Midwifery comments on using Acupressure

I have been using acupressure in the second stage of labour in primigravida women. I have found GB 21 extremely helpful, definitely reducing the time of pushing.

The first time I tried this point was with a primigravida 40 weeks gestation that had gone into labour spontaneously, she had a fairly normal first stage of labour with no pain relief. During pushing we tried many different positions, sitting on the toilet, standing, squatting, birthing stool. She had been pushing for nearly two hours and we were only seeing a peep of the baby’s head. I suddenly remembered the GB 21 pressure point and while she was sitting on the birthing stool applied strong pressure to her shoulders. Within five – ten minutes the baby descended and was delivered 3 contractions later.

The next time I used this point was on a primigravida who was 41+ 4. She had been induced for postdates, and had an extremely quick first stage of labour. She was quite shocked to feel pressure. She was very uncoordinated and resisting pushing. We turned her onto her knees and I asked her husband to apply firm pressure to GB 21 and pronto the baby dropped into the pelvis (this was so visible) Two contractions later the baby was born.

My third woman was 38 + 3 and delivering her second baby. She had a very fast stage of labour and was anxious about pushing. (She had an epidural with her first baby and hence didn’t have the intense urge to push) I encouraged her husband to massage and press GB 21 and she began to focus on pushing. Shortly after she gave birth standing up.

I find primigravidas are often fearful during the pushing stage and tend to hold back. Although I have always used different positions the delivery positions have often been semi lateral.

When using acupressure on Gb 21 these women have all given birth kneeling or standing. My observation has been that it has helped them focus and they are able to push more effectively. Matty Van Oosteram

My experience of using acupressure as another tool for women in labour has been very positive. If I find that a woman is holding her shoulders tightly, I encourage shoulder massage using GB-21 from 37 weeks to help the baby’s head descend. In preparation for labour I show the support person the points to press on the sacrum and shoulders (BL-32 and GB-21).

Many think it is simply an interesting idea but don’t hold much store by it until they are in labour. I find that the sacral points, in particular, are almost universally enjoyed in labour. Shoulder points are very helpful in some labours - but not as frequently as the sacral points.

Originally I used these points on women late in labour, and as I had found them very effective I had not seen the need to use them any earlier. I now encourage support people to start using the acupressure points early in the labour, as this approach seems to diminish the overall pain and I have been delighted by the response: women are less distressed overall and better supported during labour.

The other effective use of acupressure is when the woman is 41 weeks, wants to be in labour and is happy to start the process slowly over two or three days. At this point the induction points (L.I.-4 and SP-6) can be stimulated regularly and are generally extremely effective if practised diligently.

The more independent women can be in their labour, the happier most are in their abilities to birth. Many women have expressed satisfaction at their partners being able to give them the bulk of their support in labour.

I feel I am also encouraging an attitude of self-help, which is where I think we need to focus our efforts in normal birth. Sue Lennox

I have on many occasions used acupressure in labour. The use of SP-6 and BL -60 has worked well for me in situations where the baby's head is not coming down as it should. I have also used these acupressure points with malpositioned and deflexed heads and have achieved excellent results. Grace Pillay

Whilst working on delivery suite a distressed woman in labour with her first child arrived with ruptured membranes. Her labour was of a spontaneous nature and she was progressing well. On initial assessment I examined her to find her 7-8cm dilated. She went onto all fours and began to become extremely distressed. I used my midwifery techniques to encourage her and offered her the gas to try to help her to focus. She was wasting a lot of energy between the contractions trying to tell her self and me, that she could not go through with this labour. I feared that if this much energy was wasted on negative thought, she would not have enough reserves to push when the time came.

