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Toowoomba Acupuncturist Discusses How Acupuncture May Reduce the Symptoms, e.g. the Pain, Stress and Fatigue Associated with Labour

My name is Louis Gordon and I am an acupuncturist. I practice acupuncture from ANTRAC Acupuncture Clinic in Middle Ridge, Toowoomba, 4350, Queensland, Australia. Just as fresh clean water bubbling up from a natural well is vital to sustain life … my WELLNESS information will help YOU to sustain a healthy vibrant life beaming with optimal wellness. Call for more information on (07) 4636 6100.

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When it comes to labor and birth, things often do not go according to plan, and doctors must induce birth.  Labour Induction is often required when the pregnant woman is more than one week post term, and doctors are called in to induce birth.  Labour Induction is becoming much more common in Western countries due to the entrenched medical paradigm.  Labour Induction is fraught with many medical problems including epidurals and forceps deliveries.  My investigation revealed that there are 14 proposed natural induction methods that may assist with bringing on labour naturally. The science behind some of the suggestions is questionable.

14 Natural Induction Methods to Bring on Labour

Unsuccessful western medical induction is the number one reason for the greater rate of caesarean sections in many countries. Obviously, safe natural induction methods are the preferred option rather than western medical intervention procedures.

I have collated all the options and suggestions I could find across the internet from childbirth educators and experts, doulas, and the long-established detailed practice of midwifery. You have counted down the weeks and days, and grown larger and riper by the day, but week 40 has arrived and you have had enough, but there is no action, not even a twinge.

As the scheduled induction date approaches you would love to be able to get the ball rolling, naturally, right?

But bear in mind the cautionary fact that there is a paucity of controlled studies to confirm the effectiveness of many of the following suggestions (especially for high-risk pregnancies), so before jumping in boots and all, have a good talk to your midwife or doctor. This is not medical advice. Do not try any of these options without speaking to a midwife, herbalist, your doula and your primary care provider first so that they know what is going on and can be prepared for any of the outcomes.

The following 14 suggested  induction methods that MAY help to bring on labour naturally are presented in alphabetical order.

NOTE: NONE of the following procedures are suggested for high-risk pregnancies.

1 – Acupuncture and Traditional Chinese Medicine (TCM) May Help Patients Manage a Range of Symptoms Including Pain, Stress and Fatigue During the Birthing Process

Acupuncture treatment involves the insertion of very fine sterile needles into defined acupoints along meridian pathways throughout the body. Traditional Chinese Medical (TCM) philosophy teaches that this stimulates the Qi (energy) within the body to free blockages and stagnations in the meridians and overcome dysfunction in specific organs and disturbed biological functions.

Acupuncture includes many practices other than needles and includes the techniques of laser therapy, moxabustion, cupping and gua-sha as examples.

Acupuncture and herbs are both an integral part of Chinese medicine practice, which may help patients to manage a range of symptoms including pain, stress and fatigue during the birthing process. Chinese medicine is generally considered to be safe but occasionally (as with all health treatments) may be associated with possible adverse reactions in individual cases.

It is essential to find a qualified and accredited acupuncturist that has personal experience with treating pregnant women. In Australia, the AACMA has a searchable list that will advise where the nearest acupuncturist is to you based on your post code. You generally require several treatments performed on a daily basis until you give birth.

When searching for a Chinese medicine practitioner that is adequately trained and licensed in acupuncture, be sure to check that they are registered to practice acupuncture on the Australian Health Practitioner Regulation Agency (AHPRA) website. If they are not registered on the AHPRA website, please report them as they are fraudulent, and a danger to the public.  Question the practitioner to ensure he/she has a sound background in treating pregnant women. An MD who simply practices acupuncture once in a while often has just several hundred hours of experience, compared to several thousand hours of training and practice required for a traditional Chinese acupuncturist.

2 – Blowing up balloons

Some women attest to this option, and it is believed that blowing up a handful of balloons builds up abdominal pressure, which may induce labour to commence.

3 – Bumpy car ride

If the baby is not in a good position, bouncing firmly on your birth ball or taking a drive in your car along a bumpy road may assist at helping bubby seat better.

4 – Castor oil

Castor oil treatment for labour induction has a long history dating back to the ancient Egyptians. While there is no explanation on the reason that the procedure works, many midwifes agree that it is often successful.

