NHS maternity service: over 10,000 patients in 15 years
A three-month pilot study conducted from January to March 2006 showed the benefits of acupuncture in the treatment of a number of pregnancy related health conditions. Full implementation of the Maternity Acupuncture Service followed in April 2006.
During the lifetime of the service, a large volume of anonymous patient data was collected, providing valuable insight and feedback into the effectiveness and outcomes of acupuncture treatment. The following article is a general summary and evaluation of this data.
Aims and set-up
The acupuncture service was situated at the Whittington hospital and ran from Monday to Friday, seeing up to 10 patients per day, each receiving an average of 30 to 40 minutes acupuncture.
Patients were referred to the service by their consultant from the obstetrics and gynaecology department, with appointments booked directly with the lead practitioner of the service from Asanté Academy. Patients usually received a block of nine acupuncture sessions – although this varied depending upon stage of pregnancy, condition being treated, early birth, DNAs, and cancellations.
The aim of the service was to enhance physical and emotional health while resolving pregnancy related discomfort – in an effort to ‘normalise’ birth, which was increasingly becoming medicalised and thus associated with increased caesarean section rates.
Core points and delivery
Acupuncture treatments were provided by Asanté Academy practitioners and based on traditional Chinese medicine (TCM) principles, according to the TCM theory of meridians and points. A core group of common acupuncture points were used for the majority of patients – including ST 36 zu san li, SP 6 san yin jiao, KI 3 tai xi, LIV 3 tai chong, BL 60 kun lun. However, as TCM views each case on an individual basis, other points were incorporated depending, for example, on the condition being treated, the stage of pregnancy, and the health background of the individual.
According to TCM theory, there are certain acupuncture points that are contraindicated during any treatment in pregnancy, and some points that are used only in the third trimester, principally as part of acupuncture labour induction treatments.
Depending on the condition, points might include P 6 nei guan and HT 7 shen men for anxiety, or BL 20 pI shu and BL 21 wei shu to boost a patient’s energy. Points such as LI 4 he gu or BL 67 zhi yin are used only at certain periods during pregnancy, mainly to help with induction, and breech position respectively.
Treatment numbers and satisfaction rates
Throughout the lifetime of the service, in excess of 12,000 women were given acupuncture treatment, covering antenatal, childbirth, and postnatal periods. This number is based on available data and takes into consideration the number of possible DNAs (Did Not Attend) – less than five per cent of all patients and returning patients.
The three-month trial period saw a total of 150 treatments provided, and following the full implementation of the service, this total quickly rose to well over 1,500 treatments per year, with a peak of 2,275 reached in 2020/21 – an average increase of approximately 150 per cent.
Not including the initial three-month trial period, the data shows that approximately 30,000 individual treatments were given to patients. The protocols and methods used were developed using a combination of TCM knowledge, clinical practice, and research in obstetrics.
Using regular randomised, structured surveys of patients taken over the course of the service, it is possible to extrapolate overall trends relating to the benefits offered and overall patient satisfaction. An average of 80 per cent of patients reported that they greatly benefited, while 12 per cent said they at least felt a slight benefit, and 8 per cent felt that it made no difference. Significantly, no respondents to any survey said that the treatment received made their condition worse.
Given the large amount of data collected overall, there is certainly scope for more detailed statistical analysis which would require further study and collaboration with statisticians.
On the whole, the service was very positively received by patients. Although comments collected are anonymised and identifiable only by number, they show how well the service was received and also highlight the effectiveness of the treatment.
The following comments are taken from a small selection collected during one randomised patient survey from August to October 2017 and represent an overall trend found in other surveys:
- Patient #3-17 – leg, hip and shoulder pain: The service is amazing… My headaches have nearly disappeared, and my shoulder is much improved.
- Patient #6-17 – pelvic pain: Very positive. Prior to acupuncture walking was difficult. Since the acupuncture the severity and frequency of pain hugely diminished. It’s a great service and without it my pregnancy would have been much more difficult.
- Patient #14-17 – migraine and birth prep: Great service – didn’t want to take strong painkillers and acupuncture helped me achieve this. Very pleased to have the treatment, very relaxing.
Antenatal
A wide range of conditions were successfully treated including: nausea and vomiting; heartburn; anxiety; insomnia; breech presentation; a number of musculoskeletal pain conditions such as sciatica, shoulder pain, back pain –upper and lower – and pelvic girdle pain.
