Skeptical Dad: Alternative medicine in parenting

By Matt Kaiser

Part I: what’s so wrong with it in pregnancy?

As someone of a sceptical persuasion, I have never really considered taking complementary or alternative medicine (CAM). I prefer my medicine evidence based.

During my first year as a dad, however, I have noticed that CAM seems particularly rife in pregnancy and childbirth. My anecdotal impression seems to be backed up by further analysis – a systematic review of scientific studies reported that more women than men use CAM in general and many continue to use CAM therapies throughout their pregnancy. Various analyses have estimated that, in the UK, at least 10% of people use some form of CAM within a given year, with other countries reporting a far higher usage. This supports a multi-billion pound global business, with the potential for a significant health impact on the population.

 

Conception

It started, for me at least, before my partner got pregnant. As is common, we didn’t conceive straightaway and so we started reading about how to maximise our chances. Many ‘natural health’ practitioners offer services for want-to-be mothers, such as reflexology, reiki (“prepare the body for birth”), acupuncture (“treatment of Kidney Yin and Yang”), dietary advice (“choose foods with strong life force!”), detox (‘fertility cleansing’), massage (“help the body to become balanced”) and homeopathy (“recondition the uterus, fallopian tubes and ovaries”). There are also treatments for male fertility, which promise to “stimulate the body’s own ability to heal itself” with homeopathy or by strengthening Kidney Jing with acupuncture (for at least three months, of course!).

"Dilution"

XKCD: Dilution

This is despite no robust evidence to show that these treatments themselves actually boost fertility or increase conception rates. Reflexology or reiki does not provide ‘energy healing’, acupuncture has no effect on oviduct blockages or uterus blood nourishment, homeopathy does not change the cervical mucus or restore ‘sexual energy’, and massages cannot affect hormonal balance or the position of the uterus (all genuine claims). CAM practitioners’ websites invariably either quote testimonials, provide no research citations (even despite frequently stating that “research shows…”) or link to single, small-scale studies of dubious quality. More conclusive analyses, however, are severely lacking.

 

There is strong evidence of what does work to raise the likelihood of a woman conceiving: having frequent sex and timing intercourse at particular periods of the menstrual cycle, reducing or stopping smoking and losing weight, avoiding certain ‘teratogenic’ medications and agents, and conceiving at a younger age. It is also worth remembering that, on average, the probability of a women becoming pregnant within one menstrual cycle is around 20%, but that subfertility requiring specialist intervention affects only 10-15% of individuals. In effect, all that’s needed is time. In light of this, any testimonial claiming causality for a complementary fertility technique stands on pretty shaky ground.

What is even more disturbing, at least to me, is the promotion of various quack therapies to aid successful in-vitro fertilisation (IVF). These include distant spiritual healing to ‘nourish aura, chakras and meridians’, as well as opening relevant acupuncture channels to supply ‘more energy to the uterus and enhance receptivity’. Again, proper scientific scrutiny suggests these approaches do not work any better than placebo controls.

Assisted conception is a potentially anxious and distressing time, not to mention a potentially expensive one, and to my mind the last thing a couple needs is to invest faith and money in ‘therapies’ that don’t work.

Pregnancy

But the ‘alternative’ care had only just started. Once the little blue cross appeared on the white stick, there was a host of holistic approaches to supposedly see through a stress-free and uncomplicated pregnancy. Many boast of their ability to help prevent miscarriage, such as with acupuncture, enzyme therapy, herbs, reiki and reflexology.

There are also promotions for certain clayey soil (“Nzu”) and some of the usual CAM suspects to ease morning sickness, Bach flower remedy to reduce anxiety (“acts directly on the emotions”!), homeopathy for haemorrhoids and indigestion, and chiropractic and moxibustion to reverse breech presentation.

As has been shown time and time again, many observed benefits of CAM are derived from a placebo effect: that is the improvement seen in a patient who believes that they’re taking an effective therapy, even if they’re actually taking a sham control. But, who cares if it’s a benign treatment if the whole experience leads to an improvement in wellbeing?

