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Acupuncture Induction: And Natural Progression of Labour – By Zoe Joyce

It is of no surprise that Acupuncture and Chinese Medicine is the most leading progressive Complementary Alternative Medicine (CAM) in Australia (Smith CA 2004). For many it is perceived as a relatively new ‘alternative’ to western or orthodox medicine. However in truth Acupuncture and Chinese Medicine has been used for well over 2000 years, with records of acupuncture successfully inducing overdue labour dating as far back as the Jin Dynasty (Ad 265 – 420) (Maciocia, 2007). There have been numerous other accounts of acupuncture inductions recorded throughout the fifth century and due to its success has become increasingly recognised and practiced in many countries throughout the world today.

The Benefits of Acupuncture

Many studies have been conducted to test the efficacy of Acupuncture, with one in particular claiming ‘the average time from Acupuncture induction until delivery was 13.1 hours and the success rate of Acupuncture to induce overdue labour to be between 68-83%’ (Tsuei 1974). Further research provides evidence that not only can Acupuncture successfully initiate the onset of labour but can prepare the uterus and cervix for labour, reduce pain of contractions, shorten the average time of labour, reduce recovery time and significantly decrease the need for medical intervention (Smith 2004, Betts 2006).

Are You Approaching or Post Your Due Date?

For many women this can be a time of great uncertainty, even though it is confirmed by many experts that full term pregnancy can range from 38 to 42 weeks, (Mothers and Babies report 2006), you may experience increasing pressure from surrounding family, concerned Midwives and Obstetricians with impending induction dates. Knowing that you want to make the best choices for you and your baby…. Acupuncture can provide you with a safe and effective option, which simply encourages your own body’s natural progression towards the onset of labour.

Is Acupuncture Safe?

Yes Acupuncture is both a safe and supportive therapeutic form of medicine that is recognised by the World Health Organisation (WHO). Each practitioner here at the House of Fertility & Healing is a registered member of the Australian Acupuncture and Chinese Association (AACMA) and adheres to their strict polices and procedures of standardization.

When Is The Best Time To Come For Treatment?

It is highly recommended that treatments begin at week 36 weeks with pre-labour preparatory treatments.  This particular protocol promotes optimum health and prepares both the mother and baby for an efficient and timely birth. The treatment emphasis is on regulating the mothers Qi, Blood, Yin and Yang prior to delivery, which in turn encourages cervical ripening, correct positioning of the baby, decreasing stress and boosts general energy and stamina (Smith 2004, Betts 2006).  It is even stated, “If the qi is correct and if the blood is circulating well labour is described as harmonious” (See Auteroche & Navil 1986).

How Does Acupuncture Work, What Are The Mechanisms?

Acupuncture, as mentioned previously simply encourages your own body’s natural progression towards labour. Sterilized acupuncture needles are placed in specific Acupuncture points that have been used to encourage and induce labour for thousands of years. These points include SP-6 (Sanyinjiao), LI-4 (Hegu) and BL- 32 (Ciliao) (Betts 2006), along with other points that may be appropriate for each individual. The needles create a direct nerve and energetic stimulation to the uterus, where by “Nerve stimulation close to term has shown to increase uterine contractions either through parasympathetic stimulation or central oxytocin release” (Tempfeer C, 1998).

Oxytocin ‘The Hormone of Love’

Oxytocin is one of the major hormones responsible for initiating the onset labour and the rhythmic nature of contractions. This miraculous hormone is produced in the hypothalamus, deep in our midbrain, stored in the posterior pituitary and then released in pulses, it engenders the ‘feeling of love’ and is secreted during pregnancy, birth, breast feeding, sexual activity and orgasm. The foetus also produces levels of oxytocin during labour, which may not only influence the experience of birth, but also contribute to the initial bonding of love between mother and child with the first skin-to-skin and eye-to-eye contact (Buckley 2005).

It is interesting to note that the three other hormones integral in the natural progression of labour are all produced deep in the mid brain and are common to all mammals. These hormones include: prolactin, the mothering hormone, which helps to synthesise breast milk; adrenaline the hormone of excitement; and endorphins, the body’s natural analgesic plus the hormone of pleasure and transcendence (Buckley 2005, West 2001).

What Does a Medical Induction Involve?

