Introduction

There are a limited number of midwives trained in Chinese medicine in the UK and using acupuncture in National Health Service (NHS) maternity units. Those that have been established for many years have found that there is a huge demand for acupuncture in pregnancy, labour and post-natally. The high success rate for treating conditions such as those discussed in previous chapters has contributed to the growth in the popularity of acupuncture in thousands of women who are searching for safe, non-pharmacological methods of treatment for their disorders in pregnancy.

As well as treating many ante-natal conditions, these NHS maternity acupuncture services treat breech presentation, teach acupressure for pain relief in labour and, when available, use acupuncture in labour and post-natally. A survey of heads of midwifery throughout the UK in 2005 found that the majority would be keen to have a midwifery acupuncture service but constraints on finances for training and staff shortages made this unlikely. There may soon come a time in the UK when midwives are taught acupuncture specifically for use only in pregnancy, childbirth and for a few post-natal conditions.

This is already wide practice in much of Europe, New Zealand and other countries. The experience of the established midwifery acupuncturists is that having acupuncture in pregnancy introduces this ancient treatment to vast numbers of women for the first time, who then go on to use it for themselves and their families at a later stage.

Acupuncturists have set up groups to provide acupuncture in pregnancy and labour such as the Acupuncture for Childbirth Team (ACT) in Oxford and London. These groups have found that it is important to have a team approach when it comes to offering acupuncture for labour as it needs to be a 24-hour service.

Breech presentation

Breech presentation occurs in 2–4% of pregnant women. There are three types of breech presentation:

The problem with these presentations is that the head may not fit through the maternal pelvis, and with breech delivery there is a possibility of umbilical cord prolapse or compression. The peri-natal mortality rate after breech delivery is three to four times higher than that associated with vertex delivery. Some obstetric units offer a technique called external cephalic version (ECV) where an experienced obstetrician will manually palpate the mother’s abdomen and try to turn the baby into cephalic or head-first presentation. The results are mixed and women who have had this technique often describe it as being quite uncomfortable.

Most maternity units now tend to deliver babies in breech presentation by Caesarean section. Women hoping for a normal vaginal delivery are disappointed and frustrated by this. They are keen to try and do something for themselves and it may be for this reason that the use of acupuncture and moxibustion has attracted much attention. According to channel theory, breech presentation is thought to be due to a loss of equilibrium between the Kidney and Bladder channels. The technique to resolve this and turn the baby involves heating BL-67 Zhiyin with moxa on both feet for 15 minutes, once a day for 10 days in all.

There are many reports from China about the efficacy of this treatment.^1,2 It increases fetal activity, usually enough to turn the fetus from breech to cephalic presentation. Studies conducted in China and published in 1984 report varying success rates ranging from 89.9% to 90.3%.³

A study conducted in Italy in 1990 reports 60.6% success rate on a group of 33 women of gestational ages ranging from 30 to 38 weeks.⁴ A second study by the same authors presents the results of 1 week’s treatment with moxibustion in 241 pregnant women of gestational ages ranging from 28 to 34 weeks, in comparison with 264 control subjects. In the group of women treated with moxa, there were 195 versions (81%) as against 130 (49%) in the control group; the difference is statistically significant (P < 0.05). Cardini’s trial confirmed findings in the Chinese trials that the success rate is higher in multigravidae, as would be expected, owing to the reduced tone of the abdominal muscles.

A later study compared manual acupuncture to BL-67 with a control group on 67 women. The results were 76% version in the treatment group versus 45% in the control group.⁵ A larger randomized, controlled trial looked at 226 women with breech presentation and assigned them to either observation alone or acupuncture plus moxibustion to BL-67. The number of babies that had turned was 54% in the treatment group versus 37% in the controls.⁶

These results have significant effects on the number of deliveries by Caesarean section for breech presentation. Most research papers on moxibustion show that the 34th week of gestation is the optimum time to carry out the technique and gives a higher success rate. Much before this, the fetus is still very mobile and may change position freely and frequently. Later, there is little room left for turning.