There’s some mileage in this argument when one considers that we know that a maternal stress during pregnancy can lead to adverse outcomes, such as low birthweight, prematurity and poor growth of the baby. And certain relaxation techniques may be effective at reducing anxiety. It categorically does not, however, mean that the many CAM practitioners should be able to make entirely false and unsubstantiated claims in advertising their products and services, as this sells something at a handsome price that should be part of standard care. It also legitimises CAM practitioners’ baseless declarations, so that patients may divert care from conventional medicine to CAM. This risks shunning effective treatment, which will also include an equivalent placebo boost, in favour of sham therapies that, at best, give rise to placebo only.

And that’s still assuming CAM is benign, which may not always be the case given some adverse effects reported.

Again, there is plenty of evidence-based advice on how to reduce risks of complications in pregnancy, such as stopping smoking to reduce the risk of low birth weight, avoiding alcohol to prevent foetal alcohol syndrome, folic acid supplementation to lower occurrences of neural tube defects (also for preconception), addressing any nutritional deficiencies, and the proper treatment/management of a range of diseases known to adversely effect development.

Childbirth

One of the more varied stream of recommendations we received was how to induce labour. The list included raspberry leaf tea, cumin tea, spicy curry, sex (and other sexual practices!), nipple stimulation, a long walk, cream cakes, a glass of wine, castor oil, pineapple, scrubbing the floor, driving over speed bumps, flying and parsley (see the Mumsnet thread for some stunning cases of coincidental correlations: “X worked for me. I took it when I was due and I went into labour the next day!”). And we also have our familiar friends: herbs, acupuncture (again!) and homeopathy (although I’m not sure how pulsatilla, a herbaceous plant, relates to labour in a “law of similars” way).

Whilst the push for all things ‘natural’ is seen at all stages, never does it appear so forcefully advocated than when it comes to labour. I’ve heard quotes such as, “labour is the most natural thing a women can do”, “a women’s body is designed for childbirth” and “a women knows what to do in labour without drugs or machines”.

There is a sizeable demand for ‘natural’ approaches to pain relief during labour and there is a variety of treatments touted. These include electrical stimulation across the skin (‘TENS’), aromatherapy, audio-analgesia and acupuncture, mind-body interventions (e.g. yoga & hypnosis), homeopathy, traditional Chinese medicine, reflexology, and herbal medicines.

Unfortunately, there is insufficient evidence to make any call that these work or are more effective than placebo control (e.g. 1, 2, 34 & 5). The Cochrane Pregnancy and Childbirth Group is undertaking a review into the efficacy of hypnosis for labour pain management, so the jury’s out on that one. Massage and relaxation techniques may help with pain and reduce the likelihood of obstetric intervention (but, guess what? More research needed!).

Arnica, a herbaceous plant often homeopathically prepared, was enthusiastically recommended for our hospital bag, supposedly to prevent bruising and promote healing. Except it doesn’t (12 & 3).

It is, on the whole, likely to bedifficult to carry out interventionist, randomised studies on pregnant women. Who’d write that in their birth plan? So the data that do exist tend to be self-selected, unblinded, observational, often self-reported and prone to a myriad of confounding variables. But I guess that wouldn’t stop a CAM practitioner from cherry-picking a sweet biased result or two.

I’m sure there are many more examples of alt med infiltrating pregnancy and childbirth, but I hope I’ve given a flavour of how widespread and enduring it is. My next post will be on the influence of mainstream healthcare professionals.

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0 Responses to Skeptical Dad: Alternative medicine in parenting

  1. Jobob_80 says:

    There’s another thing worth mentioning, which is that conventional medicines are rarely demonstrated as safe in pregnancy. Most carry the lable “consult your doctor if pregnant or breastfeeding”. I’m a skeptic, but when I was pregnant and had a cold (as well as morning sickness, backache and the rest) I’d have tried just about anything that promised to make me feel better without hurting the baby!