The ability to treat these conditions using TCM acupuncture has meant that deterioration was potentially prevented or lessened, ultimately leading to a reduction in hospitalisation. In other words, the service provided therapeutic relief for patients whilst simultaneously freeing up time and resources within the NHS maternity department.
Labour and/or birth preparation acupuncture formed another crucial aspect of the service. Its use allowed for more efficient and reduced induction rates – and in some cases, fewer medical interventions during labour. Acupuncture protocols were also used within the service for cases of post-due-date labour, providing a natural method as an alternative to medical inductions.
Previous analysis of clinical patient data shows that women experienced significant relief from a variety of health issues, particularly those related to pain.
Additionally, women receiving birth preparation acupuncture were less likely to require surgical birth, or intrapartum analgesia, and more likely to have a reduced length of hospital stay.
During childbirth
At full term, acupuncture was successfully used for induction, thus reducing length of labour as well as providing a natural alternative to standard methods.
Overall data shows that acupuncture has a positive effect in lessening pain during childbirth, whilst promoting relaxation and reduction of anxiety. Additionally, acupuncture helps to promote normal physiological function during childbirth, for example by regulating contractions.
One area of focus for the service was reduction of caesarean births, and the information gathered suggests an overall positive trend, coupled with a reduction of induced labour rates. The treatment protocol in this context was designed to reduce stress and anxiety, promote preparation of the pelvic soft tissues, and regulate hormone levels – all with the aim of maximising the possibility of natural birth.
For example, in 2008-09 the national caesarean birth rate was 24.6 per cent, with NHS Whittington Hospital standing at 25.2 per cent. This compares with a caesarean section rate of just 16 per cent for patients receiving acupuncture during the same period.
Figures are similar for inductions, with an average induction rate of 20 per cent for non-acupuncture patients, compared with 16 per cent for patients receiving acupuncture.
Postnatal
The postnatal period is one area that lacks significant data as it was not the main focus of the service and was given a lower preference than antenatal and childbirth stages of pregnancy. Even so, many patients were seen post-natally – often receiving treatment for postpartum depression, anxiety, musculoskeletal pain, mastitis, and insufficient lactation.
Although further research would be beneficial, many if not all of the conditions presenting in this phase generally respond favourably to acupuncture – based on current understanding of its mechanisms and results observed in private practice clinics. We therefore feel that potential benefits for postnatal patients are as great as for antenatal patients.
Evaluating the data
Data collected over the course of the maternity acupuncture service is generally very positive, both in terms of patient response and clinical outcomes.
This mirrors overall trends for similar conditions in non-maternity patients – such as treatment of pain conditions, stress, anxiety, nausea, and vomiting. Further research is obviously needed – perhaps to include larger sample sizes and alternative study designs – to gain a broader picture of the efficacy of maternity acupuncture.
For the antenatal and childbirth periods, the data certainly shows noticeable clinical benefits for acupuncture patients, compared to those receiving no acupuncture. As previously stated, the postnatal period requires further study as it was not a primary component of the service offered – but anecdotal evidence would suggest that in this area too, acupuncture could provide noticeable clinical benefit. In all three areas, benefit is for both mother and baby.
The evaluation of data was not exclusive to the clinical aspects of the maternity service. Focus was also on overall patient satisfaction, including whether or not availability of acupuncture would affect their future choice of hospital or maternity service.
One question consistently asked was whether or not the availability of a maternity acupuncture service influenced a patient’s choice of hospital. The response was hugely positive for the provision of acupuncture within the NHS, with an average of 93 per cent indicating that the availability of acupuncture would influence their future choice.
In conclusion, based on all the data collected from just this one maternity acupuncture service, we can see overall positive trends and outcomes for the health and wellbeing of mothers and babies – both specific to labour and childbirth, and also in the treatment of more general symptoms and conditions such as pain, stress, and anxiety.
Asanté Academy was the dedicated teaching clinic for Middlesex University up to 2013. From 2013 to 2021 they worked in a private partnership with the NSH Whittington Hospital. The Academy wish to acknowledge and thank the NHS Whittington Hospital for their work and efforts during this collaboration.
Professor Song Ke, founder and principal of Asanté Academy of Chinese medicine, has practised and taught traditional Chinese medicine worldwide for over 40 years. He started to learn his skills very early, when he was a 13-year-old boy apprenticed to three herbal masters in his home province of Hubei, China. He was medically qualified in both Chinese and western Medicine in Canton University of TCM in 1982. Professor Ke has contributed to numerous books on TCM, as well as many articles and papers. His new book – The Reasoning of Traditional Chinese Medicine – was published by World Scientific Press in 2023.
