Midwifery comments on using Acupressure
Matty Van Oosteram
I have been using acupressure in the second stage of labour in primigravida
women. I have found GB 21 extremely helpful, definitely reducing the time of
The first time I tried this point was with a primigravida 40 weeks gestation
that had gone into labour spontaneously, she had a fairly normal first stage of
labour with no pain relief. During pushing we tried many different positions,
sitting on the toilet, standing, squatting, birthing stool. She had been pushing
for nearly two hours and we were only seeing a peep of the baby’s head. I
suddenly remembered the GB 21 pressure point and while she was sitting on the
birthing stool applied strong pressure to her shoulders. Within five – ten
minutes the baby descended and was delivered 3 contractions later.
The next time I used this point was on a primigravida who was 41+ 4. She had
been induced for postdates, and had an extremely quick first stage of labour.
She was quite shocked to feel pressure. She was very uncoordinated and resisting
pushing. We turned her onto her knees and I asked her husband to apply firm
pressure to GB 21 and pronto the baby dropped into the pelvis (this was so
visible) Two contractions later the baby was born.
My third woman was 38 + 3 and delivering her second baby. She had a very fast
stage of labour and was anxious about pushing. (She had an epidural with her
first baby and hence didn’t have the intense urge to push) I encouraged her
husband to massage and press GB 21 and she began to focus on pushing. Shortly
after she gave birth standing up.
I find primigravidas are often fearful during the pushing stage and tend to hold
back. Although I have always used different positions the delivery positions
have often been semi lateral.
When using acupressure on GB 21 these women have all given birth kneeling or
standing. My observation has been that it has helped them focus and they are
able to push more effectively.
My experience of using acupressure as another tool for women in labour has been
very positive. If I find that a woman is holding her shoulders tightly, I
encourage shoulder massage using GB-21 from 37 weeks to help the baby’s head
descend. In preparation for labour I show the support person the points to press
on the sacrum and shoulders (BL-32 and GB-21).
Many think it is simply an interesting idea but don’t hold much store by it
until they are in labour. I find that the sacral points, in particular, are
almost universally enjoyed in labour. Shoulder points are very helpful in some
labours - but not as frequently as the sacral points.
Originally I used these points on women late in labour, and as I had found them
very effective I had not seen the need to use them any earlier. I now encourage
support people to start using the acupressure points early in the labour, as
this approach seems to diminish the overall pain and I have been delighted by
the response: women are less distressed overall and better supported during
The other effective use of acupressure is when the woman is 41 weeks, wants to
be in labour and is happy to start the process slowly over two or three days. At
this point the induction points (LI-4 and SP-6) can be stimulated regularly and
are generally extremely effective if practised diligently.
The more independent women can be in their labour, the happier most are in their
abilities to birth. Many women have expressed satisfaction at their partners
being able to give them the bulk of their support in labour.
I feel I am also encouraging an attitude of self-help, which is where I think we
need to focus our efforts in normal birth.
I have on many occasions used acupressure in labour. The use of SP-6 and BL -60
has worked well for me in situations where the baby's head is not coming down as
it should. I have also used these acupressure points with malpositioned and
deflexed heads and have achieved excellent results.
Whilst working on delivery suite a distressed woman in labour with her first
child arrived with ruptured membranes. Her labour was of a spontaneous nature
and she was progressing well. On initial assessment I examined her to find her
7-8cm dilated. She went onto all fours and began to become extremely distressed.
I used my midwifery techniques to encourage her and offered her the gas to try
to help her to focus. She was wasting a lot of energy between the contractions
trying to tell her self and me, that she could not go through with this labour.
I feared that if this much energy was wasted on negative thought, she would not
have enough reserves to push when the time came.
I had exhausted my reserves of suggestions and encouragement. She was
progressing far too quickly to administer pethedine or an epidural. As she was
clearly not coping I used acupressure on KID -1. Nearly immediately as I lay my
fingers in the spot and applied pressure the woman stopped talking closed her
eyes and breathed through the contraction beautifully. She expressed how the
pressure I was applying was really enjoyable. I kept the pressure through the
next contraction, and again, the woman was like another person. The result was
immediate, and highly effective. I instructed the partner to use two pens to
apply the pressure firmly and the woman within the next half hour began to push
instinctively. She progressed to a peaceful vaginal birth on all fours where she
remained after the application of the acupressure.
