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Obstetrics and Acupressure

By Pamela Wallach

From Oriental Medicine Journal

Introduction

I have been a registered nurse for 21 years and have been involved in women's health and worked in labor and delivery for the past 18. I studied Chinese medicine at the Midwest Center for the Study of Oriental Medicine in Chicago because I was interested in bridging western medicine and the ancient knowledge of traditional Chinese medicine in labor and delivery work. I offer the following cases as illustrative of what I have done using simple Chinese medicine techniques even, at times, in the less than welcoming environment of a hospital where only acupressure can be used. I hope these experiences will encourage other practitioners to use whatever techniques are feasible despite the limitations under which we may have to work.

Labor Dystocia

Breech Presentation

Neonatal Resuscitation

Case #1--Labor Dystocia

A 32-year-old woman primapara presents with labor dystocia. Her vaginal exam revealed her to be at 7 cm., 80 % effaced and -2 station for 2 hours. She was on pitocin and not making progress in labor. The doctors were contemplating Caesarean section. They were concerned that the baby's head was still not engaged at such advanced dilation which might indicate that the baby could not fit into the pelvis. It seemed that the baby's head should have descended by now.

Treatment Principle

To activate blood circulation, correct stasis, regulate qi and induce labor by strengthening and stimulating the uterus.

I performed acupressure on St 36 (su san li ), Sp 6 (san yin jiao) and LI 4 (he gu). I alternated the combination first combining LI 4 with St 36 then with Sp 6. I used mild to moderate pressure for approximately 15-20 minutes. I instructed her husband to press GB 21 (jian jing).

Discussion of Points

LI 4, the yuan source point of the Large Intestine channel and Sp 6, the intersecting point of the yin channels of the foot, are important points for inducing labor as they regulate and circulate qi and blood and induce downward movernent. St 36, the he-sea point of the Stomach channel combined with Sp 6 invigorates the Spleen and Stomach, produces qi and blood and induces labor. GB 21 was chosen for its downbearing action to facilitate the movement of the baby's head.

Results

Within 20 minutes the contractions became more efficient and stronger in intensity. I was able to lower her pitosin dose as her own contractions kicked in. The patient's mental outlook became much more positive, because she began to feel the baby's head moving downward (increased rectal pressure.) Within 1 hour the patient was completely dialated and ready to push. We pushed for 1 hour going from a -2 station (head not engaged) to a +3 station where she delivered spontaneously. We all felt elated that by looking at the body in a different way and moving the energy we could help her deliver this baby and avoid a C-section.

Case #2--Malposition of Fetus

A 28-year-old woman presented with her first pregnancy, breech presentation at 38 weeks gestation. Malposition of the fetus does not produce any sign or subjective symptoms. Diagnosis was established by gynecological and obstetrical examination.

Treatment Principle

The principle of treatment was to correct the position of the fetus and regulate the Kidney qi. Moxibustion was applied to UB 67 (zhi yin) on each toe.

Discussion of Points

UB 67 was chosen as the jing-well point of the Urinary Bladder channel which has an internal external relationship with the Kidney channel. By stimulating this point the qi of the Kidney channel is thus regulated. Also experimental research has shown that secretion of the adrenal cortical hormone is promoted by moxibustion to this point which activates uterine contraction and may be responsible for causing this fetal movement. Her husband applied moxibustion to UB 67 on each toe for approximately 20 minutes daily with the hips slightly elevated. The patient was instructed to visualize the baby turning in a healthy way. Moxibustion can be applied in this manner as soon as the patient discovers the fetus is breech, which will be around 32-36 weeks gestation.

Treatment should be discontinued once the baby has turned which can be determined by examination by the physician, midwife. The mother herself will probably know by where the baby is kicking. If the baby is breech kicking is usually felt in the lower portion of the abdomen whereas if the baby is vertex, kicking is felt at the upper portion near her abdomen or ribs. This may also be confirmed by ultrasound or the Leopold maneuver.

Results

Within five days the patient came to labor and delivery completely dilated with a normal presentation and delivered a healthy 81b. 12 oz. baby whom she named Max the Moxa Baby.

Notes

Babies also respond to light and sound. A pair of headphones can be placed on the mother's lower abdomen with music playing and the baby will often respond by moving in the direction of the sound. A flashlight can also be shown at the lower abdomen which may cause the baby to move toward the light. If none of these techniques work it may be that the baby is meant to deliver breech. Cephalopelvic disproportion or malformation of the uterus may be the cause. It may be important to check with the obstetrician or midwife to make sure that the patient is having an uncomplicated pregnancy.

Neonatal Resuscitation

We all like to hear the healthy cry of a newborn once delivered. To hear the baby brings a sigh of relief, but on occasion this does not happen. This may be caused by trauma of delivery, stress of labor or use of narcotics during labor; major biomedical resuscitation techniques may be required. I have had success reviving infants using Chinese medicine, the techniques for which are reviewed below.

Treatment Principle

Invigorate the yang, resuscitate and revive. I perform acupressure on GV 26 (ren zhong), CV 17 (dan zhong), Lu 1 (zhong fu) and UB 13 (fei shu).

Discussion of Points

It is interesting that in the text "Graspig the Wind", GV 26 (ren zhong) is likened to humankind standing in the center between heaven and earth because its resuscitation capabilities certainly have the effect of pulling the baby from its heavenly origin to its earthbound destination.

On a newborn, GV 26 is an extremely small area. I use my thumb and aim right below the nose a little above the midpoint of the philtrum and apply moderate pressure in an upward motion for a few seconds. If the baby is grunting or retracting (where the baby's chest is pulling in), I apply gentle massage in a downward motion to CV 17 to regulate the qi, clear the Lung, transform phlegm, loosen the chest and disinhibit the diaphragm. Lu l courses the Lung qi. I use gentle massage in a circular motion. UB 13 is the back shu point of the Lung channel which regulates the Lung qi.

Results

These points have a very good result for reviving the newborn and stimulating respiration. Within seconds the baby is screaming. (The doctors look at me to see what voodoo I have done now.)

Notes

Sometimes the baby will begin to urinate soon after these resuscitation techniques. This is a good sign and reinforces the conception that the Kidneys have grasped the qi.

This success does not alter the fact that some infants will need major resuscitation if heavy narcotics were used during labor, there was meconium aspiration or with other emergency situations like abruptio placenta or placenta previa in which the oxygen flow has been cut off to the fetus.

I am not allowed to practice acupuncture in the hospital because of the legal prohibitions in Illinois, but with the consent of the midwives and openminded physicians I am able to make a difference using the wisdom of Oriental medicine.

Editor's note: The acupuncture laws in Illinios have changed since this last paragraph was written.

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