combine cooler, milder herbs. If a more aggressive action is desired more aggressive, fiery herbs will be selected. By knowing the ‘personality’ of each herb, the practitioner is able to design and adapt the overall formula to suit the specific needs of each woman and her unborn child.

The types of herbs typically contraindicated during pregnancy tend to be extremely harsh, toxic herbs, such as cathartic purgatives (laxatives). They tend to move, stir and invigorate blood circulation to awaken and dislodge the foetus, and have a strongly descending action to expel the foetus. They do not normally pose any life-threatening risk to mother or baby but because of their action they can promote early labour or miscarriage.

All registered Chinese Herbal Medicine practitioners will know how to properly prescribe herbal medicine to pregnant women. They will know which herbs must be avoided, and how to combine and process others to moderate or enhance herbal action, thus rendering them perfectly safe for use during pregnancy. Chinese Medicine is an ancient system of medicine which has withstood the test of time. Generally speaking it is an extremely safe, effective medicine and serious side effects are rare.

Like all invasive techniques there will be a risk of injury but this is mitigated by the skill and knowledge base of fully registered, properly qualified and trained practitioners.

[1] Maciocia, G., Obstetrics & Gynaecology in Chinese Medicine. New York. NY, Churchill Livingston, 1999, p.4.

© September 2009 Karen Pohlner