Midwifery comments on using Moxibustion
Over the last 6 months I have had three women with Breech presentations
confirmed on Scan at 35 weeks gestation. Good foetal growth in all cases. With
no hypertension, increased liquor volume, diabetes or known foetal abnormality.
I taught all three clients how to apply Moxa (using smokeless sticks) to BL-67
showing them the illustration from the acupressure booklet, and giving them a
copy of the instructions on the safe use of Moxa. I instructed all to continue
Moxa for 10 days even if baby turned.
Amber was a primigravida who employed Moxa for 7 days prior to presenting for
ECV at 37 weeks, On that day the baby was found to be in oblique position and
was easily turned to cephalic presentation by the obstetrician and stayed
cephalic until delivery.
Beth was a multigravid patient who had a previous Caesarean section and again I
started Moxa at about 36 weeks. When presented fro ECV at 37 weeks baby was
transverse and easily turned to Cephalic presentation. I was not present at ECV
as busy elsewhere and unfortunately she was advised by my colleague to stop moxa
at that point. I did not find out about this until several days later. Baby
reverted to transverse and an emergency Caesarean ensued after rupture of
membranes and a baby in transverse position.
Cathy was an interesting case. Early scan at 7 weeks showed a bicornuate uterus
with baby in right horn. Scan at 20 weeks failed to re demonstrate a bicornuate
uterus. At 34+ weeks she complained of reduced movements and a scan showed a
baby in the breech position. All other measurements normal. I decided to offer
her Moxa despite Bicornuate uterus and arranged for an ECV at 37 weeks. I fully
discussed with the obstetrician her scan reports and comments re bicornuacity of
uterus and he opted for an attempt at 36 weeks.
On presenting for ECV baby was in oblique position and ECV was successful. Moxa
continued for 5 more days. Spontaneous labour at term with normal delivery of
Alex had given birth to her third son after a normal birth. Her oldest son was
14 years old, then she had an 18 month old, and now the newest addition to the
family was here. She had three day postnatal stay planned to get her bearings of
being a mum of three.
Her labour and birth were effective, however she was unusually exhausted. I was
on duty for three nights. Her admission night being the first. We discussed the
necessity to replenish her stores of energy and her fears of going home as she
was weary and worried how she would cope.
We discussed the benefits of moxibustion use postnatally for its nourishing
potential. She was interested in trying it. The next night I brought my
Moxibustion sticks and a half inch needle. The line of Bl- 23 was given moxa,
and the point Yin tang was needled for twenty minutes for her mind to be calm
for her to gain the utmost benefit of the moxibustion treatment.
During the night approximately 0300, she woke to feed the baby. She could not
get back to sleep as was considering taking a sleeping tablet. I offered her
moxa again. This time using the line of REN-4 on her lower abdomen. This
treatment also was very soothing for her and she fell asleep during the
treatment. I left a moxa stick with her through the day and she instructed her
family how to do it and emphasized that her midwife said that it was
"imperative" that she got this treatment. The following night her baby was more
settled and Alex was in a far more settled state. We did the moxa before she
fell asleep and every time she woke during the night. She was grateful and had
noticeably more colour in her cheeks and far more vibrancy than when we had
Acupuncture in midwifery practice
- Hutt District Domino Midwives
- New Zealand
Our practice currently provides total midwifery care for approximately fifty
women each year. For the last three years my colleague and I have been amongst
the few midwives in the region to offer women acupuncture as a part of their
midwifery care. The purpose of this article is to highlight the interesting
trends we are seeing where acupuncture has been used antenatally, during labour
A significant reduction in the number of instrumental births and a similar
reduction in the number of women needing to be induced for postmaturity would be
the most obvious. The use of acupuncture has allowed a greater number of women
to achieve normal, more natural births and so a more positive birth experience
We aim to highlight the benefits of acupuncture for pregnancy and birth beyond
its popular pain relieving effects. Further research into acupuncture’s wider
uses is definitely needed. We believe the benefits for women, babies, midwives,
and society are significant and the potential therapeutic value of acupuncture
in maternity care is, as yet, unrecognised by the mainstream of maternity care
Through Debra Betts the New Zealand School of Acupuncture ran its first course
for interested midwives in Pregnancy and Birth related Acupuncture in 1997. It
is since attending this course that we have used acupuncture widely in our
practice. Traditionally in the western world acupuncture is known as an
alternative to pharmacological pain relief. This has been particularly useful
for women in labour helping them achieve more natural births. Initially this was
our primary motivation for doing the course, although, three years on,
acupuncture for pain relief makes up only a small part of our work. It is the
other uses of acupuncture during pregnancy and birth that we have, as midwives,
found so useful.
