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Content uploaded by Debra Betts
Author content
All content in this area was uploaded by Debra Betts on Dec 08, 2015
Content may be subject to copyright.
5
JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004
by Debra Betts
Introduction
Pre-birth acupuncture refers to a series of treatments in the
final weeks of pregnancy to prepare women for childbirth.
Research1 has demonstrated that the mean duration of
labour in a group of women giving birth for the first time
was reduced from 8 hours and 2 minutes in the control
group (70 women) to 6 hours and 36 minutes in the group
of 70 women who had received pre-birth acupuncture. In
clinical practice acupuncture is an ideal method to help
women prepare themselves to have the most efficient labour
possible. Feedback suggests that pre-birth acupuncture
offers a range of positive effects in labour that goes beyond
reducing the time spent in labour, with midwives reporting
a reduced rate of medical intervention. This article outlines
the use of pre-birth treatments in clinical practice in the
hope that this will encourage practitioners to promote this
practical treatment.
Western medical information
In preparation for birth, a woman’s doctor or midwife will
usually recommend weekly visits when the gestational age of
36-37 weeks has been reached. During these visits the foetus
is checked to detect its position and heartbeat. Monitoring is
carried out for gestational diabetes (a form of diabetes that
can develop during pregnancy and will usually resolve post
birth) and pregnancy induced hypertension (also known
as pre-eclampsia, a collection of symptoms including high
blood pressure, oedema and protein in the urine that if
left untreated can lead to problems such as small for dates
babies and eclamptic fitting in the mother).
‘Minor’ discomforts that the women may be experiencing
around this time, and which are considered normal, include
heartburn, constipation, varicose veins, haemorrhoids,
leg cramps, bleeding gums, nasal congestion, nosebleeds,
backache, swelling of the hands and feet, difficulty
in sleeping and increased anxiety and tiredness. It is
also considered normal for the woman to have profuse
transparent leucorrhoea, and to experience frequent
urination as the baby drops and places further pressure on
her bladder. On the plus side her breathing should become
easier at this time as the baby descends further into the
pelvis. Termed ‘lightening’, ‘dropping’ or ‘engagement’,
this descending typically occurs two to four weeks prior to
delivery in a first pregnancy, though it may not occur until
birth in subsequent pregnancies.
From about 37 weeks onwards, a woman’s preparation for
labour usually consists of attending educational antenatal
classes, talking through her plans and fears with her midwife
or doctor and trying to rest as much as possible.
Traditional Chinese medicine
Traditional Chinese medicine has a long history of advocating
that women modify their lifestyle throughout pregnancy, to
ensure healthy babies and efficient births. This has involved
advice on regulating physical activity, following dietary
guidelines and maintaining a calm emotional state.
An early reference to this practice exists in the Records of
the Historian which tells how the mother of the first emperor
of the Western Zhou dynasty (11th century to 771 B.C.E.)
refused to look upon adverse colours, hear indecent sounds,
or the utterance of any arrogant words, and because of this
she gave birth to a son who achieved great things2. Later
references to what became known as ‘foetal education’
included recommendations that pregnant women abstain
from the use of non-prescribed medications, all alcohol
and lifting heavy objects. Advice was also given on taking
frequent leisurely walks and regulating sleep (avoiding both
excessive sleep and undue fatigue). Abstaining from the
seven passions, the five unfavourable tastes and all sexual
activity was also seen as essential2.
Dr. Xu Zi Cai (493-572 C.E.) detailed beneficial and
detrimental foods for each month of pregnancy. During
the second month of pregnancy, for example, the mother
should avoid pungent, hot or drying foods, and if women
experienced abdominal or umbilical fullness and a bearing
down sensation in the third month, rooster soup should
be taken3. As a woman approached the completion of her
pregnancy, Dr. Xu Zi Cai advised that she concentrate her
qi in the lower dantian, three cun below her umbilicus, to
promote the growth of the foetus’s joints and its mental
development.