What are the mechanisms of the process? A trial carried out by the Co-operative Research Group of Moxibustion Version of Jiangxi Province postulates that the increase in adrenocortical secretion, through the resulting increase in placental oestrogens and changes in prostaglandin levels which they measured, raises basal tone and enhances uterine contractility, stimulating fetal motility, and thus making version more likely.⁷ This increase in fetal motility is one of the more striking features of moxibustion, perceived by almost all the women during the second half of the 15-minute treatment, and persisting even after the end of stimulation.

Figure 44.1 shows the hypothetical mechanism of the effect of moxibustion on point BL-67 Zhiyin to turn the fetus.⁸ As moxibustion does not involve the use of needles and needs daily applications for up to 10 days, the woman’s husband, partner or friend can be instructed in application and continue the treatment at home, with a handout covering the method and advice on safety issues regarding extinguishing of the moxa sticks.

Figure 44.1 Postulated mechanism of action of moxibustion for breech presentation.

The use of acupuncture in labour

Physiology of labour

The end of pregnancy is characterized by the shift from a stage of Yin accumulation to a phase of Yang patterns, culminating in labour and delivery. Yang expels Yin, and the Yang force provides the movement that expels the fetus; Qi pushes Blood and ‘the uterine door opens’ in a significant downward movement. A correct balance of Qi and a sufficient supply of Blood are necessary for a harmonious delivery.

Established labour is defined as the onset of regular uterine contractions with dilatation of the cervix. The first stage of labour continues until the cervix has dilated to roughly 10 cm. The second stage is from full dilatation of the cervix until expulsion of the fetus. The third stage is from the birth of the baby until expulsion of the placenta, and control of bleeding. Labour can start in different ways. Some women find that their membranes have ruptured and they are leaking amniotic fluid, which is known as ‘liquor’. The amount of leakage varies and the liquor should be either clear or slightly blood-stained. There may not be any contractions at this stage, but they will usually start and build up shortly afterwards.

Clinical Note

The three stages of labour:

1. From the beginning until the cervix has dilated to roughly 10 cm

2. From full dilatation of the cervix until expulsion of the fetus

3. From the birth of the baby until expulsion of the placenta and control of bleeding.

Because the membranes provide a protective barrier around the baby, once they have ruptured there is a risk of infection unless the baby is delivered. There is much disagreement among obstetricians as to how long the interval between the rupture of the membranes and the delivery of the baby should be, and some advocate starting the contractions after 6 hours, whereas others will wait 24. The contractions are stimulated by administering Syntocinon, a synthetic form of oxytocin, the hormone from the hypothalamus, stored in the posterior pituitary. It must be given intravenously and the dosage carefully titrated. The intravenous infusion itself restricts the mobility of the mother and, in addition to this, there is a risk that the contractions may be too strong and that they will adversely affect the fetus. For this reason, a monitor called a ‘CTG’, or cardiotocograph, is used to record the fetal heart rate and the strength of the contractions. This further restricts the woman’s mobility, and she may start to feel that she is no longer in control. This is where acupuncture and acupressure have a lot to offer. They can be used to enhance the activity of the uterus and stimulate contractions, negating the need for the interventions normally used.

Acupuncture for analgesia in labour

Many Chinese texts advocate the use of points L.I.-4 Hegu and SP-6 Sanyinjiao for analgesia in labour. However, it is our experience that these points are impractical once labour is well established and the contractions are coming every few minutes. Most women like to be mobile during labour. They take up different positions, some choosing to crouch on all fours, others wanting to walk around the room and ‘rock’ the pelvis during contractions, and others squatting. The choice varies, and most women will adopt several of these positions as the labour progresses. This is why we choose to use ear points for analgesia in labour, as they do not restrict the woman’s movements.

Ear points

To find the exact point, one can ‘probe’ with a specially designed pressure palpator, or use the blunt end of an acupuncture needle. The points to use are:

• Uterus

• Shenmen

• Endocrine.

