“I’m going to be pregnant forever!” “It’s so hard to sleep at night” “My doctor wants to induce me he’s going away for the holidays.” “I’m a few days past my due date and the doctor is talking induction.”
These are just a few sampling of common complaints women share as they near the end of their pregnancies. What I’ve been hearing lately on social media is, “Can I get my labor started with acupuncture?”
My immediate response is a resounding, “Why?”
I am an advocate of utilizing the age-old healing practice of traditional Chinese acupuncture as a modality of healing. Licensed acupuncturists place thin needles at specific points in the body to treat physical pain, many physical and emotional health conditions, and for use as a modality to induce labor. When the conditions are medically reassuring for both mom and baby, acupuncture can work well for induction.
Acupuncture may be thought of as natural however the reality is that acupuncture is a form of labor induction, starting a labor where there was none - which makes it a medical procedure regardless of what agent you are using or where you initiate the procedure. It can be just as powerful if not more as the induction agents used in the hospital. As with any procedure, risks and benefits need to be discussed so you receive informed consent and understand how the process can impact both you and your baby.
There are many medical conditions that warrant the need for labor induction, with some of the most common pertaining to the baby’s intrauterine environment that no longer nourishes and sustains the baby adequately. This can occur with post date pregnancies. Other common reasons include low amniotic fluid (see my Blog Post: http://www.manhattanmidwife.com/single-post/2017/01/18/How-to-Avoid-Induction-of-Labor-Ensuring-Your-Baby’s-Swimming-Pool-Stays-Full ) or a baby with decreased movement, tone and breathing movements, or other signs of placental insufficiency restricting the baby’s growth seen often with post dates pregnancies. With these diagnoses, I prefer to think of induction as an important intersession. Medical challenges that could arise for mother include high blood pressure or toxemia of late pregnancy. When a medical problem such as these develops which impacts either the mother or the baby’s well being, induction is appropriate and determined by your midwife, OB/GYN, or perinatologist.
Here are some things to consider and questions to ask yourself and provider, if the thought of using acupuncture to ‘get things going’ crosses your mind.
Tired? or Tired of Being Pregnant? Consider your reason for wanting to induce yourself. It is not medically safe to induce because you are tired of being pregnant. Doctors are condemned for this very tactic - inducing women because of their own personal vacations, office hours, or being tired themselves working long hours and working your induction in their schedule for convenience. If you are tired now, why would you want to go into labor? Labor requires energy, stamina and endurance. You need to rest to gather your energy for labor and birth. Take a look at your lifestyle to figure out some reasons why you are tired. Pregnancy is hard work growing a baby! Be proud of yourself! Take a nap during the day if you are finding it more difficult to sleep during the night. Visit a chiropractor for adjustment to align you and baby, and extra benefit of calming down your nervous system. Be boring! If you are tired you may be running around too much. A tired mom is a tired uterus and not optimal for strong labor contractions. Getting an energy boost from an acupuncturist would be a reasonable first visit, rather than getting induced, especially if you are not at 40 weeks gestation. Make sure you are eating well, hydrating well, eating foods rich in protein, and doing things you love to give you an energy and mood boost. Foods rich in sugar slow you down. Catch up on seeing friends and family. If you are feeling sad or depressed, talk to your health care provider or a mental health professional. Discomforts of pregnancy are real and do require a lot of continuous and enthusiastic support from your partner, provider, and family when you find yourself past your ‘due date.’
2. Due Date/ ‘Guess Date.’ I think of due dates as guess dates or a season date. I say this because sometimes we don’t have our conception date down, our menstrual cycles can fluctuate, sometimes we forget the first day of our last menstrual period, or we get an ultrasound of the baby after 12 weeks gestation which is not as accurate a measurement of the baby’s gestational age as is an ultrasound taken at nine or ten weeks. If we take these possibilities into account - we may not necessarily have the correct ‘due date’. Accurate due dates are critical because baby’s lungs need to reach maturity and begin their job once baby is born. For this reason induction policies have shifted over the years, and the procedure is can be done at 39 weeks gestation, and earlier only if medical necessity arises to avoid prematurity problems in the newborn. In my career I have seen cases whereby a baby is induced and then once born will need to be placed in the neonatal unit because rather than being a post date pregnancy, the lungs were not yet developed. This of course is a difficult situation as baby and mom are immediately separated from birth so that the baby can receive proper neonatal resuscitation, oxygen, monitoring and possibly medications to boost lung function. So how many weeks gestation are you? If you are past that due date, by how many days? Many women want to use acupuncture because they are past their due date however sometimes the date could be off by a week to ten days on either side, and we don’t want to get a woman going too early especially if the biophysical ultrasound profile of the baby is normal. The profile assesses baby’s heart rate variability, amniotic fluid level, movements, breathing, and tone. When the ultrasound determines that the baby is healthy post your due date, and you are not in early labor, seeing the experienced acupuncturist can be a good solution and confirming your cervical dilation.