This interest in promoting optimal conditions during
pregnancy, and in preparing for an efficient birth has
continued to the present day in traditional Chinese medicine,
with the emphasis on a women’s qi and blood prior to
delivery (“if the qi is correct and if the blood is circulating
well labour is described as harmonious”4).
Acupuncture sessions prior to labour provide an ideal
opportunity to ensure that the qi and blood, the five emotions
and the zangfu are all in harmony.
THE USE OF ACUPUNCTURE AS A
ROUTINE PRE-BIRTH TREATMENT
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JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004
Clinical practice
Acupuncture can be used in two main ways in the later
stages of pregnancy. Firstly, specific pre-birth treatments,
in the form of a standard set of points, can help prepare a
woman’s body for birth, with an emphasis on preparing
the cervix and pelvis for labour. Secondly, treatment can be
given to deal with medical conditions such as pregnancy
induced hypertension, and symptoms such as heartburn
and haemorrhoids.
Using a standard set of acupuncture points once a week
for three weeks prior to the woman’s due date is an accepted
practice in German hospitals where acupuncture is practised.
Midwives who have trained in a special acupuncture course
use Yanglingquan GB-34, Zusanli ST-36 and Sanyinjiao
SP-6, with Zhiyin BL-67 as an added point on the woman’s
third visit.
Other formulas used elsewhere for this purpose are i.
Zusanli ST-36, Yanglingquan GB-34, Sanyinjiao SP-6 and
Shenmai BL-625, and ii. Zusanli ST-36, Yanglingquan GB-34,
Shenmai BL-62 and Jiaoxin KID-86.
For many years my use of pre-birth treatments in
clinical practice involved women who had experienced
problems with a previous birth, and were seeking to make
their subsequent delivery as natural as possible. While my
own follow-up of these women’s resulting birth experiences
was positive (with the majority reporting an efficient
labour), I remained reluctant to promote the general use
of pre-birth treatments. My concern was that women
seeking acupuncture had prepared for their birth in many
other ways, for example finding supportive midwives,
practising yoga for pregnancy and taking homoeopathic
medicines, and I was unsure how to accurately measure
the effects of pre-birth treatment against these. However,
after running an acupuncture course for midwives in I997,
I received feedback suggesting that pre-birth treatment
was more than just a useful support to reassure concerned
women. The midwives suggested it should be offered to all
birthing women, reporting that it consistently increased the
chances of women experiencing a natural efficient labour.
They commented that the time women spent in active
labour was notably shorter than in those that did not receive
treatment, and felt that the effect of introducing pre-birth
acupuncture as part of midwifery care had contributed to
reduced intervention rates, including medical inductions
and caesarean sections.
Point prescription
Treatment was given by midwives once a week, from 37
or 38 weeks until delivery. The acupuncture points used
were taken from research1 concluding that the use of the
acupuncture points Zusanli ST-36, Yanglingquan GB-34,
Shenmai BL-62 and Sanyinjiao SP-6 once a week for several
weeks prior to a woman’s due date effectively reduced the
time women spent in labour.
All points were needled bilaterally, with the woman
sitting over a chair, or unilaterally, with the woman lying
comfortably on her side. They were used with an even
needling technique and usually retained for 20 minutes.
Jiaoxin KID-8 could be substituted for Sanyinjiao SP-6 if
the midwife was concerned about using Sanyinjiao SP-6
(see below).
If the baby’s position was not optimal (that is posterior
or remaining high) Kunlun BL-60 or Zhiyin BL-67 was
substituted for Shenmai BL-62 by some midwives.
I was initially concerned that although Sanyinjiao SP-6
was used in the above research, it might potentially have
the effect of promoting a premature labour or a labour
that was excessively rapid in certain women. It must be
noted that although women may be under the impression
that the faster labour is, the better they will feel about
the experience, this is not necessarily true. Extremely
intense rapid labours (for example three hours from start
to finish in a woman having her first baby) can be very
shocking for the mother, so much so that women often
describe feelings of panic and thoughts that they were about
to die. These extreme labours can also contribute to acute
medical problems such as foetal distress and postpartum
haemorrhage. There is therefore a vast difference between
a labour that is short and efficient, and a rapid uncontrolled
labour, potentially resulting in medical problems.
