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Acupressure Analgesia: Providing Pain Relief During Labour
In my clinicial practice, I find the use of acupressure provides consistently effective levels of pain relief for women during their labour. By comparison, acupressure displays effects during labour that are similar to the analgesic effects achieved by acupuncture-as reported in a midwifery study (Skelton and Flowerdew)1 on the effects of acupuncture when used for pain relief. Women who use acupressure report a reduction in their pain, combined with an overall sense of calmness, as well as a high level of satisfaction with their birth experience.I hope that this article will encourage practitioners to both teach and use acupressure as a birthing tool for labour.
As part of my acupuncture practice, I teach a total of eight acupressure points to both women and their support people prior to labour. This is usually in the context of one half-hour session around the 36th week of the pregnancy. The support people are shown how to locate the points, their indications and the various ways they may be used in a hands on manner. They are then provided with an illustrated booklet, which outlines the details covered in the session.
From a follow up of 74 women's birth experiences, I have compiled the following statistics: 88% of the women attempted the use of these points during their labour. Of these women, 86% found them helpful, with 62% using terms such as "excellent" and "brilliant" to describe the effects. mThe feedback I receive is very specific, suggesting that acupressure is capable of providing a positive birthing choice for both women and their support. This is not a case of "it may have been useful"-the benefits of acupressure diminish when their support people remove their hands from the points.
Following are six of the acupressure points that I teach. (The remaining two points are specific body points, and may be resourced from my acupressure booklet outlined at the conclusion of this article)
GB 21 (Jianjing)
An empirical point for a difficult labour. Chosen for its descending action to aid the first and second stages of labour.
Acupressure Technique: It is important not to just rub the skin over the area but to apply firm downward pressure with the thumb, knuckle or elbow.
When using the thumbs, the pressure needs to come from the arm rather than the thumb joint.
The points are frequently used with the support person applying pressure on both shoulders together, however I know of women who have successfully used this on themselves using only one shoulder at a time.
Pressure may be applied either at the beginning of each contraction, or continual gentle pressure applied that is intensified during the contractions.
BL 32 (Ciliao)
An empirical point for delayed labour. Chosen for the reported effects of promoting dilation and preventing the appearance of radiating lumbo-sacral pain.
Acupressure Technique: The support person can apply firm pressure by placing their knuckles into the point. Maximum pressure is achieved by the woman rocking backwards into the support person at the beginning of a contraction.
Although I have listed this as BL 32, as labour progresses women will find pressure on BL 33 and BL 34 to be also effective.
From feedback, these points are reported to produce a pleasant "anaesthetising" effect on the strength of the contractions. Noticeably "wearing off" when pressure is stopped, building up again when recommenced.
The sensation produced when pressing into the Sacral Foramen is distinct. This may be felt as either numbness, warmth, tingling, aching or buzzing. If there is sharp pain, the pressure is on the surrounding bone.
It is important to note that for certain women the Sacral Foramen are not exactly bilateral. It is important to stress to the support people that they need to feel for the points.
These points are frequently used with the woman leaning or kneeling against a wall, table, bed, etc. They can also be effectively used in water, it merely requires a little flexibility on behalf of the support people.
KI 1 (Yongquan)
Calms the shen. Chosen for this effect during labour. I have received interesting feedback from women and midwives who report this to be a very beneficial point during the second stage, as it aids the perineum to relax.
Acupressure Technique: Place strong pressure in the depression pushing inwards and upwards towards the big toe.
This point has a useful relaxing quality and may be applied at any time during labour.
It has been noted as being especially effective during the second stage of labour. (It is easily accessed if the woman is positioned on her knees.)
Also useful during labour where there are feelings of panic (for example, going into a labour with an unpleasant previous birth experience).
CO 4 (Hegu)
Stimulates uterine contractions. Chosen for its reported effects of increasing the intensity and frequency of contractions.
Acupressure Technique: Simply apply pressure with the thumb.
Indicated if labour is established but the contractions are of irregular intensity or duration.
This point may be used during the second stage of labour, aiding the body's efforts to move the baby down through the birth canal. It is indicated if the woman is tired and not pushing effectively.
SP 6 (Sanyinjiao)
An empirical point for a difficult labour. Feedback I have received from midwives suggests that this is an effective point to aid cervix to dilate.
Acupressure Technique: Direct pressure is applied with the index finger or thumb.
I recommend using this point on only one leg at a time for approximately 60 seconds. It may then be used on the opposite leg, 20 - 30 minutes later, for the same duration.
This point may be very tender, following its use some women report feeling their cervix stretching and contractions strengthening.
PC 6 (Neiguan)
An empirical point for nausea and vomiting.
Acupressure Technique: This may be used for sensations ranging from mild feelings of nausea through to vomiting.
Place pressure on the point, holding until effective, usually within five minutes. Pressure can be used on either wrists, or only one, whatever is more practical.
It is possible to buy wristbands that apply pressure to this point. These are available through chemists sold as a remedy for motion sickness. Here in New Zealand they are termed "Sea Bands."
Alternately people can easily construct their own. Form a wristband with elastic, and sew onto it a rounded mushroom shaped button. Wear it with the rounded edge pressing onto the skin. Take care that once in place, the pressure exerted on the skin is firm but not uncomfortable.
