1

Important: Notes and Slides for print out can be found under the attachment button on the upper right hand corner of this screen

Part 1

Debra Betts

2

Acupressure:Acupressure:Promoting Pain Relief and Partner Promoting Pain Relief and Partner

InvolvementInvolvement

Betts 2008Betts 2008

Acupressure Acupressure

Non evasive technique Non evasive technique Accessible, effective safe birthing tool Accessible, effective safe birthing tool

Support people Support people --providing general pain relief providing general pain relief through woman's feedback through woman's feedback

Midwives use for treating specific conditions Midwives use for treating specific conditions pre, during and post labour pre, during and post labour

AcupressureAcupressure

Application of Application of pressure to pressure to acupuncture points acupuncture points

Acupuncture points Acupuncture points situated on meridians situated on meridians containing containing qiqi that that flow through the flow through the body body

3

QiQi

Women Giving Birth 9/10Women Giving Birth 9/10thth C C

““In my household all women and girls are taught In my household all women and girls are taught personally how to doctor themselves. Then in personally how to doctor themselves. Then in childbirth they all know how to save the childbirth they all know how to save the situation. It is proper for families to instruct situation. It is proper for families to instruct orally so the households know thisorally so the households know this””

Prescriptions from the birth treasury (Chan Prescriptions from the birth treasury (Chan baobao zhufangzhufang) anonymous author ) anonymous author 1167 CE1167 CE

4

Research Research

Research Research

Since 2003 research published in nursing journalsSince 2003 research published in nursing journals

Important to promote discussion about the Important to promote discussion about the effectiveness and safety of acupressure witheffectiveness and safety of acupressure with

Health professionals Health professionals Pregnant women Pregnant women Support people Support people

Acupressure Induction Acupressure Induction

AcupressureAcupressure taughttaught toto 6666 womenwomen atat 4040 weeksweeksControlControl groupgroup 7676 womenwomenTaughtTaught byby midwifemidwife (15(15 minuteminute session)session)

PointsPoints usedused GBGB 21,21, LILI 44 andand SPSP 66

WomenWomen encouragedencouraged toto useuse pointspoints asas oftenoften asas ititfeltfelt comfortablecomfortable

IngramJIngramJ.. TheThe effectseffects ofof shiatsushiatsu onon postpost-- termterm pregnancypregnancy

5

There were no statistically significant differences There were no statistically significant differences between the groups for: between the groups for: ParityParityMaternal ageMaternal ageGestation at deliveryGestation at deliveryType of deliveryType of deliveryNumber of Caesarean deliveries Number of Caesarean deliveries Length of labour Length of labour Birth weightBirth weight

Audit questionnaire Audit questionnaire 30 women (from the 66) completed follow up 30 women (from the 66) completed follow up

questionnaire questionnaire 87 % used the acupressure87 % used the acupressure80 % found points helpful80 % found points helpful63 % used all 3 points and all these women went 63 % used all 3 points and all these women went into spontaneous labourinto spontaneous labour

Conclusion Conclusion

Post term women who used acupressure were Post term women who used acupressure were significantly (17 % p=0.038) more likely to significantly (17 % p=0.038) more likely to labour spontaneously than those who did not. labour spontaneously than those who did not.

6

Effects of Acupressure on Labour Effects of Acupressure on Labour Time Time

7575 womenwomen werewere randomlyrandomly assignedassigned toto receivedreceivedeithereither acupressureacupressure oror touchtouch (control)(control) toto SpSp 66duringduring labourlabour forfor 3030 minutesminutesAcupressureAcupressure usedused forfor 3030 minutesminutes timetime periodperiodduringduring eacheach contractioncontraction

ForFor touchtouch groupgroup thumbsthumbs placedplaced overover pointpoint

LeeLee MK.MK. EffectsEffects ofof SPSP 66 acupressureacupressure onon labourlabour painpain andand lengthlength ofof deliverydelivery timetimeinin womenwomen duringduring labour.labour.