For this reason, midwives were advised to follow the
guidelines I use in clinical practice when a woman presents
with a labour history that includes a previous rapid birth
or premature labour, which is to substitute Jiaoxin KID-8
for Sanyinjiao SP-6, to give a reduced number of pre-birth
treatments to the woman, or to omit the use of Sanyinjiao
SP-6 from the pre-birth treatment.
However, in treating women without a history of a
previous rapid or premature labour where Sanyinjiao
SP-6 is routinely used, no untoward effects have been
noted. Midwives report that the use of Sanyinjiao SP-6
noticeably helps the cervix soften and dilate prior to labour
commencing, a desirable outcome and one that is a positive
indicator for an efficient labour.
Midwives also commented that they had observed a trend
in women who received pre-birth treatment to either go into
spontaneous labour around their due dates, or, if an induction
was required, to respond well to acupuncture treatment for
induction and progress efficiently to a natural birth.
This confirms my own clinical observation of a noticeable
reduction in the number of women seeking induction
treatments since I began offering pre-birth treatments.
Traditional Chinese medicine has a long
history of advocating that women modify
their lifestyle throughout pregnancy, to
ensure healthy babies and efficient births.
7
JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004
Point discussion
• Zusanli ST-36, needled perpendicularly 1 to 1.5 cun,
Used as a pre-birth point, due to its qi tonifying and blood
nourishing properties.
• Yanglingquan GB-34, needled with a perpendicular or
slightly oblique posterior insertion 1 to 1.5 cun. Used as a
pre-birth point to help relax and soften the ligaments prior
to labour.
• Sanyinjiao SP-6, needled with a perpendicular or oblique
proximal insertion 1 to 1.5 cun. Used as a pre-birth point to
aid in cervical dilatation.
• Jiaoxin KID-8, needled perpendicularly 0.5 to 1 cun. Used
as part of a formula for pre-birth together with Zusanli ST-36,
Yanglingquan GB-34 and Shenmai BL-62, possibly due to
its ability to regulate the Conception (Ren) and Penetrating
(Chong) vessels and assist the uterus.
• Shenmai BL-62, needled with an oblique inferior insertion
0.3 to 0.5 cun. Used as part of a formula for pre-birth
treatment together with Zusanli ST-36, Yanglingquan GB-34
and Jiaoxin KID-8, possibly due to its influences over the
lumbar region and hip.
• Kunlun BL-60, needled perpendicularly 0.5 to 1 cun or
directed superiorly to join with Taixi KID-3, 1.5 to 2 cun.
Used as a pre-birth point due to its descending action.
• Zhiyin BL-67, needled with a perpendicular or oblique
insertion directed proximally 0.1 to 0.2 cun. Used as a pre-
birth point for its action in promoting the optimal position
of the baby for birth.
As pre-birth treatments offer the advantage of seeing a
woman regularly for several weeks prior to labour, points
can be carefully added to the standard treatment to deal
with presenting problems such as pregnancy induced
hypertension, insomnia, heartburn or posterior positioned
babies. Help can also be offered for emotional problems such
as frustration over a unwanted mother-in-law or friend that
wants to be present for the birth, or fear and anxiety that
this birth will follow the pattern of a previous birth (or a
friend’s birth), for example a 36-hour labour ending with
an emergency caesarean section.
Care should be taken, however, not to scatter the woman’s
energy, and thus the number of points used should be kept
to a minimum.
This is also an excellent time to advise on the benefits of
preventive rest, explaining the traditional Chinese ideas on
regulating physical activity and trying to maintain emotional
balance to ensure that she enters birth in the best possible
energetic state.
