Experiences of Pregnant Women Receiving Acupuncture Treatment from Midwives

329 Pages·2017·3.04 MB·English

by  Jeanne Lythgoe

"Experiences of Pregnant Women
Receiving Acupuncture Treatment from
Midwives"

Jeanne Lythgoe
Professional Doctorate Thesis

Submitted in Partial Fulfilment of the Requirements of
the Degree of Professional Doctorate, 2015

School of Nursing Midwifery Social Work & Social
Sciences
College of Health and Social Care
Contents
Abstract 1
1. Introduction to the study 2
1.2 Context of midwifery 3
1.3 Personal and professional position 8
1.4 Position of Western Medical Acupuncture 12
1.5 Structure of the thesis 18

2. Literature review 20
2.1 Introduction 20
2.2 Search strategy and critical appraisal methods 20
2.3 Acupuncture as a potentially effective treatment for pregnancy including 24
specific common conditions
2.4 Acupuncture as a safe somatosensory treatment 37
2.5 Acupuncture as a tool for midwives 49
2.6 Experiences of pregnant women receiving acupuncture 61
2.7 Women’s perceptions of the effects of acupuncture 65
2.8 Summary 69

3. Research methodology 70
3.1 Introduction 70
3.2 Aims & objectives 70
3.3 Phenomenology 74
3.4 Interpretative Phenomenological Analysis 78
3.5 Epistemological positioning 80
3.6 Method 81
3.7 Interviews 90
3.8 Data analysis 95
3.9 Reflexivity 105
3.10 Summary 109

4 Findings 110
4.1 Introduction 110
4.2 Overview of main themes 112
4.3 Detailed analysis of the 5 main themes 114
4.4 Examples of critical commentaries/case studies 139
4.5 Summary of the findings 152

5 Discussion of Findings 153
5.1 Introduction 153
5.2 Theme 1- Validating choice 153
5.3 Theme 2-Relief & relaxation 160
5.4 Theme 3-Trust & understanding 167
5.5 Theme 4-Regaining self 173
5.6 Theme 5-Discovering & sharing the secret 176
5.7 Summary of the discussion 178
6 Conclusions 184
6.1 Addressing the Aims and objectives 184
6.2 Recommendations 188
6.3 Professional Doctorate Journey 191
6.4 Final conclusions 193

Appendices
Appendix 1 Participation information letter 195
Appendix 2 Consent form 198
Appendix 3 IRAS Ethical approval letter 199
Appendix 4 Synthesis tables 203
Appendix 5 Interview schedule 226
Appendix 6 Participants details sheet 227
Appendix 7 Salford Midwifery Acupuncture Service (SMAS) 228
Audits
Appendix 8 Chart of theme development for super-ordinate 243
& main themes
Appendix 9 Example of theme development Case 2 244
Appendix 10 Example of theme development Case 1 251
Appendix 11 STRICTA checklist 259
Appendix 12 Participant thank you letter and summary of 260
findings
Appendix 13 Acupuncture Meridians and Points 262
Appendix 14 Glossary of terms 264
Appendix 15 Professional issues for midwives practicing 267
acupuncture
Tables
Table 3.1 IPA analysis steps 96
Table 3.2. Descriptive noting excerpt 99
Table 3.3 Development of Super-ordinal and main themes 104
Table 3.4 Excerpts from field notes 107
Table 4.1 Demographics of participants 45
Figure 2.1 Mechanisms of acupuncture 112

Reference list 2703
Acknowledgements

I would really like to thank my academic supervisors Dr Alison Brettle and Professor Martin
Johnson for their continued help and support in completing this thesis.
I am very grateful to the women who agreed to participate in this study. I felt privileged to hear
and record their stories and experiences.
I would also like to thank my colleagues for their encouragement and support particularly Dr
Lesley Choucri as my manager and midwifery supervisor.
Most of all I would like to thank my family especially my husband Dave and my children Ted,
Hattie & George for their unwavering support over the last 5 years, for having faith in me.