NoNo significantsignificant differencedifference betweenbetween thethe twotwo groupsgroupsforfor thethe variablesvariables ofofParityParityMaternalMaternal ageageGestationGestation ageageChildbirthChildbirth preparationpreparationHusbandsHusbands attendanceattendance

NoNo oxytocinoxytocin augmentationaugmentation oror administrationadministration ofofanalgesicsanalgesics duringduring thethe studystudy periodperiod

OnOn admissionadmission toto thethe LabourLabour wardward womenwomen wereweretoldtold thatthat eithereither treatmenttreatment couldcould alleviatealleviate theirtheirpainpain

AcupressureAcupressure appliedapplied bilaterallybilaterally withwith midwivesmidwivesthumbsthumbs onon SPSP 66 –– pressurepressure gravitygravity waswascalculatedcalculated byby aa medicalmedical engineerengineer toto bebe 21502150 mmmmHgHg forfor rightright thumbthumb andand 19111911 mmmm HgHg forfor leftleft

7

Percentage Anxiety Pre and Post Percentage Anxiety Pre and Post Intervention Intervention

4.54.9

4.5

6.3

0

1

2

3

4

5

6

7

Pre Post

Acupressure

Touch

P=0.03

LabourLabour painpain measuredmeasured usingusing aa subjectivesubjective labourlabourpainpain scalescale (visual(visual analogueanalogue scale)scale)

MeasuredMeasured beforebefore interventioninterventionImmediatelyImmediately afterafter interventionintervention (p=0.012)(p=0.012)

3030 minutesminutes afterafter interventionintervention (p=0.021)(p=0.021)6060 minutesminutes afterafter interventionintervention (p=0.012)(p=0.012)

AnalgesicAnalgesic effectseffects lastedlasted 6060 minutesminutes

Labour Pain Scores Labour Pain Scores

5.86.4

77.7

6.3

7.68.3

8.9

0123456789

10

Pre Post 30 Mins 60 Mins

Acupressure

Touch

8

Labour Time in Minutes Labour Time in Minutes

108

30

138146

45

191

0

50

100

150

200

250

3-10 cm 10 cm -delivery

3 cm -delivery

Acupressure

Control

P=0.006

Conclusion Conclusion

SPSP 66 acupressureacupressure waswas effectiveeffective forfor decreasingdecreasinglabourlabour painpain andand shorteningshortening thethe lengthlength ofof deliverydeliverytimetime

SpSp 66 acupressureacupressure cancan bebe anan effectiveeffective nursingnursingmanagementmanagement forfor womenwomen inin labourlabour

Effects of Acupressure on 1Effects of Acupressure on 1stst Stage of Stage of Labour Labour

127127 womenwomen randomlyrandomly assignedassignedAcupressureAcupressure toto LILI 44 andand BLBL 6767LightLight touchtouchNoNo interventionintervention

TimeTime ofof interventionintervention 2020 minutesminutes (five(five minutesminuteseacheach acupressureacupressure point)point)

ChungChung UL.UL. EffectsEffects ofof LILI 4and4and BLBL 6767 AcupressureAcupressure onon LabourLabour PainPain

9

AcupressureAcupressureThumbThumb pressurepressure toto LILI 44PressurePressure fromfrom thethe erasereraser endend ofof pencilpencil forfor BLBL 6767

TouchTouchEffleurageEffleurage (preformed(preformed toto leftleft andand rightright upperupperouterouter armsarms forfor totaltotal ofof 2020 minutes)minutes)

ControlControlMidwifeMidwife stayedstayed inin roomroom conversingconversing

Originally intended to include SP 6 butOriginally intended to include SP 6 but…….. .. Withdrawn after pilot test due to high rejection Withdrawn after pilot test due to high rejection rates by womenrates by women

Intolerable pain brought on by stimulation of Intolerable pain brought on by stimulation of this point this point

ThereThere waswas nono significantsignificant differencedifference inindemographicdemographic andand obstetricobstetric datadata betweenbetween thethegroupsgroups ofof womenwomen forforParityParityPrenatalPrenatal trainingtrainingGestationGestationHusbandHusband presentpresentWeightWeight ofof newbornnewborn

10

Mean Pain Relief Score VAS Active Mean Pain Relief Score VAS Active Stage of Labour Stage of Labour

0.17

0.66

0.81

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Acupressure

Effleurage

Control

P=0.41

Mean Time in Hours First Stage of Mean Time in Hours First Stage of Labour Labour

6.337.13

8.45

0

1

2

3

4

5

6

7

8

9

Acupressure

Effleurage

Control

P=0.19

ThereThere waswas nono significantsignificant differencedifference amongstamongst thethethreethree groupsgroups inin termsterms ofofPainPain reliefrelief inin secondsecond oror thirdthird stagestage ofof labourlabour