I had exhausted my reserves of suggestions and encouragement. She was progressing far too quickly to administer pethedine or an epidural. As she was clearly not coping I used acupressure on KID 1. Nearly immediately as I lay my fingers in the spot and applied pressure the woman stopped talking closed her eyes and breathed through the contraction beautifully. She expressed how the pressure I was applying was really enjoyable. I kept the pressure through the next contraction, and again, the woman was like another person. The result was immediate, and highly effective. I instructed the partner to use two pens to apply the pressure firmly and the woman within the next half hour began to push instinctively. She progressed to a peaceful vaginal birth on all fours where she remained after the application of the acupressure.
Angelique Baker

Midwifery comments on using Moxibustion

Over the last 6 months I have had three women with Breech presentations confirmed on Scan at 35 weeks gestation. Good foetal growth in all cases. With no hypertension, increased liquor volume, diabetes or known foetal abnormality.

I taught all three clients how to apply Moxa (using smokeless sticks) to BL-67 showing them the illustration from the acupressure booklet, and giving them a copy of the instructions on the safe use of Moxa. I instructed all to continue Moxa for 10 days even if baby turned.

Amber was a primigravida who employed Moxa for 7 days prior to presenting for ECV at 37 weeks, On that day the baby was found to be in oblique position and was easily turned to cephalic presentation by the obstetrician and stayed cephalic until delivery.

Beth was a multigravid patient who had a previous Caesarean section and again I started Moxa at about 36 weeks. When presented fro ECV at 37 weeks baby was transverse and easily turned to Cephalic presentation. I was not present at ECV as busy elsewhere and unfortunately she was advised by my colleague to stop moxa at that point. I did not find out about this until several days later. Baby reverted to transverse and an emergency Caesarean ensued after rupture of membranes and a baby in transverse position.

Cathy was an interesting case. Early scan at 7 weeks showed a bicornuate uterus with baby in right horn. Scan at 20 weeks failed to re demonstrate a bicornuate uterus. At 34+ weeks she complained of reduced movements and a scan showed a baby in the breech position. All other measurements normal. I decided to offer her Moxa despite Bicornuate uterus and arranged for an ECV at 37 weeks. I fully discussed with the obstetrician her scan reports and comments re bicornuacity of uterus and he opted for an attempt at 36 weeks.

On presenting for ECV baby was in oblique position and ECV was successful. Moxa continued for 5 more days. Spontaneous labour at term with normal delivery of 3.8kg baby. Margaret Hadley

Alex had given birth to her third son after a normal birth. Her oldest son was 14 years old, then she had an 18 month old, and now the newest addition to the family was here. She had three day postnatal stay planned to get her bearings of being a mum of three.

Her labour and birth were effective, however she was unusually exhausted. I was on duty for three nights. Her admission night being the first. We discussed the necessity to replenish her stores of energy and her fears of going home as she was weary and worried how she would cope.

We discussed the benefits of moxibustion use postnatally for its nourishing potential. She was interested in trying it. The next night I brought my Moxibustion sticks and a half inch needle. The line of Bl 23 was given moxa, and the point Yin tang was needled for twenty minutes for her mind to be calm for her to gain the utmost benefit of the moxibustion treatment.

During the night approximately 0300, she woke to feed the baby. She could not get back to sleep as was considering taking a sleeping tablet. I offered her moxa again. This time using the line of REN-4 on her lower abdomen. This treatment also was very soothing for her and she fell asleep during the treatment. I left a moxa stick with her through the day and she instructed her family how to do it and emphasized that her midwife said that it was "imperative" that she got this treatment. The following night her baby was more settled and Alex was in a far more settled state. We did the moxa before she fell asleep and every time she woke during the night. She was grateful and had noticeably more colour in her cheeks and far more vibrancy than when we had first met.
Angelique Baker

Acupuncture in midwifery practice

Our practice currently provides total midwifery care for approximately fifty women each year. For the last three years my colleague and I have been amongst the few midwives in the region to offer women acupuncture as a part of their midwifery care. The purpose of this article is to highlight the interesting trends we are seeing where acupuncture has been used antenatally, during labour or postnatally.

A significant reduction in the number of instrumental births and a similar reduction in the number of women needing to be induced for postmaturity would be the most obvious. The use of acupuncture has allowed a greater number of women to achieve normal, more natural births and so a more positive birth experience overall.