From the feedback I have collected I have surmised the following:
For the maximum benefit to be gained from acupressure, it is important that it is commenced as early as possible. Women that reported the highest satisfaction began using the points at the beginning of their labour.
The most frequently used points by the women were BL 32 and GB 21. These appeared to provide the most effective pain relief. Most women found one of these points preferable at the onset of contractions and continued with its use throughout their labour.
SP 6 and CO 4 were frequently used by midwives. As induction points, women were instructed to use acupressure on both points prior to their medical induction. Usually in the time frame of using the points at least every two hours. The application of these points are reported as beneficial in cases where, although the labour did not commence spontaneously, the resulting induced labour was straightforward and efficient. One midwife commented that she could tell those women who had actually followed her instructions due to the way the cervix softened and dilated.
For un-established contractions during labour these points were used half hourly. The feedback I receive from midwives indicates that used together they encourage the regulation of contractions and dilation of the cervix.
It must be remembered that there are many reasons why problems arise during labour. These points will not effect a labour where there is a physical problem with the baby accessing the birth canal. For example in cephalo-pelvic disproportion (the baby's head is too large to fit through the woman's pelvis), malposition (the presenting part is the baby's head but it is not in the best possible position for delivery) or malpresentation (the presenting part is the baby's bottom, shoulder, face or brow).
It is worth noting however that I have received positive feedback on the usage of an ear press needle taped to BL 67, when the malposition of the baby is delaying the progression of a labour.
Several women reported that placing motion sickness bands on their feet enabled them to apply pressure to Ki 1 while walking around, producing a calming effect.
It is important that the strength of pressure applied and the choice of points are under the control of the woman. When used effectively acupressure will produce a pleasant sensation that "wears off" when the points are discontinued. They are not to be used if pain is felt on applying pressure. Support people need to use their body weight to lean into the points, otherwise they may resort to using wooden spoon handles and rolling pins to rest their thumbs.
Of the four women that used a "Tens Machine", the feedback was that acupressure was as effective, three discontinuing with the tens, opting to continue with the acupressure.
Partners and support people reported feeling involved and useful, seeing themselves as having an important role in the birth.
The verbal and written feedback I receive from women, their partners and midwives echo's that of a study by Skelton and Flowerdew1, in which the effects of electro-acupuncture (points used ST 36, P6, Neima and auricular) were compared to a control group, using a pain scale during labour as well as answering a post natal questionnaire. The women reported "significantly lower pain scores, felt more in control of their labour and were generally more satisfied with their birth experience than the control group"
Initially, I was surprised that the women using acupressure were reporting such a high level of satisfaction, as I had been under the impression that acupuncture was required, usually in combination with electro-acupuncture, for effective pain relief.
It is possible that acupressure has been previously overlooked, due to it requiring prolonged intensive hands on involvement for it to maintain its effectiveness. While support people provide this, it is not so practical for midwives and doctors to do so.
Providing an illustrated booklet also means that women are given the option of choosing from a range of points, and are able to find those most effective for themselves.
In conclusion, I am convinced that for a birth without complications, acupressure is the preferred option for analgesia, coming from my own experiences, as well as the feedback of others. While I appreciated the effects of using acupuncture (both ear and body points) during the birth of our first child, it did not compare to the effectiveness of having the involvement of my partner, who provided the pain relief during the births of our following two children.
Acupressure provides a unique solution to the problems in trying to provide women with accessible, effective, safe pain relief during their labour. Acupressure overcomes the need for an acupuncturist to be physically present and I believe its effects to be comparable to any needling treatments. It is a non-evasive, partner involved technique, that involves no other tools than a pair of hands and a willingness to listen to the woman's feedback.
It is my hope that given time, acupressure will become a routine part of antenatal education and as acupuncturists we are in a prime position to offer this as a birthing tool to women and their caregivers.
A complementary copy of the booklet I give out to my patients is available at: http://home.clear.net.nz/pages/debra_betts/
—By Debra Betts, L.Ac., Illustrations by Tina Young
Skelton, I and Flowerdew, M., Acupuncture and labour-A summary of results. Midwives Chronicle and Nursing Notes. May 1988
Giovanni, M., The Foundations of Chinese Medicine. Churchill Livingstone 1989.
Auteroche, B. and Navailh, R., Acupuncture En Gynecologie Et Obstetrique. Maloine, Paris, 1986.
McDonald, J., Acupuncture Point Dynamics. 1989.
Giovanni, M., Obstetrics and Gynecology in Chinese Medicine. Churchill Livingstone 1998.
Debra Betts is a Registered Nurse with several years of Neonatal and Pediatric experience. She is a member of the British Acupuncture Association, having graduated from the British College of Acupuncture and is a member of the New Zealand Register of Acupuncturists.
She combines her nursing background and Chinese Medical skills to conduct an acupuncture practice specializing in Fu-Ke (Women's Health Problems). She is a member of the teaching staff at the New Zealand School of Acupuncture and Traditional Chinese Medicine, where she teaches the foundation subjects of traditional Chinese medicine and directs the Student Clinic.
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