Acupuncture for Labor Pain Management

For most women, the most daunting part of being pregnant, and bring a new baby into their life is the act of getting the baby out! "You want me to push that out of what!" 

A mother's body is a beautiful and amazing creation that can do what seems to be an impossible feat. With that said, the process is not....well...comfortable by any means, and will test a mother's strength. As all mother's know, the moment that baby's eyes meets yours, all the pain, fear and discomfort is worth that one moment when you see your baby for the first time.

During labor, levels of beta endorphins naturally increase, allowing the mother to cope with contractions. In the case of a mother that is accepting of birth and as a normal labor and delivery, these naturally occurring endorphins are enough to ease the pain. There are reasons why a mother may not be able to cope with labor pains. In the cases of occipito-posterior positioning, stress, artificially induced labors, or labors that are long and hard, the mother's levels of endorphins may not be enough, or may have been reduced (in the case of stress.) It is in these situations that Pain Management options are requested.

Western Medicine has many pain management options, most commonly the epidural, or IV DemerolBut, there are side effects and many other things that women may not be aware of before making that decision. Now, don't get me wrong, there is a time and place for the use of medical pain management in labor. More often than not, the mother just needs some moral support and enough pain management to take the edge off. Because of this, more and more women are turning to Acupuncture/Acupressure to help them deal with labor pains more naturally. Unlike the Western Medical pain management options, there are no side effects to using Acupuncture for Labor analgesia. 

So, How do we Treat with Acupuncture during Labor?

Wonderful question, I'm so glad you asked!
Well, there are several ways that Acupuncture can be used during labor. Ideally, we would be using regular Acupuncture needles, placing them in the appropriate Acupuncture point and letting them sit attached to a TENS unit to stimulate the needles continuously....wait? This does sound realistic? 

Probably because in the real birthing experience it isn't. Most of the time the mother is moving/walking/bouncing/changing positions and having her lie in one position so we can put the needles in and hook her up is just not going to work. So, in the Labor and Delivery room an Acupuncturist has to be creative! Often working in less than ideal positions, having to quickly insert needles, stimulate and go...multiple times, and having to adjust as the mother does what she needs to do.

Occasionally there are instances where the "Ideal" use of Acupuncture is realized. I have used this method in women who have severe sacral pain due to OP positioning of the baby and by inserting the needles into the sacral foramen and stimulating those points with a TENS unit while the mother was in the hands and knees position, the pain is greatly diminished and the mother is able to move past the intense back pain and focus on the task of getting baby deeper into the canal.

But in general this is not the case, and again the Childbirth Acupuncturist needs to be creative. Most commonly I use tacks! Little needles that are adhered to a piece of tape and look very similar to a thumb tack. The needles are tapped into place on the Acupuncture points, and are manually stimulated when available by pressing and rubbing them deeper into the point. It is a great combination of Acupuncture/Acupressure that works well in the Labor and Delivery room. They can stay in place, do not get into the mother or the staffs way, and allows the Acupuncturist or the Mother's partner to rub them simultaneously.

Northern Colorado has some wonderful hospitals with some wonderful birthing staff. As of now, there are still some facilities that will allow an Acupuncturist/Doula to come to the hospital, but not use actual needles. So, how do we get around this, seeing as we can't use anything that punctures the skin? Well, similar to the tacks I use during home births, or in facilities that will allow Acupuncture, I use pellets that are also attached to tape. These too can be applied to sites needed and rubbed (albeit harder than with tacks to achieve the right stimulation) as needed during labor.

Another method that can be applied at the hospital is cupping. This is the application of suction cups to various parts of the body. What does it do you ask? Another excellent question. Cupping can increase blood flow to areas, as well as relieve pressure. This application is another options for those with intense lower back, hip or sacral pain. It can also be used in situations of extreme stress where the body is diverting blood from the Uterus to the vital organs causing a decrease in contraction strength and frequency (No, the body does not perceive the Uterus as a vital organ). They can be placed quickly and easy and taken off quicker and easier. 

Another options is the use of a TENS unit on the surface of the skin without the insertion of needles. This is a nice option that can be utilized in the hospital setting, but its not nearly as effective as when you hook them up to needles that are directly accessing the sacral plexus nerves an inch or so into the sacrum. 

What does this ACTUALLY do in the body?

Anyone who knows me, knows that I LOVE science and I love research. I love knowing exactly what I am doing in the body. With Acupuncture, science is showing that we ARE making significant changes to biochemistry, but it can't tell us how.

What we know is women who are receiving Acupuncture (with the attached TENS) had higher levels of beta-endorphins and Serotonin that women who labored without Electro-Acupuncture. (Qu, Zhou 2007). Stimulation of Acupuncture point ST 36 produces Oxytocin in the central nervous system. (Yang 2007, published in Neuropeptides 2007, Jul, 28)

Auricular Acupuncture points directly stimulated brain function increasing endorphins production, reducing visceral pain perception, regulating the autonomic nervous system, and balancing hormone production.

In an RCT, they compared a group of 106 women who received "real" acupuncture and 102 with "false" acupuncture. (Real Acupuncture - needles inserted into acupoints...False Acupuncture - needles shallowly inserted into non points). Pain assessments on a scale of 11 points before treatments were the same in both groups, but significantly lower in the Real Acupuncture group 30, 60, and 120 minutes after acupuncture was given. At 2 hours postpartum, the assessment of their total labor pain was lower in the Real Acupuncture group, and there was less use of Epidural Analgesia (10% vs 25.5%) or Demerol (14% vs 35%). [1]

In another RCT, they compared the used of Demerol in 3 groups: Acupuncture - 106; Non-Acupuncture group with same midwives who had experience in Acupuncture - 92; Non-Acupuncture group with midwives with no Acupuncture experience - 92). Demerol was used in 11% of the Acupuncture group; 37% in the Non-Acupuncture same midwives group; 29% in the Non-Acupuncture different midwives control group. [2]

The best part about using Acupuncture as your Pain Management option is that it poses NO RISK to you or baby. It is safe, and effective. As will all interventions, It may not work for everyone. Even an epidural is not 100% effective.

[1] Skilnand E, Fossen D, Heiburg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand 2002;81:943-8 
[2] Nesheim B, Kinge R, Berg B, Alfredsson B, Allgot E, Hove E, et al. Acupuncture during labor can reduce the use of meperidine: A controlled clinical study. Clin J Pain 2003;9:187-91.