Castor oil is known to be a strong laxative and as there are common neural pathways it is possible that the gut stimulation flows onto stimulating the uterus to induce labour. Feeling nauseous is a likely outcome after consuming the suggested 60 mL of castor oil before the diarrhoea occurs. The oil is generally taken in orange juice. As dehydration is a possible outcome of this procedure ensure that you drink sufficient water to prevent that outcome.

A study of 100 post-term women showed that 57.7 % of the women commenced active labour after a single dose of 60mL of the castor oil. This was quite remarkable as only 4.2 % of the women in the group who did not take the oil commenced labour. No adverse affects were reported for the mother or the baby during the trial, but all the women who took the castor oil felt nauseous.

The revolting oily material may be improved by mixing it with a carbonated soft drink, maybe ginger ale to reduce the nausea. If it does not work initially, a second dose can be given 12 hours later. Be sure to consult your midwife about how your constitution would accommodate this procedure.

5 – Cervical balloon dilators

As a last resort you can try the following option. If you have reached 42 weeks, ask your midwife about the placement of balloon dilators. A balloon is placed inside your cervix and it is filled with warm water. The mechanical pressure from the water-filled balloon will imitate the pressure of the baby’s head on the cervix, and hopefully the cervix may respond by ripening and dilating.

6 – Curry

Spicy foods have often been suggested as a means of inducing labour. However, there is no scientific evidence that this is the case. However, it may be that the hot curry stimulates the gut and bowel and subsequently encourages the uterus as well. While there is no scientific confirmation either way, many formerly overdue pregnant women swear by it.

7 – Herbs that may help to induce labour

DO NOT take any of these herbs without first consulting a midwife, physician, or an herbalist.

Blue cohosh and black cohosh

Blue cohosh (Caulophyllum thalictroides) and black cohosh (Cimicifuga racemosus) are herbs which should not be used in early pregnancy but are often cited as being useful in bringing on labour.

Two Canadian reviews of studies on their use concluded that black cohosh should be used with caution and blue cohosh with extreme caution. Blue cohosh in particular has been linked with severe complications for the baby at birth. In either case, there is not enough evidence that they are safe to use. I would suggest that these two options are NOT considered at all. Herbals are much more active than homeopathic remedies and so should always be used under professional guidance. While anecdotal evidence suggests that these herbs do induce labour it is probably beneficial to completely avoid them. If you do decide to use these herbs, be sure to locate a qualified, registered herbalist near you that has extensive knowledge with their use.

Cumin tea

Cumin Tea is used by midwives in Latino cultures. Traditionally, a raw cube of potato is added to the tea as it absorbs the bitterness of the cumin. You can sweeten this one with honey.

Evening primrose oil

Evening primrose oil is an excellent source of prostalgin which can help soften the cervix. You can either use Evening primrose oil internally by placing a few capsules directly near the cervix or you can take the capsules orally.

Red raspberry leaf

Red Raspberry leaf herb is available as a tea or in tablet form. It is used as a tonic to strengthen the uterine walls, and is often mentioned alongside other methods for bringing on labour. That the herb can bring on labour has not been confirmed. Because of their stimulating effect on the uterus, raspberry leaves must not be used until the last two months of pregnancy. There is little evidence to confirm that red raspberry leaf encourages labour to begin. However, an Australian study showed that raspberry leaves speeded up the second stage of labour and reduced the need for a forceps delivery.

To prepare the uterine muscles for labour start with one cup of tea each day or take one tablet and gradually build up to a maximum of four cups of tea or four tablets daily. The tea can be sipped freely during labour, too. The tea and tablets are readily available from health food stores.

8 – Homeopathy

Homoeopathic remedies have been around for a long time, and use extremely diluted versions of more potent substances to naturally treat your body. Two commonly used homeopathic remedies that may stimulate labour are Pulsatilla and Caulophyllum. Homeopathic remedies are known to be very safe. The Faculty of Homeopathy have researched the use of homeopathic remedies in labour and they have not found any incidents of damage caused by them.

One trial into caulophyllum found no difference between the women who took it and the controls who did not take it, but the method of the trial was not thought to be reliable. If you would like to try homeopathy, contact a registered homeopath.

9 – Nipple stimulation

Nipple stimulation involves the gentle stimulation of the nipple to promote contractions to begin. This option has scientific basis as oxytocin, a hormone that causes contractions, is secreted when the nipples are stimulated. This method has been shown to have a gentle stimulating effect on the uterus, so is not traumatic for the baby.