UterineUterine contractionscontractions (as(as measuredmeasured byby externalexternalfoetalfoetal monitoring)monitoring)

11

Conclusion Conclusion

Confirm the effect of LI 4 and BL 67 in Confirm the effect of LI 4 and BL 67 in lessening labour pain during the active phase of lessening labour pain during the active phase of the first stage of labour the first stage of labour

There were no verified effects on uterine There were no verified effects on uterine contractions (external foetal monitoring) contractions (external foetal monitoring)

Ice Massage Ice Massage

Ice used on LI 4 to reduce labour pain during Ice used on LI 4 to reduce labour pain during contractions contractions Ice massage carried out for 20 minutes or four Ice massage carried out for 20 minutes or four contractions whichever occurred firstcontractions whichever occurred firstBased on a study that showed ice massage to Based on a study that showed ice massage to LI 4 resulted in a 50% reduction in acute dental LI 4 resulted in a 50% reduction in acute dental pain pain

Waters B. 2003 Ice massage for reduction of labour painWaters B. 2003 Ice massage for reduction of labour pain..

One third a cup of ice was crushed and placed in One third a cup of ice was crushed and placed in the corner of a washcloththe corner of a washcloth-- the 4 corners were the 4 corners were lifted to the centre and twisted to make a small lifted to the centre and twisted to make a small ice bagice bag

Ice bag placed on their palm side of handIce bag placed on their palm side of hand

The massage started with the contraction and The massage started with the contraction and ended when the contraction ended ended when the contraction ended

Pressure comparable to light scratchingPressure comparable to light scratching

12

Mean Pain Response VAS Mean Pain Response VAS

61.5

49.6

33.3

0

10

20

30

40

50

60

70

Pre Test

Ice Right Hand

Ice Left Hand

Conclusion Conclusion

TheThe authorsauthors concludedconcluded thatthat iceice massagemassage toto LILI 44isis aa safe,safe, nonnon--invasive,invasive, nonnon pharmacologicalpharmacologicalmethodmethod ofof reducingreducing labourlabour painpain

Acupressure Acupressure --Practical use in Labour Practical use in Labour

Partner/support person begins use early in Partner/support person begins use early in labour labour Guided by womanGuided by woman’’s feedback as to point s feedback as to point selection selection Pressure not massage Pressure not massage Pressure to woman's comfort level Pressure to woman's comfort level Move on to different points if acupressure no Move on to different points if acupressure no longer appears effective longer appears effective

13

WomenWomen whowho hadhad supportsupport duringduring labourlabour (advice,(advice,assistance,assistance, emotionalemotional support)support) werewere moremore likelylikelytoto havehave aa spontaneousspontaneous vaginalvaginal birthbirth

AssociatedAssociated withwith greatergreater benefitsbenefits whenwhen providerproviderwaswas notnot aa membermember ofof staffstaff andand whenwhen itit beganbeganearlyearly inin labourlabour (12,000(12,000 women)women)

HodnettHodnett ED.ED. (2003)(2003) ContinuousContinuous supportsupport forfor womenwomen inin labourlabour CochraneCochranereviewreview

GB 21 GB 21

Illustration from The Seirin Pictorial Atlas of Acupuncture

GB 21GB 21Most tender point Most tender point along pathway along pathway between T1 and tip of between T1 and tip of shoulder joint shoulder joint

Strong pressure Strong pressure –– not not massage massage

Knuckles/elbows Knuckles/elbows with body weightwith body weight

14

How to Locate GBHow to Locate GB--2121

Clinical Applications Clinical Applications

Pain reliefPain reliefAid the baby to descend into pelvis Aid the baby to descend into pelvis Promote efficient pushing Promote efficient pushing Promote efficient delivery of the placentaPromote efficient delivery of the placenta

Breast feeding Breast feeding –– let down reflexlet down reflex

BL 32 BL 32

Illustration from The Seirin Pictorial Atlas of Acupuncture

15

BL 32 BL 32

Location Location –– 22ndnd sacral sacral foramenforamen

Use of lower sacral Use of lower sacral foramen as labour foramen as labour progresses progresses

Dull/achy sensation Dull/achy sensation ––if sharp sensation if sharp sensation bone bone

