Acumamas | Vancouver Doulas, Acupuncture Pregnancy Downtown Vancouver

Notes and Comments on this section are written by Debra Betts. You can visit her website at www.acupuncture.rhizome.net.nz

Cervical Ripening
A randomized controlled trial into the effects of acupuncture on cervical ripening was published by Rabl 2001[9].

Summary
The objective was to evaluate whether acupuncture at term can influence cervical ripening and thus reduce the need for postdate induction. On their due dates 45 women were randomized into either an acupuncture group (25) or control group (20).

The women were then examined at two daily intervals for cervical length (measured with vaginal trasonography, cervical mucus and cervical stasis according to Bishops score). The acupuncture group also received acupuncture every two days at the acupuncture points Hegu LI-4 and Sanyinjiao SP-6.

If women had not delivered after 10 days labour was induced by administering vaginal prostaglandin tablets. The time period from the woman’s due date to delivery was on average 5 days in the acupuncture group compared to 7.9 days in the control group.

Labour was induced in 20 % of women in the acupuncture group compared to 35% in the control group.

Conclusion
Acupuncture at the points Hegu LI-4 and Sanyinjiao SP-6 supports cervical ripening and can shorten the time interval between the woman’s expected date of delivery and the actual time of delivery.

Treatment method
Hegu LI-4 and Sanyinjiao SP-6 were used bilaterally. The needles were inserted to achieve de qi and then retained for 20 minutes with no further stimulation.

Clinical Perspective
It was interesting that four women were delivered within 24 hours of having their first acupuncture treatment while no women in the control group delivered within 24 hours of their first examination.

It is also interesting to note that none of the women from the acupuncture group went into labour during treatment or within one hour following treatment, reflecting that it is a practical option for women to receive acupuncture in a private clinical setting.

From a safety perspective there was no difference in the number of women experiencing difficulties during delivery, with 3 women requiring a vacuum extraction and two women requiring a caesarean section from each group.

[9] Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical ripening and induction of labour at term – a randomised controlled trail. Wien Klin Wochenschr 2001; 113 (23-24): 942-6

Summary
Research on the use of acupuncture to prepare women for labour first appeared in 1974 with a study by Kubista and Kucera[7]. Their research concluded that acupuncture once a week from 37 weeks gestation using the acupuncture points Zusanli ST-36, Yanglingquan GB-34, Jiaoxin KID-8, and Shenmai BL-62 was successful in reducing the mean labour time of the women treated.

They calculated the labour time in two ways, the first as being the time between a cervical dilation of 3-4 cm and the delivery time. In the acupuncture group the labour time was 4 hours and 57 minutes (control group 5 hours and 54 minutes). The second as the mean subjective time of labour, taken from the onset of regular 10 – 15 minute contractions until delivery, the acupuncture group had a labour time of 6 hours and 36 minutes (control 8 hours and 2 minutes).

In 1998 Tempfer [8] used the acupuncture points Bai Hui DU-20 , Shen Men HT-7, and Nei Guan PC -6 from 36 weeks gestation. This study concluded that acupuncture treatment had positive effect on the duration of labour by shortening the first stage of labour, defined as the time interval between 3 cm cervical dilatation and complete dilation. The acupuncture group had a median duration of 196 minutes compared to the control group time of 321 minutes, (acupuncture group 3 hours and 26 minutes compared to the control group 5 hours and 35 minutes).

Treatment method
Kubista and Kucera. The acupuncture points Zusanli ST-36, Yanglingquan GB-34, Jiaoxin KID-8, and Shenmai BL-62 were used weekly on primigravidea women from 37 weeks until delivery.

The reasoning given for choosing these acupuncture points was that as a group they would relax the women, tonify qi and improve circulation of blood to the pelvis. The points were used bilaterally, with an even method with de qi being obtained and the needles retained for 20 minutes. The women were treated in sitting position and had on average three treatments.

Tempfer. The acupuncture points Bai Hui DU-20 , Shen Men HT-7, and Nei Guan PC-6 were used. No reason was given why these points were chosen. Bilateral application was used with the needles stimulated until de qi was obtained. Treatment was given with the women in a resting position with each session lasting 20 minutes. A minimum of 4 sessions was recommended.

Clinical Perspective
In terms of how many pre birth treatments are considered effective Kubista and Kucera found no effect on the duration of delivery time in woman who only received acupuncture for one treatment and Tempfer ensured that women received at least four treatments (twelve women were excluded from the Tempfer study because they received less than 4 treatments).

In terms of possible side effects from receiving acupuncture Tempfer found that there was an increased frequency of premature rupture of membranes in the acupuncture treatment group. They did not consider this a negative factor as they associated this with an acceleration of the cervix maturing. From a safety perspective there was no association with an elevated rate of complications for mother or the fetus in those women receiving acupuncture in any of the studies.

[7] Kubista E Kucera H. Geburtshilfe Perinatol 1974; 178 224-9

[8] Tempfer C, Zeisler H, Mayerhofe Kr, Barrada M Husslein P. Influence of acupuncture on duration of labour Gynecol Obstet Invest 1998; 46:22-5