A medical induction is a process whereby the onset of labour and contractions are stimulated artificially. This may include:

  1. Sweeping of the membranes (strip and stretch)
  2. Artificial rupture of the membranes (ARM),
  3. The use of prostaglandin (PEG2) gel applied to the cervix,
  4. A synthetic form of oxytocin ‘syntoxin’ administered intravenously

A ‘strip and stretch’, also known as ‘sweeping the membranes’ is where a caregiver manually separates the membranes (sac maintaining waters of the baby) from where it is attached at the lower segment of the uterus. The aim is to initiate local release of prostaglandin hormone from the cervix, which sometimes helps ripen or efface the cervix. However, the most common procedure is the use of prostaglandin gel placed topically on the cervix to facilitate ripening and dilation. This may then be followed by an intravenous synthetic form of oxytocin called ‘syntocinon’, where by, according to Theobald (1974) 130 – 570 times the amount of your own natural levels of oxytocin may be administered directly into your blood stream. In some women this can initiate extremely strong and abrupt contractions at short intervals, potentially causing both feotal and maternal stress. In turn this significantly increases the incidence of further intervention, including epidurals, CTG monitor, forceps and caesarean.

A medical induction in the right circumstances is indeed miraculous and can be life saving for both mum and baby. However unfortunately here in Australia medical inductions are becoming increasingly common, with babies induced for social or non-medical reasons. In 2006, the most common reason for Australian women to be induced (25% of us) is due to prolonged labour (Mothers and Babies report 2006). Alarmingly these induction rates here in Australia are more than double those recommended by the World Health Organisation, which claim they should not be above 10% (WHO). According to (Buckley, P. 1, 2005) “an induction past 42 weeks may save 1 in 300 to 1 in 500 babies form unexpected death”. This is why we consider the risks against the benefits and strongly urge all mothers to ask questions and research information so that each of you can make your own informed choices.

When is a Medical induction Necessary?

There are numerous medical condition that benefit and do require a medical induction, these include:

1)      Diabetes
2)      High blood pressure
3)      Heart Conditions
4)      Epilepsy
5)      Bleeding in late pregnancy
6)      Cholestasis in pregnancy
7)      Pre-eclampsia
8)      Rupture of membranes without commencement of labour
9)      Placenta dysfunction
10)    Over 42 weeks

However, Acupuncture and Chinese medicine can also be very effective treating and/or assisting western medical treatments in most of these conditions and we highly recommend seeking treatment as early as possible. Starting with weekly preparatory treatments from week 36.

The Benefits of Acupuncture over a Medical induction

Acupuncture:

As Acupuncturists it is our aim to support and encourage both the mother and foetus towards a harmonious and natural labour. Preparatory treatments are tailored specifically to each individual and conducted in a relaxing, low lit and welcoming environment. This enables the mother to relax, allowing the deep mammalian brain to proceed over the neo-cortex or (rational part of the brain) (Buckley 2005). This process is extremely beneficial for the secretion of labour initiating hormones as well as encouraging a deep peaceful state of transcendence. Acupuncture in combination with deep relaxation gently encourages the body’s own natural progression of labour.

Medical Induction:

Syntocinon when administered intravenously does not act in the same way as our own natural oxytocin. It does not cross the blood brain barrier and therefore the levels of natural oxytocin ‘hormone of love’ are not present in either the mother or foetus. (Buckley 2005). Synthetic oxytocin also initiates stronger and more abrupt contractions, which may increase the need for further interventions.

Other Points to Consider:

1) Quick induced, strong and painful of contractions leaves little or no time for the body to produce enough of its own analgesics (endorphins). Thus significantly increasing the need for painkillers such as pethodene and epidurals. According to Duff (2000) medically induced labour increases the rates of epidurals by17.09% and caesarean section by 5.14%.

2) Over stimulation of the uterus may decrease uterine resting time in between contractions and deprive the foetus of sufficient blood and oxygen supplies, causing increased foetal stress, elevated Foetal Heart Rate (FHR), increase chances of caesarean and even uterine rupture (Stubbs 2000).

3) Due to the risk of foetal stress a continual heart monitor (cardio tocograph or CTG) is often attached to record foetal stress and the strength of contractions, this in combination with the IV drip makes movement through labour extremely difficult and limited.

4) It is also known that overall blood loss and chance of haemorrhage after birth is increased in women who are induced with oxytocin and prostaglandins (Duff 2000).

5) And perhaps most importantly the mother may feel diss-empowered as everything can very quickly spins out of her own control (Maciocia 2007).

Does My Baby Have A Say?

It is suggested that the foetus does actually play an influential role in the onset of labour and the initiation of myometrium and uterine contractions. According to (Smith & Challis 2001) the activation of uterine contractions may be provoked by an endocrine pathway “resulting from increased activity of the foetal hypothalamic-pituitary-adrenal axis”. This implies there is a hormonal communication from the foetus to the mother signalling for the timely onset of labour. Taking this into consideration it is most optimal to adequately prepare both the mother and the foetus for an efficient labour with preparatory treatments from 36 weeks.