Use one ear, and change to the other if the first becomes sore or if the woman wishes to lie on the side in which the needles have been placed. Half-inch needles can be taped to the ear and electrodes attached to points Uterus and Endocrine, or to Shenmen and Endocrine. Tuck a small piece of cotton wool between the two needles to prevent them from touching or it will be uncomfortable for the patient should they short out. The electro-acupuncture apparatus provides stimulation to the needles and the woman can control it herself, increasing the intensity when a contraction takes place. Women tend to increase the intensity of stimulation gradually as labour progresses. There is much difference of opinion on the correct frequency to be used, but we have obtained the best results with dense-disperse frequency, set at 20–80 Hz.

The auricular acupuncture can be started at any stage of the labour, according to individual needs. Some women will cope very well until the latter part of the first stage, when the cervix may be dilated by at least 6 or 7 cm; others may feel they need to start the acupuncture earlier; it is worth bearing in mind that, on average, it needs around 10–15 minutes to take effect. Many women like to spend their labour in a bath or birthing pool, and even give birth in water, and there is no reason why they should not have auricular acupuncture, but in these cases it will of course be necessary to disconnect the electro-acupuncture apparatus and use manual stimulation of the needles instead. The needles may be left for as long as necessary, usually until after the birth; they tend to be in the way once the baby has been born.

There are a number of research trials looking at acupuncture analgesia in labour, with variable methodologies, point selections and results. One trial looked at the effect of electro-acupuncture on 168 women, using the auricular points Shenmen bilaterally, and body point L.I.-4 Hegu bilaterally for either 20 or 30 minutes.⁹ They found that the analgesic effect began at a mean of 40 minutes after its application, and that its duration was a mean of 6 hours. It was not necessary to use analgesic drugs of any kind on any of those who delivered during this period of time.

Origins of acupuncture treatment for delayed labour

Difficult or delayed labour was a very well-known and frequent cause of maternal and fetal mortality in ancient China. Stories about the use of acupuncture for the stimulation of contractions, or to ‘ease’ the ‘birth passage’, are well documented in Chinese history; this is probably because in cases of difficult labour acupuncture does indeed give good results.

In her article, Legends about Acupuncture Treatment of Difficult Labour, Zheng Jin Sheng describes some of the legends that have been written down about this. One of the earliest legends dates from the Jin Dynasty (AD 265–420):

It is said that Yu Fa Hai, an acupuncturist, came across a woman in labour when he put up for the night at an inn on his journey home. The woman happened to be the innkeeper’s wife. She had been in labour for several days, but the baby was still not born. ‘I can hasten the course of labour’, he said to her husband, and asked him to have a fat sheep slaughtered, and to make with the meat a delicious dish. Then he forced the woman to eat more than ten pieces of the mutton. Having finished eating, the woman was given acupuncture treatment. Soon the baby was born with a layer of sheep fat covering its body.¹⁰

Later, around the 5th century AD, a famous physician and acupuncturist, Xu Ben, was well known for his skill in using acupuncture on women as an oxytocic measure to expedite labour and promote a safe delivery.¹¹

During the Tang Dynasty (AD 618–907) under the rule of Emperor Tai Zang, it was recorded that a famous doctor, Li Tong Yuan, had saved the life of a baby born to Empress Changsun during a traumatic labour and birth.

The Empress had been in a great deal of pain for several days and the baby had still not been born. Dr Li received an order to treat her as best he could. Having palpated the Empress’s pulse, he said ‘The baby’s hand has got hold of your heart, that’s why you can’t give birth to it easily.’ What should be done then? asked the Empress anxiously. Li Tong Yuan said, ‘The mother will die if the baby is saved, or the baby will die if the mother is saved.’ On hearing this, the Empress, showing the greatness of maternal love, said definitely: ‘Let the baby live, and may it bestow prosperity on the Empire in years to come.’ At her word, Dr Li Tong Yuan inserted the needle into her abdomen. The needle penetrated her heart and thrust directly toward the baby’s hand. In later life the baby became Emperor Gao Zong of the Tang Dynasty. It was said that the needle mark on the Emperor’s hand could still be seen, though faintly, on gloomy days.¹²

Many similar cases were reported from this time onwards, the most common form of treatment being to needle the fetus’s hand so that it drew back from the mother’s heart, and thus could be born easily. While these legends are obviously exaggerated and distorted, the names of the doctors, patients, dynasties, years and places are accurate.

