The last few weeks of pregnancy are unique. You’re excited because you’re going to meet your new baby so soon! There’s anxiety because oh wow, there is so much still left to do. Maybe you’re a little scared. And you might be frustrated because you’re big enough now that if you drop something on the floor that it lives there now.
You could be any of this and more. Every pregnancy is different, every woman is different but there is one thing that is pretty much constant across pregnancies:
You want it to be over and that 40 week mark is juuuuuuuust within your reach.
Having a late term baby
Some of us pass 40 weeks and it’s so incredibly frustrating. That’s why we hear people start talking about “induction” or artificially initiating labor. We hear things like nipple stimulation, eating spicy food, and evening primrose oil can help with “natural” induction. And we may even hear Cervidil and pitocin being thrown around, usually in contrast to natural methods.
“Sign us up. We want to meet our baby!”
One thing that often gets recommended is acupuncture and as an acupuncturist I’m thrilled. I’m more than happy to help you meet your little one as soon as possible. But there is so much more to it than getting a treatment at 40 weeks.
Acupuncture as labor induction is part of a process – a series of treatments that can:
- help alleviate the common discomforts of pregnancy such as sciatica, low back pain, hemorrhoids, heartburn and more
- reduce the anxiety, fear and depression that may start to increase as your guess date draws near
- help cervical dilation and effacement
- reduce mean labor duration
- reduce the need for medical intervention
Acupuncture can absolutely induce labor. But…
Quite frankly, the research for labor induction via acupuncture isn’t very positive. One study by BJOG found that:
“Under the treatment regimen investigated in this study, acupuncture for the induction of labour in post-term women at gestational age 41+6 weeks may not be effective.”
Another study, from Obstetrics and Gynecology found:
“Two sessions of manual acupuncture, using local and distal acupuncture points, administered 2 days before a scheduled induction of labor did not reduce the need for induction methods or the duration of labor for women with a postterm pregnancy.”
Finally, a Cochrane review reports:
“Overall, there have been few studies assessing the role of acupuncture for induction of labour. Before implications for clinical practice can be made there is a need for well-designed randomised controlled trials to evaluate the role of acupuncture to induce labour and for trials to assess clinically meaningful outcomes.”
They’re not wrong – there are almost no studies that show whether or not acupuncture can help mothers facing the possibility of going overdue. And as you can see, the results are not necessarily in favor of acupuncture.
But there are two crucial points that researchers are missing in these studies:
- Acupuncture is not pitocin and is not meant to be used as such
- Traditional Chinese Medicine (TCM) relies on the context of a patient’s condition – the protocols used for studies like this are not acupuncture, they are merely needling technique
Using the right tool
As a research driven practitioner, it breaks my heart to see researchers come to no conclusions because they’re missing out on the biggest parts of TCM. But the very thing that makes TCM such an customizable medicine makes it difficult to study.
One treatment can’t be applied to two people and get the same results. In some instances, the same treatment can’t be applied to the same patient because their condition has changed.
Furthermore, let’s look at the turn around on those first two studies. Acupuncture at 41+6 means that acupuncture only has 24 hours to work. As we’ll see below, that’s not how it’s typically used. You can’t use a pair of pliers as a hammer – acupuncture at 41+6 without having laid the appropriate groundwork with prebirth acupuncture is not using the appropriate tool to get the job done.
We see the same problem with the second study – two sessions of acupuncture without having laid the appropriate ground work and not being customized to the specific patient’s needs is going to have a very low chance of inducing labor.
It is the misunderstanding of how acupuncture works that often leads these acupuncture studies astray. So in light of the dearth of studies that exists for labor induction and acupuncture I would like to clear up some misunderstandings around using acupuncture to prevent post-term pregnancy.
Acupuncture is not pitocin
Western medicine still doesn’t know what exactly triggers labor. One study found that it’s possible that our bodies respond to the deterioration of telomeres, or the ends of chromosomes, in the amniotic fluid. There are other factors such as cervical dilation and effacement that may indicate that labor is near, but nothing concrete. For the most part it’s just a waiting game.
TCM, on the other hand, is very clear on what causes labor:
- Yang activity replaces yin material growth
- Qi flows freely and moves blood
- The door of the uterus opens
“When qi flows correctly 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 feotus.”Debra Betts, Acupuncture in Pregnancy and Childbirth, p 150
An acupuncturist is then tasked with making sure that qi and blood are circulating correctly. Instead of triggering labor, we help the body get to a place it will trigger on its own. It’s passively supporting the body in its own journey. This is why I keep repeating that acupuncture is not pitocin.
Pitocin is artificial oxytocin. Oxytocin is the hormone that causes contractions. Pitocin is often administered in hospitals to do the same.
