It’s a situation I’ve encountered many times: a woman calls me up because she’s been told that if she doesn’t go into labor on her own in a few more days, she’ll be induced. Of course she wants to avoid this, and she has read about trying a “Labor Induction” acupuncture session.
After over 10 years of practice in women’s health and two years of an intensive perinatal acupuncture certificate program, I’ve learned there’s a better way to approach this issue, and it’s backed by studies as well as advice of medical practitioners. Read on to find out what I think is much more effective and relaxing than just this single “Labor Induction” session. I’ll also discuss the situations in which a labor induction treatment might be helpful.
What Labor Induction Acupuncture Usually Involves, And Some Possible Downsides
Acupuncture is a really marvelous modality during pregnancy. Traditional Chinese Medicine (TCM) works via looking at our bodies as a reflection of nature- we all have elements of heat, cold, dryness and dampness, and when these aspects become imbalanced we feel unwell. Additionally, anything that flows through our bodies like blood, fluids or the electrical impulses of the nervous system is wrapped up into a term we call Qi (also spelled Chi). When the Qi isn’t flowing properly problems can arise such as pain or swelling. Acupuncture, massage, cupping, gua sha and dietary recommendations are all tools we use in TCM to restore balance to your body.
The usual way an acupuncturist would approach a situation where mom needs to go into labor quickly (and the way I have in the past) would be to see the woman as soon as possible and needle a standard set of 4-5 acupuncture points with the goal of stimulating contractions and downward movement. This is referred to as “labor induction acupuncture”. The points are stimulated fairly strongly and a few other points may be added in based on the woman’s unique symptoms. If you still haven’t gone into labor you would then return 1-2 days later for another treatment that’s quite similar to the first. I’ve certainly had women find good results with this type of treatment, but these were situations where the cervix was effaced and dilated and baby’s head was engaged- all we needed to do was gently nudge the contractions to start.
But, this isn’t the majority of what I see in clinical practice. Most of the time, a woman in this situation doesn’t have much cervical dilation or effacement or there are other issues such as the baby not being properly engaged in the pelvis or natural production of oxytocin hasn’t peaked yet. So, even if an acupuncture treatment does create contractions things can quickly fizzle out. Or, the contractions simply aren’t very efficient because of lack of hormonal coordination, and you might end up needing some type of medical help anyway. Think about it this way- the cervix needs to soften and efface before the uterus will have effective contractions. The uterus may push the baby down but there’s no way for her to get through the cervix, just yet.
The mental/emotional component here is also really important to consider. Imagine you’re already feeling hurried along and pressured due to worry over being medically induced. Then, you arrive at your acupuncture treatment (maybe never having had acupuncture before) and points are needled which try to push your body to do certain things. Even though acupuncture is a wonderful, natural modality which tends to work with your body, it’s still powerful stuff! It’s definitely not optimal to undertake something new when you’re coming from a place of fear and feeling pressured. So what is a better approach?
A More Mindful Way: Labor Preparation Acupuncture and Acupressure
I encourage my pregnant moms to come in starting around week 36 or 37 for weekly treatments which can gently and gradually help your body get ready on its own. The acupoints in this type of treatment do not focus on creating contractions, but instead helping with cervical maturity and items numbered 1-5 listed below. You should also be taught acupressure points that you or your birth partner can use at home. I also like to give women tips on how to naturally increase oxytocin production (such as- watch funny movies, go out with friends, and don’t watch stressful news stories).
This is especially helpful for women who have previously had tough labor and delivery experiences to feel more relaxed and in control, as well as for first time moms who aren’t sure what to expect.
During Labor Prep Acupuncture Treatments, I have 5 goals:
- Ensure optimal positioning of the baby- anterior position, head down so that it can engage with the cervix and help with effacement and softening, and eventually, dilation
- Facilitate your body’s own oxytocin release in the weeks leading up to the estimated due date
- Help with cervical maturity- thinning (effacement) and softening. When the cervix has undergone these changes, contractions are more effective.
- Increase the stamina you’ll have during labor via addressing other discomforts. If you aren’t sleeping due to digestive discomforts, swelling, anxiety or back and pelvic pain, you won’t have as much energy as when you’re feeling healthy and balanced, right? Acupuncture can help with all of these issues.