A final record written during the Song Dynasty (960–1279) records a delightful story which tells of the acupuncture treatment of a woman by an eminent doctor called Pang An Shi.

During his medical practice at Tong County, Anshi Province, Pang An Shi received a patient who was in difficult labour for seven days. All treatment applied by other doctors had failed, but at the sight of the woman, Pang An Shi said with assurance, ‘Don’t worry, you’ll be all right.’ Immediately he had the woman’s abdomen and back warmed with hot, wet towels. Then he gently massaged her abdomen. Gradually the woman became quiet. Just as she was feeling better she experienced a spasm of pain in the stomach and intestines which made her groan again. Before long, a boy was born to everyone’s joy and surprise. When asked what treatment method he applied, Pang An Shi said ‘As a matter of fact, the birth was not a difficult one. The problem was only that the baby’s hand had got hold of the mother’s intestines. I massaged the mother’s abdomen in order to find out the position of the baby’s hand. When I located it, I quickly inserted the needle at the point between the thumb and the index finger. As the hand shrank back with pain, the baby was born.’¹³

Acupuncture in labour: a short history

Acupuncture for the relief of pain in labour and delivery was rarely used in China because, in accordance with Chinese culture and oriental tradition, women were expected to experience the pain of childbirth. This was an accepted way of life and thus no acupuncture points were described just for pain relief in vaginal delivery. This may be very difficult for Westerners to understand, as Western practice often (and maybe incorrectly) emphasizes getting ‘rid’ of the ‘pain of labour’ and giving mother and child a comfortable birth experience.

This tradition survived as late as 1970; the chapter on childbirth in the first Chinese–English edition of The Barefoot Doctor’s Manual, printed in that year, mentions nothing about labour pain and gives no advice on caring for the woman during the contractions; it does, however, refer to ‘sensations’ that a woman may have once contractions begin. The manual drew on the practical expertise of local country people in the various provinces (often self-taught health workers) who went from house to house administering medical care in the form of acupuncture or herbal medicine.¹⁴

It was during this same era in Europe that interest in acupuncture analgesia for childbirth became the focus of much research by some eminent pioneers. In 1972, Christman Ehrstroem was reported to have performed the first acupuncture deliveries in Stockholm, Sweden. In 1974, Darras in France reported 20 electro-acupuncture deliveries of primiparae (first-born child) and multiparae (second or subsequent children).¹⁵

In China, Pei and Huang of the Nanjing Municipal Maternity hospital reported on a retrospective review of 200 women who had taken part in a study using acupuncture analgesia during childbirth in 1975.¹⁶

Parallel to these developments in this new field was the work on auricular acupuncture which over the past 40 years has been developed and refined by such pioneers as Nogier and Bardiol in France. Using the ear auricle with acupuncture needles inserted into the cartilage enables women in labour to move about freely and assume natural birth positions while benefiting from the potent analgesic effects.

Acupuncture has rapidly become more popular for women in childbirth today, mainly because it is a natural pain reliever with no harmful side effects for mother or baby. Moreover, women like to feel in control during their labour and delivery, a feeling which they may be deprived of by some of the more potent conventional analgesia used in today’s maternity units. For example, the inducement or augmentation of labour with oxytocic drugs means the artificial forcing of a process which has not yet occurred within the woman’s body according to her own natural biological rhythm. It often involves rupturing the amniotic membranes artificially, using an intravenous infusion and Syntocinon (oxytocin) to stimulate uterine contractions. It is generally then necessary to use an epidural for anaesthesia, because of the increased pain that is frequently experienced in induced labour. Often these are the first steps down the ‘slippery slope’ that leads to surgical delivery and women feeling a loss of control in their own labour.

