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PCOM-NY Labor and Delivery Externship Report by Melanie J. Sage, MPH

ACUPUNCTURE IN LABOR AND DELIVERY: TWO EXPERIENCES, TWO BENEFITS

Acupuncture is finding its place in complementary medicine working closely with Western providers in many healthcare settings.  Acupuncture during Labor and Delivery has found its place in the birthing room, side-by-side nurses, residents, and Obstetricians. 

The Pacific College of Oriental Medicine – New York Acupuncture in Labor and Delivery Externship Program offers laboring women free acupuncture services for pain management and progression of labor.  To be eligible for treatment by student interns, women must have a low-risk pregnancy with fetuses between 37 to 41 weeks gestational age.  Eligible women were offered acupuncture and acupressure services and were given a brief description of the treatment with a brochure explaining the program.     

 A Case-Controlled Research Study of the hospital-based program in which PCOM participates demonstrated that a significant decrease in the number of Cesarean sections can be achieved utilizing acupuncture during labor and delivery.  Of the 45 women receiving acupuncture 7% received Cesarean sections as compared to 20% of the 127 matched control women.  Cesarean section birth is a major surgery which can lead to an increased risk for bleeding, infection, blood clots, and internal injuries to the Mother.  Baby’s who are born through Cesarean section have changes in activity level, breathing, and are less likely to breast feed (March of Dimes). 

THE PROGRAM

Once a woman has decided to utilize acupuncture services, an order is written by her physician in her hospital chart and an acupuncture consent form is signed.  Separate charting is utilized to record each individual needle inserted and withdrawn including the starting and completion time of each procedure in order to correlate with changes on the contraction monitor.  Western labor markers are also recorded to compare with the timing of acupuncture. 

Common labor acupuncture points include Auricular sympathetic, uterus, shenmen, bladder, and endocrine.  Associated symptoms are addressed with appropriate points for the symptom as well as points for constitutional involvement.  Symptoms typically addressed including pain, nausea/vomiting, emotional distress, and fatigue.  In addition, points are chosen for progression of labor including adjustment of contractions, fetal position, cervical dilation and effacement, fetal head station, and cervical ripening.

TWO WOMEN

The Pacific College of Oriental Medicine – New York Labor and Delivery Externship is a five day, 60-hour intensive during which I received education on the use of acupuncture during labor and delivery, procedures for providing acupuncture in a hospital based setting, the benefits of Tuina and acupressure, and Western practices for monitoring labor and delivery.  During this week I watched the contraction monitors of many women, one of whom I observed through the birth of her baby by emergency Cesarean section and two which I provided acupuncture services to directly through the birth of their babies. 

The first women I worked closely with was a 30 year old woman who had a two year old daughter with whom she was in labor with for 2 days and had both Pitocin and Epidural medication resulting in a normal spontaneous vaginal delivery (NSVD).  When we offered her acupuncture services she was in the latent (first) phase of labor with cervical dilation to 2cm, cervical effacement at 70%, fetal head stationed at -2, and receiving Pitocin at 12 ml per hour.

 After 20 minutes of chaffing her KD meridian from KD2 through KD9 between contractions and pulsating on ear seeds placed on UB67 during contractions, her contractions became smoother and stronger.  She experienced increased discomfort after the physician artificially ruptured her membrane and requested continued acupuncture treatment for pain management.  In the active phase of labor, her discomfort was managed with firm pressure on LI4 with pelvic rocking and pressure on SP6 during contractions; and pulsating pressure on LI4 with pelvic rocking and Kidney chaffing between contractions.  While providing this treatment her cervix dilated 1.5 cm in one hour.  With the addition of auricular acupuncture utilizing ear uterus, sympathetic, and point zero bilaterally her cervix continued to dilate. 

 The fetal head station remained at -1 for 2 ½ hours, at which time LV2 and LV5 Ashi were needled bilaterally resulting in a drop of 1 ½ stations in little more than half an hour.  With the addition of electro-acupuncture stimulation to Left Auricular uterus/sympathetic and Left LV2/LV5 Ashi her cervix dilated 1cm and effaced 10% in less than an hour.  Firm tapping on UB67 seeds increased the variability of the fetal heart rate within 20 seconds.

During short bursts of emotional distress, acupressure on LV3 to KD1 proved to immediately descend Liver Qi.  Acupressure on LI4 and LV3-KD1 was maintained during the transition phase of labor.  With the acupuncture and medical teams side-by-side, the woman progressed through the second and third stages of labor (pushing of the baby and placenta).

The woman was able to withstand the increasing physical discomfort of contractions (even through artificial rupture) and the emotional stresses related to labor with acupuncture.  Her baby girl was born after eight hours of labor through normal spontaneous vaginal delivery (NSVD) without epidural medication.

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The second woman I worked with was a 23 years old, Spanish-speaking woman in labor with her second child, at 39 weeks gestation.  We offered acupuncture and acupressure for management of discomfort and labor progression with a Spanish language brochure.  She was interested in acupressure for pain management during the contractions, but refused acupuncture.   We received an order for acupressure only.  As we began working with her, she was dilated 3 cm, membrane intact, Pitocin at 12 ml per hour to augment (progress) labor since she had been in the latent (first) phase of labor for nine hours. 

We began by holding firm pressure on LI4 while rocking her sacrum.  This protocol relieved discomfort for a while, but as contractions strengthened the women tightened the muscles throughout her body and twist her abdomen, not allowing the contractions to do their job of descending the fetus.  As the woman began to trust us and the discomfort became stronger, she realized we needed all of our skills to assist her and she consented to receive acupuncture.

It became clear that the fetus was not in the ideal position for descending.  We positioned the woman on her right side and opened the Dai Mai needling Left SJ5, GB41, and tender points GB 30 and 31.  The woman was still twisting her body during active labor contractions.  After receiving her physician’s permission, we assisted the woman in walking around her bed and instructed her on pelvic movements to allow the fetus to descend.  She was much more comfortable upright and tolerated stronger contractions.  Through active labor the woman moved her hips from side-to-side, front-to-back, and in circles pausing briefly with each contraction while receiving medial pressure on GB30. 

The transition phase of labor progressed quickly with the woman still standing and rocking her hips.  She reported a sensation of needing to have a bowel movement and was assisted back into bed.  She began pushing shortly after.  The woman was able to withstand the increasing physical discomfort of contractions with hip movements and pressure on GB30.  Her baby girl was born after four hours of acupuncture through normal spontaneous vaginal delivery (NSVD) without artificial rupture of membrane or epidural medication.      

CONCLUSION

The utilization of acupuncture as complementary medicine during labor and delivery has been shown to be effective.  Physical discomfort and progression of labor can be managed with acupuncture, Auricular acupuncture, acupressure, and electro-acupuncture stimulation.  Labor pains can be tolerated without the side effects of medications.  The acupuncture protocol utilized by this program has been found to reduce the number of Cesarean section births.  Acupuncture in labor and delivery provides beneficial outcomes for both Mother and baby.

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