I have also found these pre-birth visits provide an ideal
opportunity to discuss the use of acupressure points in
labour for pain relief7, and the role Chinese medicine can
play in postnatal recovery.
Patient advice
The traditional Chinese medicine view is that a healthy
pregnancy depends on adequate rest, a suitable diet and
emotional well being. This provides a welcome alternative
middle ground to the two prevalent approaches found
in modern western culture: that pregnancy is a medical
problem that medicine should control, on the one hand,
and that pregnancy is something that no healthy woman
should let change her daily life, on the other.
The often-subtle pressure to be a “super pregnant mum”
comes from a perception (from the woman herself or from
those surrounding her), that all any woman really requires for
a “healthy” pregnancy is a few antenatal visits. In contrast,
the advice from the Chinese classic Admonitions to Ladies
states, “A pregnant woman carries with her the finest piece
of jade. She should enjoy all things, look at fine pictures and
be attended by handsome servants”8
While the advice concerning servants may today be
somewhat impractical, this passage does convey a great
respect for pregnancy
Physical activity
In terms of physical activity, it is important for a woman to
find a form of gentle, stamina building exercise that suits
her lifestyle. This should be invigorating but not exhausting.
Suggestions include walking, swimming, Tai Chi or yoga
classes designed for pregnancy. It is also just as important
for women to be able to rest before becoming exhausted. In
the latter stages of pregnancy it is suggested that a woman
creates a “down time” during the day when she can just
rest or have a sleep. Whatever a woman’s experience of
labour is going to be, it will not be enhanced by feelings of
tiredness and exhaustion.
Diet
Dietary recommendations include avoiding spicy, pungent
and greasy foods. I often find there is a problem with
excessive mucus production in the later stages of pregnancy,
as women tend to increase their consumption of damp
producing foods (for example dairy products, rich meats,
bananas and concentrated juices, especially orange and
tomato) in the belief that these are healthy and that they
need the extra calcium or iron these foods provide.
Emotions
While women may not want to go to the extent of avoiding
all of the “seven passions” (which includes avoiding sex until
after the birth), it is useful to ask women to pay attention to
activities that upset them, instead of dismissing these feelings
as “just hormonal”. It might be helpful to avoid watching
disturbing films, reading sad books, or listening to negative
news reports and instead where possible concentrate on
more positive events.
Clinical experience from midwive’s practice
One
One aspect of the acupuncture course for midwives that
has been particularly useful in my practice is the use of
pre-birth treatments. I believe that this has made an impact
8
JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004
on the birth experience of the primigravida women who
have received the treatment. All first-time mothers under
my care, from October 2000 to February 2001, agreed to
have pre-birth acupuncture, once a week for three weeks.
These were their outcomes:
Janice: normal birth, five-hour labour.
Andrea: normal birth, nine-hour labour.
Robin: normal birth, six-hour labour.
Suzette: normal birth, seven-hour labour.
Nicky: water birth, seven-hour labour.
Rachael: normal birth, seven-hour labour.
Janice went overdue and received two consecutive days
of acupuncture treatment for induction (Ciliao BL-32,
Sanyinjiao SP-6 and Hegu L.I.-4). She went into labour
spontaneously on the third day. Ciliao BL-32 was used with
success for an anterior lip during her labour. (Anterior lip
is when during the later part of the first stage of labour
the cervix becomes swollen, and is unable to fully dilate
to allow the baby to descend. As the women is in the later
stages of labour she will have the urge to push but will be
told by her midwife not to as she is effectively just making
the lip more swollen by forcing the baby’s head onto the
cervix. This becomes a problem during labour as it is very
uncomfortable for the woman and delays progress).
During labour Andrea remained 6cm dilated for three
hours. Ciliao BL-32, Sanyinjiao SP-6 and Hegu L.I.-4 were
used, and one hour later she was actively pushing.
Nicky Costello – Midwife
Two
I have been using Zusanli ST-36, Yanglingquan GB-34,
Sanyinjiao SP-6 and Kunlun BL-60 as pre-birth treatments
at 37, 38 and 39 weeks gestation.