Recently, there has been an enormous increase in the use of acupressure for labour for these very reasons, particularly when administered by birthing partners, thereby negating the need for needles and the availability of an acupuncturist.

In the 1930s, Dr Grantly Dick-Read was the first doctor in England to advocate ‘natural childbirth’. In his famous book, Childbirth without Fear, first published in 1942, he states:

Anaesthesia for childbirth up until 1853 in England was unheard of. However, on the 7th April 1853, John Snow anaesthetized Queen Victoria when Prince Leopold was born. Simpson (a famous surgeon and obstetrician) was greatly criticised for using anaesthesia for this purpose. To prevent pain during childbirth, he was told, was contrary to religion and the express command of the scriptures. But anaesthesia had come to stay.¹⁷

Along with Ferdinand Lamaze of France, Dick-Read was a staunch advocate of the natural birth process, which had been lost sight of in preceding years. Today, women do not want to undergo the pain of childbirth, but they put a new emphasis on what they need in the birth process. To be ‘in control’; to be allowed to choose; to be encouraged to trust one’s own body to overcome the pain barrier through its own natural rhythm: this is what women are asking for. There are a number of ways of helping a woman to achieve the desired balance: yoga, massage, TENS (trans-cutaneous electrical nerve stimulation), Alexander technique, meditation, acupuncture and, more recently, a growing trend in the use of acupressure.

Although Western doctors today are much more open to alternative ways, it remains very important for the medical profession to shake off its doubts and overcome its scepticism towards complementary medicine, so that women from the outset may be offered the choice. Recently, with much higher rates of epidurals and Caesarean sections, they are beginning to embrace other techniques which may help reduce some of the interventions responsible for these figures.

Acupressure for labour

Acupressure, the application of pressure to acupuncture points. has become increasingly popular as a method of pain relief in labour. Acupuncturists and midwives are teaching it to birthing partners as a way of becoming more involved in the labour and the results are very promising in terms of these women needing much less in the way of pharmaceutical pain relief. They are also having shorter labours and less intervention.

Couples are taught that it originates in ancient traditional Chinese medicine, based on the concept of channels carrying Qi throughout the body, and that, in modern terms, the stimulation of certain points on these channels has an effect on blood flow to the uterus, cervical dilatation, movement of the baby, release of endorphins and helping the mother to relax. They are taught that, with acupressure, although the person applying the pressure may not be able to feel the Qi, the woman has the sensation of aching and tingling and they will see the changes in her body as she feels less pain, her contractions feel less intense, baby changes position and the cervix dilates.

The majority of women really like it but it is obviously not for everyone. When it is working well for the woman, she does not want the partner to stop pressing and often asks for more pressure. The birthing partners may need a bit of persuasion, but they soon become good at it and really appreciate having something helpful to do instead of sitting, watching and not knowing what to do with themselves. Ideally, they will already have learnt about it at the end of the pregnancy, around 37 weeks, and be familiar and confident with it before labour starts. Those who do not find it useful tend to use it too late in labour, when the contractions are unmanageable, or in a short labour with intense contractions from the beginning. It is therefore most effective when the support person has time to use the points before labour goes into its most intense stage.

It is important to teach and demonstrate the type of pressure needed, and when I am teaching I press on the birthing partners arm with a jab, explaining that this is not the type of pressure we are looking for, then press again as if sinking into butter slowly until there is a pleasant deep sensation which is the correct type of pressure.

Specific actions of acupressure points used for labour are as follows:

• To enhance contractions: L.I.-4.

• To dilate cervix: SP-6.

• For cervical lip: BL-32 and SP-6.

• To aid descent into the pelvis: G.B.-21 and BL-60.

• For posterior position: SP-6, BL-60 and BL-67.

• To help deal with fear: KI-1.

• For nausea: P-6.

• For efficient delivery of the placenta: G.B.-21, BL-60 and L.I.-4.

