Acupuncture treatment in threatened miscarriage : a mixed methods study

Abstract

Threatened miscarriage is a common complication of early pregnancy, with risk factors for miscarriage or pregnancy complications that may include premature delivery. Currently, no Western medical pharmacological or non-pharmacological management is strongly recommended, resulting in medical monitoring with a 'watchful waiting' approach. While it is known that chromosomal abnormalities are responsible for approximately 50% of miscarriages, treatment options may be available for women where these factors are absent. The overarching aim of this study is to explore supportive care with a focus on the role of acupuncture in the treatment of threatened miscarriage. The following research questions are addressed: What is the current interest and use of acupuncture among acupuncturists, and what are their considerations for clinical practice compared to textbook recommendations? Is acupuncture a feasible intervention to deliver, and what effect does acupuncture have on quality-of-life and pregnancy outcomes for women with threatened miscarriage compared to women receiving supportive care? What do Western-trained health practitioners consider optimal clinical practice for the treatment of threatened miscarriage? What are women's experiences of threatened miscarriage and the care they receive? A mixed methods research (MMR) approach is used with quantitative methods for a survey and a pilot randomised controlled trial (RCT), and qualitative methods are used for semi-structured interviews and Internet-based data collection. Four studies are undertaken, including an online survey of acupuncturists in Australia and New Zealand in which practitioners have been purposely selected for an interview. A pilot RCT is undertaken, which involves 39 women who have received acupuncture or an active control of touch, with women interviewed as they exited the RCT. Western health practitioners who treat women with threatened miscarriage are also interviewed, and data are collected from threatened miscarriage discussion forums on the Internet. Thematic analysis is used to code and analyse the data from the interviews and Internet forums. A 'following-a-thread' technique and dialectic approach is used to integrate the data sets. Women express dissatisfaction with the care they receive from their Western health practitioners, and challenge medical authority when this support is not received. The value of hope emerges as a key theme, with women demonstrating a need for emotional support in addition to medical monitoring. This support involves offering the possibility of hope for a viable pregnancy, offering hope by doing everything possible and providing access to information by talking to a knowledgeable person. Western health practitioners and acupuncturists have different approaches to the care they offer women, as well as different perceptions on acupuncture as a treatment for threatened miscarriage. Western health practitioners offer medical monitoring and maintain a professional responsibility not to give 'false hope' by using the results of medical diagnostic tests and preparing women for potential pregnancy loss. These practitioners see acupuncture as one of many complementary alternative medicine (CAM) therapies that have the potential to provide relaxation, but not as a treatment that can influence pregnancy outcomes. In contrast, acupuncturists see themselves as offering a treatment to stimulate positive qi responses in early pregnancy through acupuncture, diet and lifestyle advice, and therapeutic support. Acupuncturists also express concern about the safety of treatment if used incorrectly, and they describe using diverse treatment modalities for acupuncture and moxibustion in clinical practices to treat threatened miscarriage. The RCT demonstrates that acupuncture is a feasible treatment to offer in a Western clinical setting, and it demonstrates a statistically significant improvement for threatened miscarriage symptoms such as anxiety due to vaginal bleeding, abdominal cramping and back ache (MD 1.36; 95% CI, 0.07, 2.66, p=0.04). In conclusion, women presenting with threatened miscarriage seek care beyond medical monitoring from Western health practitioners. In addition, they actively seek hope for a viable pregnancy, with medical expertise challenged when this is not provided. This study demonstrates how acupuncture treatment meets women's emotional needs for support, including hope, and how it significantly reduces symptoms related to threatened miscarriage. This study provides clinical guidance for acupuncturists treating women with threatened miscarriage, as well as information for Western health practitioners wanting to offer these women support. This thesis also provides knowledge for future research to investigate what types of care women view as supportive, as well as the potential of acupuncture as a treatment for women presenting with this common complication of early pregnancy.

Date of Award	2013
Original language	English