- Give you and your birth partner acupressure “homework” to help with numbers 1-4, as well as providing resources, referrals, emotional support and other strategies to help you feel good about your birth, no matter how things unfold
This is something I feel passionately about because when women feel supported and are helped from a holistic and integrative approach (working in partnership with your OB or midwife), they absolutely do have better births!
What Does The Evidence Say?
I might be a bit of an anomaly- I’m an acupuncturist who is a total skeptic! I really do my best to have an evidence informed acupuncture practice. Still, it might be surprising to hear me say that the studies we currently have don’t show that acupuncture treatments make women go into labor any earlier. And this is actually good news because it means acupuncture won’t make you go into labor sooner than you’re ready to. However, a study in the British Medical Journal does show that acupuncture when combined with acupressure and other mind/body modalities may result in:
- Decreased rate of cesarean section
- Decreased rate of epidural use
- Decreased rate of labor augmentation using artificial methods
- Decreased rate of resuscitation of babies using oxygen and/or bag and mask
Additionally, a 2017 Cochrane Review which looked at 22 trials found that “Acupuncture showed some benefit in improving cervical maturity, however, more well-designed trials are needed.”
Acupuncture: The Take-Home Messages:
- If you’ve come across this article and you’re already at 40 weeks or beyond, don’t panic. You can still have acupuncture to help you relax and help with the above items numbered 1-5. Or, if you know your cervix is ready to go and the baby is well-positioned, and your OB or midwife has given you the thumbs up, it’s appropriate and safe to have a typical “labor induction” treatment to try and help with contractions. However if this is not the case, I would avoid getting an acupuncture treatment where the goal is to stimulate contractions. Risa Klein, Certified Nurse Midwife believes that it is essential that every acupuncturist understand the concept of The Bishop Scoring System, and ask their client, (in advance of the visit) ‘What is your Bishop Score?’ She explains:
“The provider does a vaginal exam and based on the woman’s Bishop Score, can have a good indication if the cervix is ripe and ready for induction. The factors being assessed are: baby’s station/engagement, cervical dilation, cervical effacement, position of the cervix – posterior, midline, or anterior, and cervical consistency – soft, moderate. or firm? The Bishop Score is a total of the scores, maximum 13, and if she scores greater than 6, the cervix is considered ripe with a more favorable vaginal outcome. This means a woman would have a more favorable outcome with acupuncture needle induction as well. And that is excellent news.”
- If you’re earlier on in pregnancy, contact an acupuncturist who has lots of experience and expertise in supporting women who are preparing for labor. In my experience it’s best to begin labor preparation treatments around week 36.
- Even if you know you will be medically induced or end up needing medication to help things along, acupuncture treatment can help the labor to go more quickly and easily if we’re able to help with establishing some amount of cervical maturity, and plenty of your body’s own oxytocin is flowing.
A Few Other Important Notes:
- Be sure that you are not already in early labor if you get acupuncture for encouraging contractions. It can be useful during labor for pain relief and promoting healthy contractions, but this is a very different situation. The acupuncturist needs to be aware this is going on in order to appropriately time the points to coincide with the contractions. If it turns out you are in early labor, problems can arise. Risa Klein, CNM says,
“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.”
- I cannot overemphasize the importance of taking a great childbirth education class. In this class you should learn how your mental, emotional and physical health can dramatically impact when and how you go into labor. Additionally, learning strategies for optimizing your prenatal health can go a long way in giving you the type of birth you can feel empowered by.
- Overall, strive to find a healthy balance between letting go of controlling exactly how your birth will go and doing everything you can to have one that feels powerful and healthy to YOU. This includes knowing that there is so much that is in your power to have the birth you want.
Recommended Reading and Resources:
Spinning Babies: maneuvers and techniques to help optimize baby’s position
Ina May’s Guide To Childbirth – a must-read for all pregnant women! Learn about the sphincter rule and why “what gets the baby in, gets the baby out.”
Debra Betts’ Acupressure Guide for birth preparation and pain relief during labor
She Births: online classes and research information
**I’d very much like to thank my teachers and mentors in maternity acupuncture for sharing their many years of experience and research on this subject! They include: Debra Betts, Sarah Budd and Claudia Citkovitz. I would also like to thank Risa Klein, CNM for her contributions to this article.**