i
Abstract
Title: "Experiences of pregnant women receiving acupuncture treatment from midwives"
Acupuncture is potentially an effective treatment for common conditions of pregnancy and
labour pain with midwives being well placed to offer it. The aims of this study were to explore
the experiences of pregnant women receiving acupuncture treatment from midwives, to
provide insight into their perceptions of effect including the influence and value of the midwife
on this experience. The lack of qualitative evidence has provided the rationale for this study.
Within a phenomenological methodology an 'Interpretative Phenomenological Analysis' (IPA)
approach was adopted, with 10 women attending the Salford Midwifery Acupuncture Service
(SMAS) being recruited to this study. Data was collected via semi-structured interviews and the
IPA analysis identified five main themes; justification of choice, relief & relaxation, trust &
understanding, regaining self, discovering and sharing a secret. The women were happy to
access acupuncture if recommended by a health professional; they gained pain relief and
improved function, with more ability to care for their children and to continue working. They
were grateful for the opportunity to access acupuncture, finding it enjoyable and reporting
intense emotional and physical sensations. It offered prolonged effect, improving sleep and
wellbeing, and it correlated well with purported neurophysiological mechanisms. Responses
seemed more intense than in previous reports, possibly due to their pregnant state or
heightened affective component. A midwife-acupuncturist was advantageous having
knowledge and understanding of pregnancy, with ‘understanding’ being more important than
professional background. The women felt optimistic and empowered to make plans for birth
and parenthood and were wishing to share their experiences with others. The ‘lay network’ was
an important factor within the women’s choice to access acupuncture. These findings indicate
acupuncture is an acceptable treatment which can provide relief, improved wellbeing and
support normality. Midwives could offer acupuncture as an adjunct to their role to facilitate
individualised reflexive practice.