We aim to highlight the benefits of acupuncture for pregnancy and birth beyond its popular pain relieving effects. Further research into acupuncture’s wider uses is definitely needed. We believe the benefits for women, babies, midwives, and society are significant and the potential therapeutic value of acupuncture in maternity care is, as yet, unrecognised by the mainstream of maternity care providers.

Through Debra Betts the New Zealand School of Acupuncture ran its first course for interested midwives in Pregnancy and Birth related Acupuncture in 1997. It is since attending this course that we have used acupuncture widely in our practice. Traditionally in the western world acupuncture is known as an alternative to pharmacological pain relief. This has been particularly useful for women in labour helping them achieve more natural births. Initially this was our primary motivation for doing the course, although, three years on, acupuncture for pain relief makes up only a small part of our work. It is the other uses of acupuncture during pregnancy and birth that we have, as midwives, found so useful.

We have noticed in particular, that women who have always grown small babies in previous pregnancies, seem to grow significantly larger babies when acupuncture has been used throughout the pregnancy and are more likely to continue the pregnancy to term.

There is also some indication that acupuncture may have a mitigating effect in women with mild Pregnancy-Induced Hypertension if it is used early enough. Acupuncture needs to be used with care, and in conjunction with the usual screening measures. It appears that blood pressure signs can be kept normal for longer and these women are more likely to carry to term.

Indications from our yearly data are that it has reduced the number of women needing medication to control blood pressure whether it be pregnancy induced or mild essential hypertension. Blood pressure in both pregnancy and labour seem less labile for these women. Proteinuria seems less common and if present, less in its severity. Observing the blood results in those women who received acupuncture every day or on alternate days shows significant biochemistry changes over a period of a week or less. Raised uric acid levels are often brought back to the normal range and ALTs are more likely to remain normal longer in women having regular acupuncture therapy so there is less need for intervention and the early induction of labour.

It is rare now in our practice to have a woman undergo induction for postmaturity at 42 + weeks gestation because acupuncture done from 40 + weeks has resulted in spontaneous labour by 41 + weeks. The average number of treatments to achieve this is between three and seven. The few women that do reach 42 + weeks after acupuncture will usually labour with one or two doses of prostin E2. Rarely do these women (mostly primigravidas) require the addition of intravenous syntocinon.

Women who have had acupuncture preparation in the pregnancy are likely to have significantly shorter labours. This is particularly noticeable with first labours where the average length of established labour is between four and six hours. It seems that acupuncture helps to regulate contractions and women appear to labour more efficiently. The beneficial effects increase with an increased number of treatments. The number of women experiencing long latent phases of labour has now also decreased.

Certain acupuncture points are useful in managing malposition. Persistently posterior babies and transverse arrest in labour are now almost unheard of in women having had acupuncture, even with babies of above average size. The rate of instrumental assisted births in our practice has also fallen dramatically. The use of epidurals is infrequent. Acupuncture does not work for a small percentage of women where there is some degree of true cephalopelvic disproportion due to foetal size or perhaps, the shape of the maternal pelvis.

We have also observed that women who have had regular acupuncture during their pregnancy are less likely to suffer a large blood loss at delivery because of the regulating effect it seems to have on contractions. The majority of women in our care would have a physiological third stage and our rate of postpartum haemorrhage is significantly lower than the national average. We can only attribute this to our use of acupuncture and the resulting lower rate of intervention in labour.

Acupuncture also has its uses in the postnatal period. It can assist lactation and let-down. It can also be used in the treatment of blocked milk ducts. It is useful in restoring a mother’s energy level after birth and promoting her general recovery and wellbeing. It may also be helpful in reducing the emotional swings that some women experience early and later in the postpartum period so it may have a role in reducing the likelihood of postnatal depression in susceptible women.

Our hope is this article will generate interest amongst midwives to explore this area further. The benefits of acupuncture for the childbearing woman need to be formally addressed in the literature, and we believe that midwives, as the guardians of normal birth, are in a unique position to begin and continue this research for the future benefit of all women.

Lisa Errol
Independent Midwife
Hutt District Domino Midwives
New Zealand