  2. Matt Kaiser says:

    Jobob_80: That’s a really good point. When my wife was pregnant, all she could take was paracetamol and not much else!

    This issue has been in the back of my mind for a while and I wanted to write something longer on it. I kind of touched upon it when I mentioned that it’s difficult to imagine someone writing an RCT in their birth plan, but it’s equally applicable for many conventional therapies. I would really like to know whether it’s down to a difficulty in enrolling pregnant women in trials, a problem getting ethical approval or an unwillingness from researchers (or something else).

    However, alt med practitioners should also be held to the usual standards!

  3. Elodie Glass says:

    Fair enough. I’m sorry that you and your wife went through such a difficult time during conception.

    However, I think it’s interesting that you opened with the topic of pregnancy. Any uterus-owner is bombarded constantly with messages dictating how to form oneself into an optimal child-carrying vessel, with the secondary messages that anyone who does not follow these protocols is deliberately neglectful and dangerous. Pregnant women are told by a straight-faced medical community not to cross their legs when sitting, not to use laptops, not to take baths, not to eat cheese. Meanwhile, they are bombarded with constant messages to enforce this fear; Do Not Do Anything That Might Remotely Endanger The Fetus! If you analyze your work in the greater context of western society’s pregnancy culture, it circles back to the fact that pregnant women are strongly discouraged from making their own decisions about their pregnancy during health care. While the literature is pretty convinced that a well-timed glass of wine will be absolutely fine for a baby, witness the societal censure of the pregnant woman accepting anything but the purest, most virginal water! No shrimp for you, pregnant lady! There is an infinitesimal chance that it might be a Listeriosis Death Shrimp, and although the statistics of receiving one are surprisingly equal for non-pregnant shrimp consumers and pregnant shrimp consumers, YOU WOULDN’T WANT TO TAKE THE CHANCE, WOULD YOU? Is it, perhaps, possible that your claim “CAM seems particularly rife in pregnancy and childbirth” is partly due to the fact that our pregnancy/childbirth culture encourages parents to give up control to Forces Who Know Better?

    I’m not arguing with the points you’ve made, they’re salient; I do think that culture is always something to consider. When I was an undergrad, I had the following exchange with an OB-GYN on campus, who was promoting folic acid:
    Her: Folic acid pills! They’re free! And prevent birth defects!
    Me: That’s a great idea! But no thanks, I’m not intending to get pregnant.
    Her: But you might get accidentally pregnant.
    Me: Granted, I’ve read that folic acid overdose induces miscarriage, but I don’t think these pills are enough for that?
    Her: … No, it’s totally safe. They’re so that the baby doesn’t get sick. If you don’t take them your baby will be born crippled and armless, how could you NOT take them?
    Me: I’m not interested in taking a pill for no reason to prevent neural tube defects in my highly fictional future baby.
    Her: Well if you want a baby in your future, then you should start taking them now.
    Me: This conversation, it just keeps circling the drain to Nowhereville.

    Anyway, FozMeadows has already said it best :And this is what makes me angry: that facts which have been edited to the point of fearmongering are not only passed on to pregnant women as inviolate gospel, but lent weight as such by dint of being delivered in the same breath as legitimately useful, unambiguous and instantly applicable information…

  4. Matt Kaiser says:

    Elodie Glass:

    Thanks for the comments. You raise some good points about the health advice passed on to pregnant (and, indeed, non-pregnant women) – something which I hope to touch on more in my next post.

    It’s interesting you raise the ‘Listeriosis Shrimp’ issue. From my own experience (anecdote ahoy!), there seems to be some confusion over why pregnant women are advised to avoid certain foods/drinks/drugs. Some could directly affect the development of the foetus (smoking affects birth weight, excessive alcohol may lead to FAS, etc.) but others, as you mention, are just to avoid the small chance of developing an infection/disease (runny egg yolks and salmonella, soft cheese and listeriosis, etc.). This information is often missing from health advice but I think it should be included.