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Chapter 1: Introduction and background to the study
1.1: Introduction
This study has been developed to address the deficit of evidence regarding the experiences of
women receiving acupuncture treatment in pregnancy. It seeks to provide insight into pregnant
women’s perceptions of the effects of acupuncture treatment provided by midwives and the
influence and value of the midwife on this experience. The study also explores the acceptability
and appropriateness of acupuncture treatment being offered during pregnancy and the
possibility of acupuncture being an adjunct to the midwife’s role
Acupuncture is often categorised as one of a number of alternative therapies generally termed
Complementary and Alternative Medicine (CAM). Medical acupuncturists consider it to be a
valid treatment that deserves a place alongside conventional drugs and surgery as a form of
somatosensory stimulation (White, Cummings & Filshie, 2008). There is now sufficient evidence
to be reasonably confident that its’ effects are real rather than placebo and recent large
reviews of trials show acupuncture to be better than placebo in treating nausea & vomiting,
back pain, headache and chronic knee pain in the non-pregnant population (Ezzo, Streitberger
& Schneider, 2006; Furlan, Van Tulder & Cherkin, 2005; Linde, Allais & Brinlhaus, 2009;
Manheimer, Cheng & Linde, 2010). Acupuncture has been used to treat pregnant women
within Traditional Chinese Medicine (TCM) for centuries but the evidence demonstrating its
efficacy within the western medical model is still developing. There is limited evidence of its
positive effect on common conditions of pregnancy; such as nausea and vomiting, and back
pain and for the turning of a breech presenting fetus using moxibustion a form of treatment
derived from acupuncture (Coyle, Smith & Peat, 2012; Matthews, Dowswell & Hass, 2010;
Pennick & Young, 2007).
Thus acupuncture seems to offer potential as an effective treatment for these conditions and
midwives are in an ideal position to offer it being the health professionals providing ongoing
care for pregnant women. Acupuncture is known to be a holistic treatment able to affect nerve
and muscle by stimulating the production of opioid peptides to reduce pain, and by having
additional effects to promote wellbeing (Campbell, 2006; White et al., 2008). This holistic
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treatment could complement individualised midwifery care providing a tool to relieve pain,
discomfort and promote wellbeing, avoiding treatments that may have potentially teratogenic
effects. Acupuncture it could be argued can support normality within pregnancy and childbirth
by reducing the need for medical intervention and empowering women to feel in control of
their pregnancy increasing their confidence in their ability to cope with pregnancy and birth.
1.2: Context of Midwifery
The paradigm of midwifery has forever been predicated on women supporting women
throughout pregnancy, birth and motherhood from the earliest civilisations to the 20th century
professionalisation of the role (Donnison, 1977; Leap & Hunter, 1993). The role of protector
and supporter for pregnant women, essentially a midwifery role, has evolved from the innate
need to protect and promote the health of the next generation. Humans instinctively feel that
the health and wellbeing of the mother will have a significant impact on this outcome
(Chamberlin, 1999; Cronk, 2000; De Vries, Benoit & Van Teijingen, 2001).
Ancient civilisations have demonstrated their nurturing of pregnant women through various
cultural and religious practices. The Chinese for example regard pregnancy as a potential
imbalance or disharmony within the body and as such strive to protect the pregnant woman
supporting her wellbeing both physically and psychologically to promote harmony (Deadman,
Baker & Al-Khafaji, 2001).
The miracle of pregnancy and childbirth is fundamental to human existence and as such
remains a fascination bound up within the culture in which the woman presides (Davis-Floyd &
Sargent, 1997; Jordon, 1997). Over the last century developed countries have seen this
fascination change in nature from an emphasis on nurture and protection to that of control and
suspicion of pathology. The benefits of this significant shift to more 'medicalised birth' in
statistical terms has seen a reduction in maternal and perinatal mortality (Tew, 1998), yet the
impact of the corresponding improved health and living standards of these populations on this
reduction in mortality and morbidity remains difficult to assess (Barros, Victoria & Barros, 2005;
Walsh, 2007). The morbidity associated with this more reductionist approach to birth is
something of concern, over the last half century the emphasis on a more biomedical approach
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to birth has invariably led to increased medical intervention which in turn has been
demonstrated to reduce women’s autonomy and satisfaction within the birth process (Sandall,
Soltani & Gates, 2013). Evidence demonstrating the improved outcomes resulting from
reducing intervention and increased continuity of midwifery care is merely acknowledged yet
rarely leads to changes in policy or practice (Sandall et al., 2013; Walsh, 2007).
Over the last twenty years evidence demonstrating the importance of pregnancy wellbeing to
the short and long term outcomes for both mother and baby has been growing in significance
supporting the putative beliefs of many women and midwives. Research into the effect of
anxiety and stress during pregnancy has convincingly been demonstrated to have a negative
effect on the neurodevelopment of the fetus (Clarke, Wittwer & Abbott, 1994; Huizink, Mulder
& Buitelaar, 2004; Teixieria, Fisk & Glover, 1999; Welberg & Seckl, 2001) affecting cognitive
skills, behaviour and increasing the risk of mental health problems and relationship problems in
adulthood (Mulder, Robles De Medina & Huizink, 2002; Talge, Neal & Glover, 2007; Van den
Berg, Mulder & Mennes, 2005).
These significant findings have impacted upon social policy within the UK with
recommendations emphasising the need to address perinatal mental health problems and
promote development of good infant-parent relationships. These issues are now an integral
part of government public health strategy (Department of Health- (DH) 2009a; DH, 2013; NICE
2014b; Wave Trust, 2013). The emphasis on the importance of the psychosocial wellbeing of
parents, baby bonding and attachment and on the development of good parenting skills puts
midwives at the forefront of these recommendations being well placed to promote and
augment these important public health proposals. Midwives are able to assess the holistic
needs of pregnant women and their families and to offer services that address those needs. The
government are investing in this approach offering choices in models of care for pregnant
women that promote normality, and recognising the benefits that continuity of care can have
on birth outcomes and on parental self-efficacy (Hodnett, Downe & Walsh, 2010; Klaus &
Kennell, 2002; Sandall et al., 2013). Other national drivers focusing on the centralisation of
obstetric and neonatal services can create opposing challenges in terms of the National Health
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