It is ideal to simulate the sucking of a baby. This can be imitated by massaging the entire areola (the dark area around the nipple), not just stimulate the nipple alone. The procedure can be performed by placing your palm over the areola and rotate it in a circular motion, applying firm but gentle pressure in the process. To be effective the procedure must be performed for an hour at a time, three times a day, spending 15 minutes continually stimulating one breast at a time and then paying attention to the other breast for 15 minutes until the hour is up.

There is evidence that this suggestion offers significant benefit for women whose cervix had already began to soften and open ready for labour. A reported 37% of women who trialled this procedure went into labour within 72 hours compared to only 6% of those who did not perform the procedure.

10 – Pineapple

NOTE: Do not try this suggestion if you are allergic to pineapples.

It is a scientific fact that pineapple contains the proteolytic enzyme bromelain which is thought to help to soften the cervix and so bring on labour. Pineapple contains only very small amounts of the chemical bromelain. It has been estimated that you would have to eat as many as seven pineapples to have any effect on the cervix. The most probable side-effect of eating large amounts of pineapple would be a severe case of diarrhoea. In which case you would be better off trying the castor oil option discussed elsewhere in this article.

Some cultures swear by this option of inducing labour but there is insufficient research data to confirm whether eating pineapple really works. There is no solid evidence establishing whether it is a safe option or not. If trying this option bear in mind that the pineapple must be fresh as the enzyme bromelain is destroyed by the manufacturing processes of canning and juicing.

Another option is to buy bromelain tablets from your health food shop. As bromelain is a proteolytic enzyme that breaks down protein, it should not be eaten with protein as it will merrily digest that and be consumed in your stomach rather than doing its desired work at the cervix. It should be taken on an empty stomach and the tablets should never be chewed as the digestive enzyme will burn your tongue.

Bromelain is often used to reduce inflammation associated with tendinitis, sprains and strains, and other minor muscle injuries. In Europe, bromelain is used to treat sinus and nasal swelling following ear, nose, and throat surgery or trauma. To treat arthritis, up to 2,000 mg of bromelain is taken each day in two divided doses. So you could safely take 1,000 mg (1 gram) twice a day in an effort to induce labour.

11 – Relaxation techniques

Babies know when you are relaxed and when you are tense. They intuitively know when it is their time to enter the world. A mother who is stressed-out may go past her due date because her baby feels that it is too stressful to enter the world. Remember your stress hormones are flowing through baby’s circulatory system too.

One of the reasons why many labours start at night is because mum is finally relaxed. Having a good cry eliminates stress hormones and relieves tension, so watch a real tear-jerker movie to vent those stress hormones.

Women often go into labour after a good cry. The most important thing to do is to find a way to relieve tension. Tension works against labour. Deep breathing exercises also help to reduce stress levels.

12 – Sex

This option should not be considered if your waters have broken as that may enhance the possibility of infection occurring. You should also avoid sex if you have a low-lying placenta (placenta praevia) or have vaginal bleeding.

Sex can get labour happening in three ways: firstly orgasm often helps to stimulate the uterus; secondly, sexual intercourse triggers the release of oxytocin, which is the “contraction” hormone; thirdly, semen contains a high concentration of prostaglandins which may help to ripen and soften the cervix allowing it to more readily dilate when labour starts.

While many women do not want to have sex in the last month of their pregnancy, having sexual intercourse is one of the most ancient methods of inducing labour, and rest assured that no harm will occur to the baby.

The substance Prostaglandin which is present in semen naturally softens the cervix. If you are fortunate enough to feel like having sex at the time and actually reach orgasm this will further open the cervix. Female orgasm has been shown to open the cervix by 2cm. If having sex is too difficult aim to have a self-induced orgasm. If you are just not in the mood for getting “jiggy with it”, try using your partner’s sperm by inserting it into your vagina as close to the cervix as you can. The possible discomfort of sex at this time is certainly the preferred option to having to undergo medical induction or having a caesarean section.

13 – Visualization

Get quiet and relaxed, and imagine your cervix softening and ripening and opening, and imagine your uterus walls contracting to help the baby glide towards the ripened opening.