We have noticed in particular, that women who have always grown small babies in
previous pregnancies, seem to grow significantly larger babies when acupuncture
has been used throughout the pregnancy and are more likely to continue the
pregnancy to term.
There is also some indication that acupuncture may have a mitigating effect in
women with mild Pregnancy-Induced Hypertension if it is used early enough.
Acupuncture needs to be used with care, and in conjunction with the usual
screening measures. It appears that blood pressure signs can be kept normal for
longer and these women are more likely to carry to term.
Indications from our yearly data are that it has reduced the number of women
needing medication to control blood pressure whether it be pregnancy induced or
mild essential hypertension. Blood pressure in both pregnancy and labour seem
less labile for these women. Proteinuria seems less common and if present, less
in its severity. Observing the blood results in those women who received
acupuncture every day or on alternate days shows significant biochemistry
changes over a period of a week or less. Raised uric acid levels are often
brought back to the normal range and ALTs are more likely to remain normal
longer in women having regular acupuncture therapy so there is less need for
intervention and the early induction of labour.
It is rare now in our practice to have a woman undergo induction for
postmaturity at 42 + weeks gestation because acupuncture done from 40 + weeks
has resulted in spontaneous labour by 41 + weeks. The average number of
treatments to achieve this is between three and seven. The few women that do
reach 42 + weeks after acupuncture will usually labour with one or two doses of
prostin E2. Rarely do these women (mostly primigravidas) require the addition of
Women who have had acupuncture preparation in the pregnancy are likely to have
significantly shorter labours. This is particularly noticeable with first
labours where the average length of established labour is between four and six
hours. It seems that acupuncture helps to regulate contractions and women appear
to labour more efficiently. The beneficial effects increase with an increased
number of treatments. The number of women experiencing long latent phases of
labour has now also decreased.
Certain acupuncture points are useful in managing malposition. Persistently
posterior babies and transverse arrest in labour are now almost unheard of in
women having had acupuncture, even with babies of above average size. The rate
of instrumental assisted births in our practice has also fallen dramatically.
The use of epidurals is infrequent. Acupuncture does not work for a small
percentage of women where there is some degree of true cephalopelvic
disproportion due to foetal size or perhaps, the shape of the maternal pelvis.
We have also observed that women who have had regular acupuncture during their
pregnancy are less likely to suffer a large blood loss at delivery because of
the regulating effect it seems to have on contractions. The majority of women in
our care would have a physiological third stage and our rate of postpartum
haemorrhage is significantly lower than the national average. We can only
attribute this to our use of acupuncture and the resulting lower rate of
intervention in labour.
Acupuncture also has its uses in the postnatal period. It can assist lactation
and let-down. It can also be used in the treatment of blocked milk ducts. It is
useful in restoring a mother’s energy level after birth and promoting her
general recovery and wellbeing. It may also be helpful in reducing the emotional
swings that some women experience early and later in the postpartum period so it
may have a role in reducing the likelihood of postnatal depression in
Our hope is this article will generate interest amongst midwives to explore this
area further. The benefits of acupuncture for the childbearing woman need to be
formally addressed in the literature, and we believe that midwives, as the
guardians of normal birth, are in a unique position to begin and continue this
research for the future benefit of all women.