FRAMEWORK FOR MIDWIFE CERTIFICATION FOR
ACUPUNCTURE USE IN LABOUR

Entry-level midwives in British Columbia provide primary care to women throughout the perinatal period under their own responsibility. The CMBC’s Competencies for Registered Midwives states that entry midwives must have ability to manage labour and birth, including the ability to assess the need for relief of pain and intervene using non-pharmacologic and pharmacological measures as required. They must also have knowledge of complementary therapies which may be used during the intrapartum and postpartum period.

Under sections 5 (1) (c) and 6 (2) of the Midwives Regulation, midwives with specialized training who are certified by the College of Midwives of BC (CMBC) may insert acupuncture needles for pain relief in labour or the post partum period.

Acupuncture means an act of stimulation, by means of needles, of specific sites on the skin, mucous membranes or subcutaneous tissue of the human body and may be used to alleviate pain. Acupuncture requires specialized education and training, as this therapy is not without risk.

Acupuncture therapy has a role in the management of pain and can be beneficial for women in labour or the immediate post-partum period. A randomised controlled trial evaluating acupuncture treatment during labour has demonstrated enhanced relaxation and a significant reduction in the need for epidural analgesia.# Other clinical trials conclude that acupuncture is an effective therapeutic treatment for analgesia in labour.#

Specialized practice certification in this competency area may be obtained through a course or program established or approved under the authority set out in the Bylaws for the CMBC that meets the requirements set out in this framework. The objective of the specialized practice certification is to understand the theoretical and practical knowledge in the foundation of acupuncture treatment with a special focus on learning how to appropriately use acupuncture to provide pain relief to women in labour or during the postpartum period while implementing the highest standards of safety.

Limitations

A midwife with specialized practice certification in this competency area may only insert acupuncture needles during spontaneous labour# or in the immediate post-partum period for the purpose of pain relief.

Certification

The certification process must be carried out by approved qualified educators using a curriculum and program of supervised clinical practice. The CMBC will approve a curriculum and program of supervised clinical practice through a process of consultation and collaboration with the College of Traditional Chinese Medicine Practitioners and Acupuncturists of BC (CTCMA). The clinical experience portion must take place under the supervision of a registrant of the CTCMA authorized to practice acupuncture, or a regulated health care practitioner authorized to perform acupuncture and experienced in using acupuncture in the intrapartum period. Upon successful completion of the certification process, proof of completion must be submitted to the College of Midwives of BC before certification is granted. Where competence in this area of specialized practice has been acquired in a jurisdiction outside of British Columbia, the registrant must present proof of certification and competence to the College of Midwives for assessment of equivalency in meeting CMBC requirements.

Specialized Practice Certification must include:

Demonstration of theoretical and practical knowledge in the foundation of acupuncture treatment in completion of an approved course of at least 50 hours of instruction, and successfully passing written and/or oral and simulated practical assessments including:

Knowledge of theory in acupuncture

Knowledge and understanding of principles involved in acupuncture as they pertain to anatomical and physiological considerations; location and surface anatomy; proper procedure for location, depth and angle of needle insertion;

Knowledge of basic to intermediate point differentiation and of indications and contraindications;

Knowledge and understanding of safe acupuncture technique and appropriate universal precautions;

Knowledge of the indications and protocols for use of acupuncture during labour and the postpartum period;

6) Ability to use acupuncture for pain relief during labour and in the immediate postpartum period;

7) Knowledge and ability to recognize when a consult and referral to another health care practitioner is indicated;

8) Knowledge and ability to manage possible complications;

9) Knowledge and ability to facilitate a full informed choice discussion with a client about the nature of the acupuncture treatment being offered, its risks, benefits, indications and contraindications.

After verifying the midwife’s knowledge and skill through completion of study materials and the successful passing of written and/or oral and simulated or actual practical assessments, the certification process must include initiating and managing pain relief for a minimum of 3 women under supervision during labour followed by documentation of managing pain relief for an additional 10 women to be reviewed by retrospective chart review. Assessments of practice and chart reviews must be under the supervision of a registrant of the CTCMA authorized to practice acupuncture, or a regulated health care practitioner authorized to perform acupuncture and experienced in using acupuncture in the intrapartum period.

Recertification

A recertification process may be needed if a midwife has not provided acupuncture treatments for a sufficient number of women over the course of a year. The need for recertification will depend on the number of acupuncture treatments a midwife has performed in the preceding 12 months. The College of Midwives recommends recertification where the midwife has managed fewer than three acupuncture treatments over that period unless she has significant prior experience.

References

AmJ Chin Med. 2009;37(1):1-18. Review: acupuncture analgesia in clinical trials. Lin JG, Chen WL. Graduate Institute of Acupuncture Science, China Medical University, Taiwan. jglin@mail.cmu.edu.tw

Acupuncture Research Resource Centre, British Acupuncture Council – Briefing Paper No 12 Obstetrics (2) Pregnancy and labour the evidence for the effectiveness of acupuncture. Budd, S. Sept 2006

BJOG June 2002, Vol. 1109, pp.637-644 Acupuncture treatment during labour – a RCT Agneta Ramnero, Ulf Hanson, Mona Kihlgren

College of Traditional Chinese Medicine Practitioners and Acupuncturists of BC http://www.ctcma.bc.ca/index.asp

The College of Physicians and Surgeons of British Columbia – Resource Manual – Acupuncture 2008