14 – Walking and exercise

It appears that the pressure of your baby’s head pressing down firmly on the cervix stimulates the release of oxytocin, a natural substance known to bring on labour. Of course, just standing allows gravity to do its job naturally and work in your favour, encouraging the head of the baby to move downwards onto the cervix.

Be careful not to overdo it and become exhausted. Labour can be very draining and you don’t want to consume your energy before your birthing process has begun.

This has not been scientifically verified. If your baby has not “dropped” or is still high in the pelvis, walking is thought to promote a better position of the baby, so that labour will probably commence naturally. Remember not to overdo it. A leisurely walk is probably the preferred option.

I wish you a Happy Birthing Day,

Dr Louis Gordon (Bachelor of Acupuncture).

AHPRA Registration number: CMR0001717120

 

 

Western Medical Induction Procedure

Medical Induction refers to initiating labour artificially, which usually involves the use of prostaglandins and possibly oxytocin.  The prostaglandin action is to ripen the cervix.  A small plastic hook is placed through the cervix to painlessly rupture the membranes that contain the amniotic fluid around the baby.  Once the amniotic fluid has been discharged, the baby will move down into the pelvic cavity, causing more pressure on the cervix to increase further dilation.  If labour fails to progress, syntocinon is administered intravenously to induce contractions.  This can make the contractions too intense, painful and difficult to cope with.  This often warrants intervention by an epidural anaesthesia procedure to deal with the labour pains.  This in turn often necessitates the use of forceps or a caesarean delivery.

Reasons For Induction
Post-term babies
There are several reasons for medical induction.  Most commonly the woman becomes post-term, that is she is significantly past her due date of 40 weeks.  A full term pregnancy can last anywhere between 38 to 42 weeks, with delivery occurring within two weeks either side of the calculated due date.  There is often an imposed medical limit regarding the number of days past 40 weeks that the pregnancy is allowed to continue.  The concern is that as the pregnancy continues the uterine environment will begin to deteriorate, potentially compromising foetal health.  As due dates are often inaccurate, doctors and midwives will book women into hospital for induction when they pass 41 weeks, and often on the tenth day past their due date.  Others will monitor the baby and uterine functionality until they feel induction is the best option, usually before 43 weeks.

Premature rupture of membranes
If the baby is of viable gestational age, induction will be considered if labour does not start spontaneously within a certain time of the membranes rupturing.  This is usually between 24 and 72 hours.  The concern is around the likelihood of a group B streptococcal infection developing that will infect the baby.  Some protocols recommend women be given IV antibiotic 18 hours following rupture of the membrane.  Similarly a course of IV antibiotic is given to women that tested positive for group B streptococcus for vaginal swabs in the antenatal period at 36 weeks gestation.

Other health problems
These include diabetes, pregnancy-induced hypertension, chronic renal problems, active genital herpes infection, small-for-dates babies, babies of multiple pregnancies, babies of diabetic mothers that grow too large and when there are signs of poor placental functioning.  Induction may also be indicated for women with a prior stillbirth, severe back pain or symphysis pubis pain.

 What to Wear for the Acupuncture Treatments

As I may need to access acupoints on the legs to the knees and arms to the elbows, and maybe the shoulders and sacrum, it is important to wear clothes that allow me to readily access these areas, and that are loose fitting over the abdomen and the buttocks.

Traditional Chinese Medicine Terminology for Requirements for a Natural Labour
In Traditional Chinese Medicine labour is expected to commence when three factors occur simultaneously:

1 – yang activity replaces yin material growth,

2 – qi flows freely and moves the blood, and

3 – the door of the uterus opens.  When qi flows freely and the blood circulates well, a harmonious labour follows with the onset of contractions, dilation of the cervix, rupture of the waters and expulsion of the foetus.

Optimal Timing of Acupuncture Treatment
I like to see women each day for 3 days before a medical induction is planned.

During the First Treatment
After taking the Case History, I lay the patient down on the couch preferably on her left side.  Generally it is more comfortable sitting, but if they wish to lay down, they lie on their left side to prevent pressure of the baby on the inferior vena cava vein, which if compressed could cause mum to feel faint.  For points that might be painful, I use a painless laser treatment to set about balancing all the meridian energies.  Electroacupuncture at 2 Hz is applied to points that need to be tonified – Bladder 32, Bladder 67 and Large Intestine 4, for example.

