The value of obstetric acupuncture

I agree whole-heartedly with Dr. Betts' assessment of the current OM Community's involvement in OB care. What's always been puzzling to me about Acupuncture Fertility specialists is that they continue to be their patient's provider after the first trimester is completed. When an RE has gotten the patient to approximately 8 weeks gestation, they refer them to an OB for the remainder of the pregnancy. Why the difference in our practices here in North America? I can think of several reasons:

1. The patient feels very comfortable with the Acupuncturist who has helped them to achieve the much desired pregnancy, and would therefore prefer not to change providers (of course the patient probably doesn't know that the practitioner may not be very qualified in Obstetrics care, and probably doesn't have the same close relationship with the Obstetrician that they do with the RE's).

2. The Acupuncturist is reluctant to "lose the business". (This may sound petty, but it is a very real concern for many acupuncturists).

3. There is no reliable network of trained and/or certified OB Specialists in our profession thus far, so there is no incentive for the Acupuncturist to refer to someone who may or may not have any more knowledge, training or experience than they do. (This is partially do the current situation with malpractice stipulations that do not allow for coverage for most OB-related conditions).

So what is the solution? I have several ideas regarding this. Because I teach the reproductive medicine section in the Doctoral Program at Emperor's College in Los Angeles, and because my private practice is strictly focused on the treatment of male and female infertility patients, most of the students/interns/acupuncturists who come to study with me do so because they want to learn reproductive medicine. Why is infertility as a specialty so popular? Because it's seen as the fast track to making money as an acupuncturist. This is a new phenomenon. I have personally been working with infertile patients for over a decade, and the patient and RE demand for OM related to Infertility did not explode until after two events: 1. The publication of Randine Lewis' book, "The Infertility Cure", and 2. The publication of the Paulus Study confirming higher clinical pregnancy rates in patients undergoing IVF with Acupuncture. After these two events, acupuncture was "on the map" in the fertility world.

Interestingly, about the only other acupuncture "specialty" that seems to come close or maybe even surpass infertility care, is "facial rejuvenation". In fact, if you do a website search on Acufinder.com across the US, there is a peculiar tendency for many infertility specialists to also be facial rejuvenation specialists. I guess the equivalent in western medicine would be the Plastic Surgeon who offers face-lifts and liposuction in conjunction with IVF.

I think what I am trying to get at - in a very roundabout way - is that one of the keys to establishing and growing a successful acupuncture practice is to specialize. Obstetric care is one of the most under-served specialties I can think of. A perfunctory pub-med search of Acupuncture and Pregnancy turns up far more peer-reviewed published research than that related to Infertility and Acupuncture. And as Debra mentioned, this is a very motivated patient population. The malpractice thing seems to be a sticking point, but my guess is that if there were a training program followed by a certification exam, and if there was a professional organization formed of OB specialists - with some western OB's as advisors - these restrictions could be lifted. There should also be far more Acupuncturists seeking out opportunities to work with OB's on research related to acupuncture and obstetric conditions. There are enough published clinical trials already in existence to probably do a Cochran Review Meta-Analysis and use this to establish baselines for acupuncture as a legitimate part of routine OB care.

Most of my colleagues who specialize in infertility work, routinely attend the ASRM and PCRS conferences for Western Medicine Reproductive Specialists. We are also members of those Organizations. Why aren't OB acupuncture specialists attending the national conference for the American College of Obstetrics and Gynecology and "rubbing elbows" and presenting research?

There are several good texts related to TCM and Obstetrics by Debra, Zita West and Bob Flaws. There are terrific courses taught by Debra, Raven Lang, and others. As mentioned above, there is tons of good research data to support acupuncture in pregnant patients. The only missing pieces seems to be the public and Obstetrician awareness of TCM/Acupuncture effectiveness in relationship to pregnancy-related conditions. Two things would remedy this situation and make acupuncture for pregnancy as sought after a specialty as it is for Infertility:

1. More participation by Acupuncturists in National OB Societies, and at OBGYN Conferences (and perhaps forming a OM Obstetrics specialty training and certification Association).

2. Some practitioner writing a book for the public about Acupuncture and Pregnancy care, ala Randine's book about Infertility. "The Ancient Chinese Path for a Healthy Pregnancy and Happy Baby" by ???

Any takers?

Ray Rubio