Acupuncture is also not artificially rupturing the membranes. It’s not the application of prostaglandin gel to ripen the cervix. It is not any of these very active processes done to induce labor.
It is preparation and encouragement.
Prepare for natural childbirth with TCM
So why would you add this passive, slow process to your treatment plan?
Because according to a study published in Geburtshilfe Perinatol, mean labor duration for first time mothers was reduced by almost two hours.
For mamas wanting to go the natural route, adding acupuncture reduced the rate of medical intervention. Combining shorter labor times and the reduced need for interventions like forceps, epidurals and cesareans are common goals for mamas everywhere. This reduces costs, stress and recovery time. It’s a win all around.
But focus shouldn’t just be on the labor. Many mothers experience discomfort, anxiety and stress in the last few weeks.
In the ninth month, patients often come to clinic complaining about insomnia, back aches, hemorrhoids, heartburn – a litany of things that make them want to get this over with. Acupuncture can help reduce or eliminate these symptoms so you can better focus on preparing for labor as opposed to getting through the day.
As for anxiety and stress, acupuncture can help you relax. For those of you who have read Ina May Gaskin’s work you are familiar with the Sphincter Law:
The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, the vagina, and the anus to open to full capacity….The primitive brain, or brain stem, is also considered to be a gland that releases hormones. All female mammals, including humans, release a certain number of hormones such as oxytocin, endorphins and prolactin in the process of giving birth. Stimulation of the neocortex [versus the brain stem], on the other hand, can acutally interfere with the birth process by inhibiting the action of the primitive brain in hormone release.Guide to Childbirth, Ina May Gaskin, pp 170-171
Relaxation is the most immediate effect of acupuncture, no matter the treatment. By helping you relax in the moment as an effect of needling, and focusing on longer term anxiety reduction we can make it easier for your cervix to begin to open.
Acupuncture for labor is about laying the groundwork ahead of time and helping you feel comfortable emotionally and physically so you can prepare.
Pre-birth acupuncture and labor induction
Pre-birth acupuncture starts weekly at 37 weeks. For the first couple appointments we focus on building your reserves and helping with any discomforts you may have. One point in particular is helpful to “open the door of the uterus” which is why pre-birth acupuncture is sometimes called “cervical ripening”.
If labor has not started spontaneously by 40 weeks we focus more on moving qi and blood. It should be noted that a normal and healthy pregnancy can last anywhere from 38 to 42 weeks and there can be some variance in length if your due date was calculated by your last menstrual period instead of implantation. This is why more practitioners are beginning to refer to it as an “estimated due date” or even better, “guess date”.
Most practitioners don’t want the baby to develop much past 42 weeks and will attempt to induce before that. Prebirth acupuncture can make you more receptive to both acupuncture inductions and the other more active Western methods of induction, like castor oil and herbal treatments on the natural side and prostaglandin gels and pitocin on the allopathic, or hospital-based side.
After 40 weeks, focus moves to stimulating the nerves in your sacrum and moving qi and blood through points on your hands and feet. A study in 2001 found that getting acupuncture to He Gu and Sanyinjiao, points to induce labor on your hands and legs, every second day following your guess date “supported cervical ripening at term and shortened the time interval between the woman’s expected due date and the actual time of delivery.”
This works best when combined with self-administered acupressure at home, under the instruction of a trained Traditional Chinese or East Asian medical practitioner.
Acupuncture as part of your birth plan
Acupuncture and TCM is a comprehensive way to support you through your pregnancy and labor. It’s a slow medicine that builds on itself and it’s difficult to apply in one-off situations such as a labor induction (though it can be done).
Using acupuncture to support you through your last month can shorten your labor time, reduce the discomforts of the ninth month and reduce the likelihood of interventions. Acupuncture is an excellent addition to your birth plan, no matter where you are planning to deliver.
If you are in the Minnesota metro area and would like to explore pre-birth acupuncture, or see if it would be effective for other conditions earlier in your pregnancy please check out my services page.
Disclaimer: I am an acupuncturist in the state of Minnesota, and the information falls within my scope of practice in my state. However, unless I have directed you here as your homework I am probably not your acupuncturist. The information in this post is for general purposes only and does not constitute medical advice. As always, check with your own acupuncturist or primary care provider before making any lifestyle changes. This post does not create a patient-practitioner relationship and I am not liable for any losses or damages resulting or relating to the content in this post.
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Jessica Gustafson is a licensed acupuncturist in St Paul, MN specializing in women’s health and fertility. She loves working with patients through the Health Foundations Birth Center on Grand Avenue in St Paul as well as doing home visits in the Twin Cities area. Check out the services page for more information!
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