Tuesday, 13 October 2015

Acupuncture For All - On the NHS?

I was really disappointed to read this article today in the Guardian, The general gist is that some doctors think acupuncture works and should be available on the NHS with all doctors learning at least a little about it in training and midwives being trained to administer it to ease labour pain. According to the article the NHS is only denying us this treatment because of the "entrenched scepticism...of the medical establishment" and GPs "making a judgement on something they do not know anything about".

The first thing that really bugged me about this piece is how very one sided it is. Those promoting acupuncture are painted as brave and caring individuals fighting against a faceless dogma. But non of those sceptical establishment figures or judgy GPs actually get to articulate why they don't refer patients for acupuncture. The piece also throws in various claims to support the practice but they don't stand up to a great deal of scrutiny and the writer doesn't question any of them. Edzard Ernst has gone over a number of these on his blog so head over there to see what I mean.

But what really bugged me was the statement that a major London hospital was offering acupuncture to all women who wanted pain relief in labour. I actually find this idea a bit insulting.

At this point it might surprise you to know that I had acupuncture just before MissE was born. I was overdue, hot, uncomfortable and desperate to avoid an induction. The acupuncture session was lovely. I lay in a dim room for an hour, soothing music playing and a friendly woman listening to how I felt, offering to help with my concerns and asking if there was anything else she could do for me. I came out feeling calmer and less achy than I had done in weeks, but I didn't go into labour for another four days and I suspect a good massage would have had much the same effect.

Which is one of the things that concerns me about offering acupuncture in labour, The evidence for it is, at best, limited. But I have no doubt that a midwife taking time to listen to a women, understand her fears, acknowledge her pain and offer ways to ease it would make labour easier, less stressful and probably less painful. That's the placebo effect, it's very powerful and you don't need needles to achieve it, you need time. If a women accepts the offer of acupuncture and gets dedicated one to one care, even just for a little while, then that's great for her, but does it also draw care away from women who don't want needles put in them? Perhaps this hospital has plenty of midwives to go round so they can afford to give every woman great care, needles or no? If so I'd rather they were promoting whatever it is they've done to achieve that because it certainly wasn't the case for me at another major London hospital not far away!

I hope they also have lots of anesthetists available. I hadn't wanted an epidural when I had MissE, but 24 hours into labour with no end in sight I asked for one. I then had a miserably long wait as all the anesthetists were busy, then the drugs had run out. Frankly, if they'd offered me acupuncture instead at that point I'd have thought they were taking the piss! Difficulties in getting an epidural are a pretty common story, I've heard plenty of tales of women told they couldn't have an epidural because they weren't far enough along/ were too far along/ should just try to cope without. Perhaps those things never happen at this hospital? I certainly hope women aren't being encouraged or perhaps forced to rely on an unproven technique instead of effective drugs.

Which all in all leaves me wondering if women are being fobbed off here? Sending a midwife on a one day course is a lot cheaper than training and employing more anesthetists. Taking time to listen to and care for those women who want acupuncture is easier than applying the same standard of care to all. I also get that familiar, uneasy feeling that women who choose the serious, pharmacological pain relief options in labour are being judged for it. Acupuncture is ok because it sounds ancient and mystical and (if it does anything) it'll only help with the pain not remove it entirely. But drugs are modern and man made and perhaps women should still suffer to bring forth life?

In a fantasy world where NHS maternity services had infinite supplies of money and staff I'd be fine with it offering acupuncture for all, chuck in some massage therapy for those who don't like needles, doula's for anyone wanting non medical encouragement etc. etc. But that isn't the NHS we have or, probably, ever will. So I'm really uncomfortable with the idea that we should be spending more time and money promoting techniques that may be little more than placebo, especially if doing so could mean ignoring the need to improve access to proven forms of pain relief and better midwife care.

Time, care and choice - I wish those were available to all on the NHS

SBx

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