How to Locate BlHow to Locate Bl--3232

Clinical ApplicationsClinical Applications

PromotePromote anan efficientefficient labourlabourAidAid inin cervicalcervical dilationdilationRelieveRelieve aa cervicalcervical liplipProvideProvide painpain reliefrelief inin labourlabour (( especiallyespecially earlyearlylabour)labour)

PrePre labourlabour preparationpreparation withwith massagemassage fromfrom 3737weeksweeks

16

CombsCombs

How to use CombHow to use Comb

Combs IICombs II

17

KID 1 KID 1

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate KidHow to locate Kid--11

Clinical Applications Clinical Applications

Fear/panicFear/panic issuesissues

SeaSea sicknesssickness bandsbandsduringduring labourlabour

ForFor useuse duringduringtransitiontransition

InductionInduction

18

LI 4 LI 4

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate LiHow to locate Li--44

LI 4 Clinical ApplicationsLI 4 Clinical Applications

To enhance the efficiency of contractions To enhance the efficiency of contractions Provide pain reliefProvide pain reliefAid women through transitionAid women through transitionFor use during second stage to encourage For use during second stage to encourage effective pushingeffective pushingPromote delivery of the placenta and reduce Promote delivery of the placenta and reduce blood loss in the third stageblood loss in the third stage

19

BL 60 BL 60

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate BlHow to locate Bl--6060

BL 60 BL 60

Used by holding Used by holding ankle and applying ankle and applying firm pressure with firm pressure with thumbs thumbs

Often used as women Often used as women approaching approaching transition transition

20

BL 60 Clinical ApplicationsBL 60 Clinical Applications

ToTo provideprovide painpain reliefrelief inin labourlabour asas womenwomenapproachapproach transitiontransitionWithWith SPSP 66 toto repositionreposition aa babybaby inin aa posteriorposteriorpositionpositionPromotePromote efficientefficient labourlabour

ToTo promotepromote thethe efficientefficient deliverydelivery ofof thetheplacentaplacenta

SP 6 SP 6

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate SpHow to locate Sp--66

21

SP 6 SP 6 Four of the womanFour of the woman’’s s finger widths above finger widths above tip medial tip medial malleousmalleous

Sensation sharp, Sensation sharp, pressing on bonepressing on bone

Infrequently used Infrequently used pain relief pain relief

Clinical ApplicationsClinical Applications

Irregular contractions with LI 4Irregular contractions with LI 4

Clinically used to aid cervical dilationClinically used to aid cervical dilation

Encourage efficient labour Encourage efficient labour

After pains post delivery After pains post delivery

PC 6 PC 6

Illustration from The Seirin Pictorial Atlas of Acupuncture

22

How to locate PcHow to locate Pc--66

PC 6 PC 6

Pressure or sea Pressure or sea sickness bandssickness bands

Nausea/anxiety Nausea/anxiety

23

Summary Summary

Pain relief Pain relief –– all points all points Will depend on the individual woman and her Will depend on the individual woman and her

preference preference

Essential to try out differing points and listen to Essential to try out differing points and listen to the womanthe woman’’s feedback s feedback

Specific Actions during Labour Specific Actions during Labour

To enhance contractions LI 4 To enhance contractions LI 4 To dilate cervix To dilate cervix SP 6 SP 6 For cervical lip For cervical lip BL 32 and SP 6 BL 32 and SP 6 To aid descent into pelvis To aid descent into pelvis GB 21 and BL 60GB 21 and BL 60For posterior position For posterior position SP 6 and BL 60 / BL 67SP 6 and BL 60 / BL 67To help deal with fear To help deal with fear KID 1KID 1For nausea For nausea PC 6 PC 6 For efficient delivery placenta For efficient delivery placenta

GB 21, BL 60, LI 4 GB 21, BL 60, LI 4

Pro D SeminarsPro D Seminars

This course was a ProThis course was a Pro--D Seminar D Seminar production.production.

For more information on this or other For more information on this or other ProPro--D Seminar courses, please visitD Seminar courses, please visit

www.prodseminars.comwww.prodseminars.com

24

Continue to Part 2Continue to Part 2

Close this window and proceed to part Close this window and proceed to part two of Debra Betts: Acupressure for two of Debra Betts: Acupressure for

LabourLabour