Then, I demonstrate how to apply moxabustion treatment to the chosen acupuncture points at home.  The Moxa stick is held over the points bilaterally until they feel uncomfortably hot.  Then “hen-pecking” moxabustion is applied for twenty minutes bilaterally, for one minute on the left side and then for one minute on the right side.  In this method, the ignited moxa stick is moved up and down over the point like a bird pecking. The hot glowing moxa “cherry” is held about a thumbs width away from the acupoints so it does not burn the skin.  This tonifying “hen-pecking” technique is applied to Bladder 67, Large Intestine 4 and Bladder 32.

Moxabustion over Spleen 6 is to be gentle and pleasantly warming and soothing (sedation) and may soften, ripen and open the cervix.  Don’t “hen-peck” acupoint Spleen 6.

It is very beneficial if the patient can take along their partner or a friend to be trained in the moxabustion procedure, so that the procedure can be carried out at home.  This is especially so for acupoint Bladder 32 which must be treated by another person, due to its inaccessibility.

Two Subsequent Treatments
I apply the acupuncture treatment as above for two more days, and ensure that the patient is confident with location of the acupoints and with the moxabustion procedure.  I also answer any further questions.

Due Diligence & Warnings Regarding the Moxabustion Procedure

  • The outer cover of the moxa stick should be removed before lighting the moxa.
  • The moxa stick is held vertical, and the lighter is held underneath until the flat end lights.
  • Once lighted, blow on the end of the moxa stick to make the end glow orange.
  • Note any darker regions (ash accumulation) and wipe this region on the edge of the moxa extinguisher.  Blow on the end again until the entire surface is glowing orange.  This is called the “cherry”.
  • The smoke from the burning moxa may set off smoke detectors.
  • The smoke from the burning moxa permeates hair and clothes, and can irritate sensitive eyes, so perform in an open area or outside if possible.
  • During treatment, hold the moxa stick like you would hold a pencil.
  • Wipe the ash off about every minute and blow the “cherry” to make it glow.
  • During treatment hold the glowing tip about a thumb width away from the acupoint being treated.
  • For acupoints being tonified use the “hen-pecking” procedure – (See above).  For Spleen 6 warm the acupoint gently so it is soothing, unlike the irritating “hen-pecking” procedure.
  • When finished, the burning moxa stick must be extinguished in the moxa extinguisher, which sits on a dinner plate to catch ash and prevent scorching damage and starting fires.
  • The moxa stick must be snuffed out in the extinguisher without damaging the “cherry”, so it is ready to light easily during the next treatment.
  • Should the “cherry” break off in the extinguisher, cut the end off with a sharp knife and start again.
  • Do not leave the moxa on any timber or combustible surfaces to prevent the possibility of scorching damage to surfaces or starting fires.
  • When the moxa extinguisher is half filled with ash, use the handle of a teaspoon to scrape the ash out into a tissue and discard.  Make sure the ash is cold so it does not ignite the tissue.
  • Advise asthmatics to avoid inhalation of the moxa smoke.
  • Greater care should be exercised if the woman is a diabetic to prevent burns on the sensitive skin.

Foetal Activity
There is a cumulative effect of moxabustion especially on acupoints Bladder 67, with the baby becoming more active with each subsequent treatment until eventually the woman feels a rather uncomfortable period of activity.

Further Beneficial Treatment Procedures – Intradermal Needles
It is worthwhile to give women intra-dermal needles to take home to apply to Bladder 67 and Large Intestine 4 and Spleen 6.  They should be applied after the three acupuncture treatments at the Clinic are completed or prior to going to hospital, whichever comes first.

The patient should swab the area with the alcohol wipe, then insert the needles at Bladder 67 and wrap a sticking plaster firmly around their little toes to secure the needles in place.  The same procedure should be progressed for Large Intestine 4 and Spleen 6.  Note that the intradermal needles at Bladder 67 and Large Intestine 4 should be stimulated often (tonified) while the intradermal needle at Spleen 6 should be left alone (sedated).  These intradermal needles should be removed after 3 days in place, secured in a tissue and disposed of in a bin.

I wish you a Happy Birthing Day,

Dr Louis Gordon (Bachelor of Acupuncture).

AHPRA Registration number: CMR0001717120

REFERENCES:
Betts, D. The essential guide to acupuncture in pregnancy & childbirth. The Journal of Chinese Medicine Ltd. 2006. 320 pp.

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