Labour induction

Preparing for birth naturally

Inducing labour is actually 2 processes, firstly ripening the cervix (medically done with gels or a balloon catheter) and then starting contractions (medically- breaking the waters and the oxytocin drip). Inducing with acupuncture is the same, the cervix needs to be ripe. Throughout your pregnancy your cervix lays down collagen and ‘knots the fibres’ in order to hold the cervix closed and in the last few weeks hormones trigger the reabsorption of this collagen and realigning of the fibres- a ripe cervix can dilate from the pressure applied by contractions and labour can progress. If ripening hasn’t happened labour is long, painful and doesn’t progress.

Clinical studies of acupuncture to induce often aren’t positive, partially because of the definition of labour induction- it needs to begin contractions within 24 hours of the intervention to be deemed effective. Acupuncture is a gentle stimulus that encourages the natural process including cervical readiness, it doesn’t over ride it. If the cervix isn’t ready you don’t want to just start contractions, you want to start a labour that can progress, that means it often takes longer than 24 hours.

Evidence- 2017 Cochrane review, Smith et al, could not draw any conclusion on the success of induction because no trials reported on vaginal delivery not achieved within 24 hours, it did conclude it did not reduce caesarean sections but did show some improvement in cervical maturity and called for more research to be done.

The exact mechanism that starts labour is still not understood, and without all the natural triggers it is not an easy process to begin. Unfortunately, a number of acupuncture studies used fixed points (not chosen to suit individually), used hand stimulation only and for a short duration, with often only 2 sessions. This is like taking 2 aspirin and expecting it to stop a whole cold. The treatment you receive must be tailored to you and take into account information such as baby’s position, engagement, and your accompanying signs. Electro-stimulation (a gentle stimulation that feels like a tapping) is used in this clinic, it has been shown to be more effective. Smith et al 2017, states ‘Acupuncture vs usual care- There appeared be a differential effect according to type of acupuncture based on subgroup analysis. Electro‐acupuncture appeared to have more of an effect than manual acupuncture for the outcomes caesarean section (CS), and instrumental vaginal and spontaneous vaginal birth. It decreased the rate of CS, increased the rate of instrumental vaginal, and increased the rate of spontaneous vaginal birth. However, subgroup analyses are observational in nature and so results should be interpreted with caution’.

Preparation for birth?

The better prepared you are in advance for labour the shorter and less painful it can be as shown in Levett 2016 et al http://dx.doi.org/10.1136/bmjopen-2015-010691. This study included acupressure with visualisation, relaxation, breathing, massage , yoga and facilitated partner support, it significantly reduced epidural use and caesarean sections.

Acupuncture done in the weeks before your delivery can assist to prepare you emotionally and physically, increasing the likelihood of you labouring successfully. Betts, Lennox 2006 (https://www.researchgate.net/profile/Debra_Betts/publication/284625163).

As well as the state of the cervix labour progressing is dependent on many factors, such as the co-ordination of contractions, position of the baby, and the emotional state of the mother. Starting a labour fearful and feeling out of control is not conducive to releasing endorphins , natural painkillers. Posterior positioned babies (back of baby’s head is toward your spine) do not enter the pelvis and birth canal easily, they put more pressure on the mother’s pelvis causing a slower and more painful labour. During your preparation sessions we will discuss options for optimal positioning.

They want to induce me …what can I do? ….

1. You need to be in labour by 38 weeks…
   If possible begin at 35 weeks and have support to encourage ripening your cervix and to prepare physically and emotionally for your birth. At the same time we can assist the common complaints of late pregnancy such as musculoskeletal pain and returning nausea. If you’re past 35 weeks, that’s fine we can still get good changes going in the cervix.
2. You need to birth by your due date…. you can start birth preparation at 36 weeks (or later if that date has passed, every little bit helps).
3. You didn’t hear about acupuncture until now and you are about to be induced, can acupuncture help? Yes it can. If you see your doctor or midwife ask if they will assess your cervix, helps to know what we need to work on.
   1. if its hard and closed let’s get started (the chances are you may still need medical induction but inductions are more successful when the cervix is ripening).
   2. If your cervix is soft and dilating then let’s see if we can trigger the next step and start contractions.