3. Am I Ripe? Is your cervix ripe enough for acupuncture to work? It needs to be. While the idea is out that ‘if it doesn’t work, it’s not a problem - it could be. You could be up all night contracting, anticipating labor, and the contractors can peter out. When the time comes for labor, you could be physically and emotionally drained. I talk about safety because acupuncture can be quite effective in stimulating the uterus, and if you are already in a pre or early labor phase, acupuncture can create problems for your baby, your labor, and you. Sometimes it is difficult to know if we are in early labor, especially if it is your first baby. If your cervix is not ripe, meaning, if it is not at least 2 cm dilated, 50 percent effaced or thinned out, and for a first time mom, if your baby is not engaged, meaning the head is not in the pelvis at your ischial spines, 75% of the time induction with acupuncture, pitocin or other meds that are helpful when medically needed to induce, will usually fail and a c section will be the procedure to have the baby born safely. Determining readiness for induction is used with the Bishops score, a chart listing aspects of the baby’s station (position in the pelvis with regard to ischial spines,) cervical position, (posterior, midline or anterior), consistency, (soft or firm) dilation, and effacement of the cervix. A score less than six indicates the cervix is not ripe for induction. After a two or three day induction in the hospital, or a day at home contracting with acupuncture contractions, though not strong or making a change in the cervix, a mom and baby are often tired, so delivering vaginally is more challenging. If your cervix is ‘ripe’ and you are past your due date and the baby and placenta and amniotic fluid levels are within normal limits, acupuncture with your health care provider’s consent could be a most effective way to start labor. If acupuncture does effectively start your labor and it continues, keep in close contact with your health care provider to gauge the progress of the labor and when they would like you to come in to the office or hospital to check on the baby.
4. Am I Already In Early Labor? Some women get a stomach ache along with diarrhea, and these symptoms could be signs of early labor. (those were my signs of early labor) Without considering that they are in early labor (as early as 37 weeks) they visit an acupuncturist. Unfortunately women can experience contractions that come every minute or two and then the uterus is hyper stimulated - not good for your baby’s heart rate or the uterus which doesn’t catch a break to rest. These are referred to as tetanic contractions and if you get to the hospital with this labor pattern, the baby and uterus could become overstimulated by contractions that are coming too close, strong, or without breaks. This scenario can cause the baby’s heart rate to become fast (tachycardia) or drop with decelerations due to the hyper stimulation and you end up in the operating room. While this is not meant to be a tutorial on fetal heart rate monitoring, it is vital to understand that baby’s respond to contraction intensity, length of the contraction, and frequency. The contraction pattern impacts the well being of the baby, and continuous fetal monitoring, external and sometimes internal (requires releasing the bag of water) would then be mandatory to ensure accurate fetal surveillance. Acupuncture is an intervention, and can be just as powerful as any medications given to start labor in the hospital. It’s works best when you are not in early labor.
5. When Given the Thumbs Up: Good news is that when your midwife or physician gives you the go ahead, you and your baby are ‘ripe’ for acupuncture to help, as Erin Borbet (http://www.erinborbet.com/how-it-works/) a licensed Acupuncturist, who relocated to Idaho from New York City says, “acupuncture offers a gentle way to nudge labor along.” Once your uterus starts working, it is important to have early communication with your health care provider so they can learn about the frequency, duration, and intensity of your contraction pattern. and decide when it is time to arrive at the hospital or birthing center. Once the uterus gets into a rhythm with acupuncture, and the timing is ‘ripe’ the labor can be quicker than most! Borbet, states, ”induction"/prenatal points are on the low back, shoulders, feet and hands - not near the belly”. Treatments vary between 4-10 sessions, and for some just one session before labor begins, as each woman’s situation varies. Borbet states that the principle of acupuncture is to open the meridians (energy channels) within the woman’s unique body, stimulating points and getting a woman's energy meridians nourished and balanced so everything is "flowing" optimally”. “Eight of these twelve meridians run through the pelvic floor, and with the meridians of the pelvic floor open, the muscles and organs become nourished,” This improved circulation helps facilitate labor to then begin spontaneously.
6. Ask your potential midwife or OB/GYN: “What is your policy and philosophy about use of acupuncture for induction with post dates pregnancies? This question should be on your list when interviewing potential birth providers. This issue should not be left for a last minute discussion leading to possible confrontations when you are in your third trimester or past your due date. Many women transfer into my practice for this very reason. Induction is a decision based on medical facts and findings. It should be a discussion without misunderstandings about hospital policies and clinical protocols. It should be a mutually respected joint decision between you and your health care provider based on their medical findings. Do not take on the responsibility to get things going with acupuncture without first consulting with your healthcare provider. When your provider is involved in the process you will feel better. If you decide to secretly see an acupuncturist, then you are with the wrong provider! If you take it upon yourself to induce yourself, you are taking medical matters into your own hands and then are basically responsible for the baby’s outcome by wearing a healthcare provider’s hat.I have seen this done with women taking castor oil as well.
Over the years I recall having had a few woman seek the services of an acupuncturist without my consent, (there may have been more I am unaware of) and several have ended up with a hyper stimulated uterus, mom and baby needing oxygen, continuous fetal monitoring, and a watchful eye creating an unnecessarily stressful labor. Babies can also have a bowel movement in utero when under duress with unrelenting contractions, and then risk further respiratory complications once born. On the opposite side of the spectrum, I have had many women including an acupuncture student induce herself when she knew her cervix was ripe. These women had wonderful births and their labors started and progressed as though labor started on it’s own. If you are well rested, cervix ripe, not in early labor, baby’s ultrasound normal past your ‘due date/guess date,’ - seeing an acupuncturist with good communication with your healthcare provider, could be the way to start labor. Barring any immediate known problems for mom or baby requiring immediate induction, enjoy your trip to the licensed acupuncturist.
I hope you find this information useful.
Can you think of ways you can initiate constructive communication with your midwife or doctor about post dates induction?