Complementary and Alternative Medicine

The Whole Pregnancy Handbook
by Joel M. Evans, M.D.

(Page 4 of 4)

Do You Need a Study to Know It Is Safe?

As consumers, we're bombarded with information every day about the latest study on this or that new drug or supplement. We're taught to think that the medicine we're given by doctors has been stringently studied before we take it. But that's not always the case. In fact, not every conventional medical treatment has substantial data behind it, especially when we're talking about medication in pregnancy. Even over-the-counter medicines have not always been subject to in-depth clinical studies on humans. (The ethical issues are enormously complicated.) Doctors often decide on or guide a patient toward a course of action based primarily on their patient's individual needs and wishes combined with their clinical experience, meaning their experience practicing medicine day-to-day and the knowledge they've gained from teachers and peers.

Studies of alternative and complementary therapies that are constructed according to the standards of Western science are in an early stage in the U.S. and Europe. The information we have from these clinical trials about CAM therapies as opposed to the knowledge about CAM that's been disseminated by practitioners over time, sometimes centuries is scanty. Clinical studies are hard to design because many CAM therapies, and the philosophies behind them, require that treatment be tailored to the individual. To complicate things even more, it's difficult to run an ethical clinical trial of any medication conventional or herbal to assess safety in pregnancy. Finally, even with conventional allopathic medicine, scientific studies aren't always available to give us answers for every clinical situation.

Is it best to avoid even 'safe' medications and herbs during pregnancy? Yes. Is that always realistic? No. The odds are that at some point during a pregnancy, you'll get a cold or have indigestion or back pain, which a conventional or alternative treatment can help. Will the treatment work? Probably (there's no 100 percent guarantee for any treatment). Is the treatment or medication safe? If an experienced, well-trained doctor or midwife recommends you take something be it medicine or herb if you trust her as a prenatal care provider, you can trust that she wouldn't suggest a treatment if she didn't believe it to be safe for you and your baby. That said, you can choose whether or not to take something, and you can do your own research on drug safety and ask your provider any questions you may have.

Likewise if you're working with a Chinese or Western herbalist or homeopath who's experienced working with pregnant women, ask what his philosophy is. Is he cautious in giving herbs to pregnant women? Where does he get his information about herb safety? (For example, Commission E, the German FDA, is a recognized authority on botanical medicine.) How long has he been using this herb with pregnant women and where does he get his herbs? If you're not familiar with any of his answers, feel free to take notes and do follow-up research. In general, you probably can trust that established, experienced practitioners would err on the side of caution when working with herbs during the preconception, pregnancy, and postpartum periods. But just as with your medical provider, it's important to ask the questions. And you should check with your doctor or midwife before taking anything.

Ultimately, when it comes to safety in all health-related matters, but especially in pregnancy, there are no absolutes, only our best knowledge at any given moment in time.

FIRST QUESTIONS

Before the consultation, prepare a list of questions. You can ask about anything that you're wondering about. For example:

• What kind of training do you have?
• How long have you been practicing?
• What's your experience with women's health issues in general and pregnancy in particular?
• How can you help me?
• Is there scientific literature supporting your approach? (It's okay if there aren't many conventional, controlled studies of the modality, but you should know what's out there and the practitioner should be able to tell you.)

Is This Practitioner Good for Me?

Jacques Depardieu, MSOM, L/Ac, treats patients with acupuncture, Chinese herbs, diet, and qi gong. He works with me at the Center for Women's Health. Specializing in women's health, Jacques speaks widely on acupuncture, Chinese medicine, and herbal medicine.

Q: How do you know if a practitioner is good?

Jacques Depardieu: First, the match of experience to condition has to be right. Some acupuncturists are phenomenal at back pain, and some practitioners are incredible for gastrointestinal problems, but not everyone is great for everything. And you should get results relatively quickly. Not for everything an internal issue like a fibroid can take months. But for pain, you should start feeling better after a couple of treatments. If you've had more than, say, four treatments and you're not feeling better, I would strongly suggest that the practitioner may not be good for your specific problem.

Another key thing is to find a connection with a practitioner and to cultivate that connection. In the U.S., you get so many different types of practitioners and styles of acupuncture, as well as other modalities of complementary medicine. You as the patient need to feel a practitioner is there for you and listening to you. Really, feeling connected to a practitioner can be more important than the modality itself.

Finally, I believe that a practitioner should empower a patient. As a patient, you should understand that it's your body's intelligence receiving the treatment, making sense of it, and then integrating it. The practitioner isn't some big 'Healer'; your body is doing the work. So when you see someone, be open to being critical and engaged. Question them. Why? Why are you giving me those herbs? What can I do for myself? Can I change my diet? Do you suggest I do yoga or qi gong? Do you think I should take naps? The point is that the practitioner should be able to help you engage in your own healing process.

WHAT TO WATCH FOR

• Locking you into multiple sessions: A practitioner might recommend that you come in regularly, and he may even offer a discount if you purchase a number of visits in advance, but you should not have to pay for multiple sessions up front.

• Dirty space or disheveled appearance: A workspace may have unusual decor, but it needs to be clean. Likewise, a practitioner needs to look professional and put together.

• No questions asked: A practitioner should have a lot of questions about your current health, your health history, and your treatment goals. If a practitioner doesn't ask thorough questions, you need to find someone else.

Copyright © 2005 Joel Evans, M.D.

About the Author

Dr. Joel M. Evans is a practicing integrative OB/GYN and Founder and Director of the Center for Women's Health in Darien, Connecticut. He is an assistant professor of obstetrics and gynecology at the Albert Einstein College of Medicine and a faculty member at the acclaimed Center for Mind/Body Medicine in Washington, D.C. A leader in the holistic medicine movement who lectures extensively on the subject, Dr. Evans is also a founding diplomate of the American Board of Holistic Medicine.