I also often include Taichong LIV-3, Yintang (M-HN-3) and
Baihui DU-20 to help relaxation and enhance the woman’s
calmness in this anticipatory time.
I have found that this is also a great time to chat while
waiting for the treatment to be completed.
I have found that the women who have had this preparatory
acupuncture usually come into labour before 42 weeks gestation
and have an efficient labour. They make good progress and do
not usually stop and start. The cervix is usually quite effaced by
the time they reach 3cm dilatation and progress is often swifter
than in those women who have not had any acupuncture. I do
notice a difference between those who have had the pre-birth
acupuncture in that even if the head is ‘high’ and will not come
down (despite using Jianjing GB-21), or if the position is posterior
(and has not responded to Zhiyin BL-67) so that women end
up having a caesarean section, those women who have had
acupuncture will have a much more favourable cervix than
those who have not.
Liz Brunton - Midwife
Three
Beverly had a history of long labour, going 2 weeks overdue
with all her previous 3 children and requiring medical
inductions for 2 of them. She was very keen to try pre-birth
acupuncture for this pregnancy, as in her opinion it could
only help.
At 37 and 38 weeks Zusanli ST-36, Yanglingquan GB-34,
Shenmai BL-62 and Jiaoxin KID-8 were used.
At 39 weeks Sanyinjiao SP-6 was substituted for Jiaoxin
KID-8 and Jianjing GB-21 was added.
At 40 weeks Jianjing GB-21, Zusanli ST-36, Sanyinjiao SP-6,
Hegu L.I.-4, Taichong LIV-3 and Ciliao BL-32 were used.
Beverly went into spontaneous labour 2 days later. I used
Hegu L.I.-4 and Sanyinjiao SP-6 when she arrived in the
delivery suite, as the contractions seemed to have spaced
out. Within half an hour they were coming more frequently
and more regularly.
She had her quickest ever labour (8 hours and18 minutes)
and it was her first-ever drug-free labour.
Karen Wakelin – Midwife
Conclusion
Pre-birth acupuncture offers acupuncturists the opportunity
to promote a safe and effective treatment to promote
natural labour. It is ideally suited for western style private
practice and overcomes the limitations of being on call
when providing acupuncture for women during labour.
With acupuncturists able to use their training to provide
individualised treatments, they have the possibility of
offering holistic care on top of a set of prescribed treatment
points. I would encourage all acupuncturists interested in
supporting women through the birthing process to promote
this treatment, allowing women access to the benefits of
acupuncture as part of their preparation for labour.
Notes and references
1 Kubista E, Kucera H, Geburtshilfe Perinatol 1974; 178 224-9.
2 Zhang Ting-Liang. A Handbook of Traditional Chinese Gynaecology,
Blue Poppy Press, 1987, p4.
3 Maciocia, G., Obstetrics & Gynecology, Churchill Livingstone 1998,
pp. 447-449.
4 Auteroche, B., Navailh, R., Acupuncture en Gynecologie et Obstetrique,
Chapter 11, Maloine 1996.
5 Beal, M., Journal of Nurse Midwifery, vol 37, no. 4, July/August 1992,
p263.
6 Alison, J. 1993 in a lecture given to the New Zealand Register of
Acupuncturists.
7 Betts, D. Acupressure Analagesia: Providing Pain Relief During
Labour, The Journal of Chinese Medicine, issue 59, January 1999,
pp25-27 and http://home.clear.net.nz/pages/debra_betts
8 Gascoigne, S., The Manual of Conventional Medicine for Alternative
Practitioners, Jigme Press, 1996, p 371.
Debra Betts practises in New Zealand. She is also a tutor at the New
Zealand School of Acupuncture in Wellington. Her booklet on using
acupressure for pain relief in labour can be downloaded at http://
home.clear.net.nz/pages/debra_betts. She may be contacted at debra.
betts@jalna7.co.nz