The growing popularity of this technique is mainly due to the work by Debra Betts who, for years, has generously provided the acupressure booklet available for free download on her Web site.¹⁸. This has made acupressure accessible for countless couples, midwives and acupuncturists in an easy, concise form. She started teaching it to women in 1992. They consistently reported a reduction in their pain, combined with an overall sense of calmness and a high level of satisfaction with their birth experience. Debra has also taught acupressure to many midwives and others in venues across the UK, Europe, Canada and, of course, her native New Zealand.

It was an honour for me to help her teach it to a group of 20 Italian midwives in Milan in September 2009. I have been teaching it to couples for several years now and have been delighted with the results. We use Debra’s booklet, encouraging patients to download and print it for themselves, and I recommend her book for further details on the technique.¹⁹

Advantages

There are many advantages to acupressure in labour:

• Non-invasive technique.

• Accessible, effective, safe birthing tool.

• Promotes birthing partner involvement.

• Comfortable, not painful.

• Can be started at home when labour begins.

• Acupuncturists and midwives can use it for specific conditions pre, during and post labour.

• Reduces need for intervention.

Research

Since 2003, research has been published in nursing journals and all say this is a safe technique. In 2005, Ingram et al published on acupressure for induction of labour. They taught acupressure to 66 women at 40 weeks’ gestation with a control group of 76 women. The women were taught by a midwife in a 15-minute session using points G.B.-21, L.I.-4 and SP-6 and were encouraged to use the points as often as it felt comfortable. There was no statistically significant difference between the groups for the usual parameters (e.g. parity, maternal age, etc).²⁰

From the 66 women in the acupressure group, 30 completed the follow-up audit questionnaire: 87% used the acupressure, 80% found the points helpful and 63% used all three points. All went into spontaneous labour. They concluded that post-term women who used acupressure were significantly (P = 0.038) more likely to go into labour spontaneously than those who did not.

A randomized controlled trial in 2004 by Lee et al looked at the effects of acupressure on labour pain and length of delivery time in 75 women using just the SP-6 point. They concluded that SP-6 acupressure was effective for decreasing labour pain and shortening the length of delivery time.²¹

In 2003, Chung looked at the effects of acupressure on the first stage of labour. One hundred and twenty-seven women were randomly assigned to acupressure on points L.I.-4 and BL-67 or controls. Acupressure to these points was found to lessen labour pain during the active phase of the first stage of labour.²²

A systematic review by Smith and Cochrane included three trials on acupuncture for pain management in labour, and concluded that evidence from the trials suggested women receiving acupuncture required less analgesia, including the need for epidurals. The results also suggested a reduced need for augmentation with oxytocin.²³

The largest randomized controlled trial to date was conducted in Denmark with 607 women in labour at term who received acupuncture to individualized points, TENS or traditional analgesic drugs. The use of pharmaceutical and invasive methods was significantly lower in the acupuncture group (P < 0.001).²⁴

There are not many studies published to date, mainly due to difficulties with obtaining funding for these types of study, but also due to acupressure for labour being a relatively new technique to research-minded practitioners in the West. However, as this is rapidly becoming a more popular choice for women in labour, it is likely that more research will follow. In any case, it is good practice for acupuncturists and midwives to at least record and audit their results. This will build and contribute to a growing body of evidence, such as some of the case studies and testimonials below.

Acupuncture in the treatment of difficult labour

Difficult labour may result from abnormality of the uterine contractions, cephalo-pelvic disproportion (i.e. imbalance between the size of the maternal pelvis and the fetal head) or malposition of the baby. Acupuncture can be of help in the first of these, but not for the others. It is important to note that ‘malposition’ of the baby should not be confused with ‘malpresentation’, i.e. when the baby’s bottom (breech), face or brow presents first as opposed to head, as in normal cephalic presentation. ‘Malposition’ means incorrect positioning of the head, which includes occipito-posterior position and deflection of the head (short of brow presentation). ‘Malpresentation’ occurs when various presenting parts other than the head show first, i.e. face, brow, breech (bottom) or shoulder (see Fig. 44.2).