Will Acupuncture Initiate Labour Straight Away?

This is a very important question. Firstly it must be understood that acupuncture will not force but encourage your own body’s natural process. It strongly depends on the state of the mothers Qi, Blood, Yin and Yang (Betts 2006), as well as the positioning of the baby and how ripe or effaced the cervix is. For some women contractions may begin during or shortly after treatment, whilst others it may be necessary to receive treatments daily right up until labour is initiated. Again it must be emphasised here the benefits of preparing the body’s energy, blood and Qi for a timely harmonious labour with preparatory treatments. In most cases preparatory treatment enables labour to progress naturally with little or no need for any form of intervention (Betts 2006).

However, research also shows that, “ Bilateral Acupuncture at LI-4 (Hegu) and SP-6 (Sanyinjiao) for 20 minutes every second day from a woman’s due date supported cervical ripening at term and shortened the time interval between the woman’s expected due date and the actual time of delivery” (Betts 2006, p., 150).

What Will You Experience When You Come Into Our Clinic?

Firstly a warmly greeted welcome, then an initial consultation will provide us with the necessary information so that we can tailor treatment according to your specific needs and requirements. After being made very comfortable either lying on your side or sitting upright with your body and belly fully supported, we will proceed with traditional Acupuncture points that are predominantly found on the lower legs, hands and feet. For most this experience becomes a wonderful time to relax and recuperate. Treatments will last for around 30 to 40 minutes but allow a full hour for the initial consultation. Partners are most welcome and in fact we encourage this, as it is a perfect chance to demonstrate effective acupressure points that can be utilised at home to help initiate, maintain and hasten labour along with reducing pain of contractions.

(From all here at the House of Fertility and Healing) we very much look forward to being able to provide quality Acupuncture and Chinese Herbal treatments to support and encourage optimum health for you and your baby, pregnancy, natural efficient labour and a post partum speedy recovery.

References

  • Kang, W. (1990). A Study on 98 Cases of Insufficient Milk Supply Treatment by of
  • Acupuncture. Chinese Acupuncture & Moxibustion. 10(5): 24.
  • Betts D. (2006), The essential guide to Acupuncture in Pregnancy & Childbirth, The Journal of Chinese Medicine Limited, England.
  • Duff C. (2000), Exploring the risks associated with induction of labour: a retrospective study using the NIMATS database, Journal of Advanced Nursing, 31(2), 410-417.
  • Maciocia G. (2007), Obstetrics & Gynaecology in Chinese Medicine, Churchill Livingstone, Edinburgh, UK.
  • Mothers and Babies (2006), NSW Public Health Bulletin Supplement Volume 20   Number S-1, March 2009.
  • See Auteroche B., Nevil R. (1986), Acupuncture en Gynecologie et Obstetrique, Malonie, Paris.
  • Smith CA, C. C. (2004), Acupuncture for induction of labour, The Cochrane Database of Systematic Reviews (1).
  • Smith S, K. & Challis, J,R., (2001), Fetal Endocrine Signals and Preterm Labour, Biology of The Neonate, Vol. 79;163-167 (DOI: 10.1159/000047085).
  • Stubbs TM. (2000), Oxytocin for labor induction. Clin Obstet Gynecol 2000;43(3):489-94.
  • Tempfeer C, Z. H., Heinzl H, Hefler L, Husslein P, Kainz CH. (1998). Influence of acupuncture on maternal serum levels of interleukin-8, prostaglandin F2 alpha, and beta-endorphin: a matched pair study, Obstetrics & Gynecology, 92(2), 245-248.
  • Theobald GW. Letter: Dangers of oxytocin-induced labour to fetuses. Br Med J 1974;4(5936):102.
  • Tsuei JT, L. Y. (1974), Induction of labour by acupuncture and electrical stimulation. Obstetrics & Gynecology, 43(3), 337-342.
  • West Z. (2001), Preparation for Labour. In Acupuncture in Pregnancy and Childbirth (pp. 154- 158), Sydney: Churchill Livingstone.
  • World Health Organisation (WHO) http://www.who.int/en/
  • Australian Acupuncture and Chinese Medical Association (AACMA) www.acupuncture.org.au
  • Buckley, S, J., 2005, Hormones In labour & Birth, How Your Body Helps You, http://www.bellybelly.com.au/birth/ecstatic-birth-natures-hormonal-blueprint-for-labor
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