    Incidentally, I was under the impression that pregnant women are more likely to develop listeria infection than the rest of the population (see http://www.nhs.uk/conditions/Listeriosis/Pages/Introduction.aspx) and the consequences are definitely worth avoiding.

    I think much of boils down to understanding risk. Rather than just a list of things to avoid, any advice should contain information on why and what the actual risk is. As an analogy, the cancer charity I work for puts out of lot of advice in relation to preventing and treating cancer, but is adamant that it is not playing the blame game. It’s about letting people know about risk (usually as a population, not as an individual), so it equips people with the knowledge of how to stack their odds one way or another. http://scienceblog.cancerresearchuk.org/2012/04/11/lifestyle-and-cancer-against-the-blame-game/

    And this, for me, is the crux. It’s not just about choice (a justification used by proponents of CAM), but about *informed* choice. I don’t think that allowing false advertising for health benefits brought by CAM allows for informed choice, and this was the motivation for the post. I agree that culture should always be considered in health advice (something I’ve considered before – http://theskepticaldad.wordpress.com/2011/09/21/on-the-social-environment/ & http://theskepticaldad.wordpress.com/2012/05/31/is-breastfeeding-all-its-cracked-up-to-be/) and I certainly want to see women more empowered to make decisions.

  5. Elodie Glass says:

    Sorry, should have been more clear – pregnant women are at greater risk of developing listeriosis infections, but don’t necessarily have a higher rate of infection, and that causes a lot of confusion in the lay public, on account of not being encouraged to learn the difference. (http://cid.oxfordjournals.org/content/54/suppl_5/S405.long) Listeriosis RATE is disproportionately high in, say, low-income English populations; we don’t shame economically-deprived Brits into Saying No To All Shrimp and Brie (THINK OF THE BURDEN ON THE NHS, YOU SHAMEFUL CHEESE-EATERS!) because it’s mostly old folks and pregnant people at RISK. This is absolutely something that should be clarified, and I agree, this information should be in a damn manual, with pleasant colorful graphics and the revolutionary assumption that pregnant women can actually think.

    And that’s it, isn’t it? The culture of magical thinking, lack of female agency, and genuine fear that surrounds pregnancy. The concept that if new parents press all the right buttons, go to the right classes, take all the herbal supplements and chant the magical chant, smudge the incense and speak smugly and loftily of folic acid, Lamaze and listeriosis, then they’ll have a healthy baby, and if they don’t, they somehow brought it upon themselves. They Did It Wrong. Pressed the wrong buttons. Probably ate a secret shrimp.

    At the moment our extended family is rocking from the difficult arrival of the first member of the next generation. They did everything perfectly – both parents stopped smoking years before trying! Nobody drank! Folic acid! Healthy baby! We are a family of journalists, scientists, medics and social workers; we have credentials to flourish and blogs to link to; surely we’ve pressed all the correct buttons. And the perfect healthy baby that was In There is now struggling in the hospital, because her birth was damn hard and it squished her. Which button did you all miss? people ask accusingly. Which button was it? Was it the history of evolutionary biology that resulted in humans being born unformed, with very large skulls, through very small passages? Was it the fact that the father’s genes encourage the baby to grow as large and fat as it can, while the mother’s genes tell it to stay small and easily birthable, and the tradition is for the genes to battle across the placenta and sometimes the mother’s genes don’t put up a fight and the baby is too big to be born? No, that’s not the right button. You missed a button somewhere. You didn’t put in the right equation to get Healthy Baby. And it hurts, because who thinks about rate and risk once the terrible thing has already happened? These are things to measure and evaluate in a calm room.

    I look forward to the rest of your essays! The intersections of culture and medicine are a few of my favorite things.

  6. Ashley says:

    I had apprehensions when it came to alternative medicine, but I read this interesting article on cinnamon supplements http://www.regenerativenutrition.com/cinnamon-cinnamomum-verum–p-176.asp and how they can help with infertility.

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