Figure 44.2 Malposition and malpresentation.

(Reproduced with kind permission from AWF Miller and R Callander 1994 Obstetrics Illustrated, Churchill Livingstone, Edinburgh, p. 296.)

The dangers of malposition and malpresentation are: the forewaters are not protected from the force of uterine contractions and are forced through an incompletely dilated cervix; the membranes rupture easily and the cord may prolapse; the contractions may be irregular and poorly sustained (if moulding occurs and the presenting part fits better, labour may progress more normally); labour may proceed too quickly in spite of the ill-fitting part; with brow or shoulder malpresentation there is a danger of obstructed labour and uterine rupture. Thus, acupuncture may not be effective in cephalo-pelvic disproportion and in malposition or malpresentation of the baby. Although certain acupuncture points (e.g. L.I.-4) can help to stimulate uterine contractions, when there is a cephalo-pelvic disproportion there is no way that acupuncture can ensure a safe delivery. The mechanics of the situation simply prevent vaginal delivery and make a Caesarian section inevitable.

Malposition of the baby is also a common cause of difficult or delayed labour. In this case, the baby lies within the pelvic cavity in such a way that its head creates a larger presenting diameter so that it becomes obstructed at the outlet of the pelvis. This could happen when the baby is in an occipito-posterior position (baby is on its back instead of facing downwards) or in an occipito-transverse position (baby lies on its side). The malposition of the baby tends to slow down contractions and acupuncture here may be of some help in rotating the baby by increasing uterine contractions, but it is unlikely to produce good results. Acupuncture is not usually indicated in such cases which will be managed by artificial stimulation of contractions with Syntocinon or by mechanical delivery with forceps or Caesarian section.

In all these situations it is very important that the acupuncturist works closely with the midwife or the obstetrician. Through vaginal examination, the midwife will be able to feel what the presentation and position of the baby are and advise accordingly. Our experience shows that in cases of difficult or delayed labour due to cephalo-pelvic disproportion or malposition, acupuncture is helpful only to stimulate or regulate contractions in cases when this stimulation or regulation is desirable. In certain situations, acupuncture would be the treatment of choice if contractions have weakened in strength, rhythm or regularity or if they are totally absent.

The ABC of Acupuncture (Jia Yi Jing, AD 282) states: “In prolonged labour and retained placenta use Kunlun [BL-60]”.²⁵ Various research studies have explored acupuncture’s ability to initiate contractions prior to rupture of the membranes, and prior to the woman experiencing any labour pains.²⁶ The acupuncture points which may be used vary according to the situation. In a straightforward case of ruptured membranes in a fit and healthy woman, with no contractions, such a treatment as the following may be used:

– L.I.-4 Hegu, SP-6 Sanyinjiao, BL-31 Shangliao, BL-32 Ciliao.

Explanation

– L.I.-4 is an empirical point to promote labour.

– SP-6 regulates menstruation and labour.

– BL-31 and BL-32 in our experience help to stimulate contractions.

However, it is important to look for (and treat) any underlying pathology which may be present.

Identification of patterns and treatment for difficult labour

There are two primary causes of delayed or difficult labour in Chinese medicine:

Ancient acupuncture prescriptions for difficult labour²⁸

1. SP-10 Xuehai, ST-36 Zusanli, SP-6 Sanyinjiao and Ren-6 Qihai (ABC of Acupuncture, Zhen Jiu Jia Yi Jing, AD 259).

2. Ren-6 Qihai, Ren-4 Guanyuan, L.I.-11 Quchi, SP-6 Sanyinjiao, L.I.-4 Hegu for postpartum abdominal pain and persistent lochial discharge (New Edition of Acupuncture and Moxibustion, Zhen Jiu Xue Xin Bian).

3. G.B.-21 Jianjing for difficult labour with reducing method (Thousand Golden Ducat Prescriptions, Qian Jin Yao Fang, AD 652).

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