JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

THE USE OF ACUPUNCTURE AS A

ROUTINE PRE-BIRTH TREATMENT

by Debra Betts

Introduction From about 37 weeks onwards, a woman’s preparation for

Pre-birth acupuncture refers to a series of treatments in the labour usually consists of attending educational antenatal
final weeks of pregnancy to prepare women for childbirth. classes, talking through her plans and fears with her midwife
Research1 has demonstrated that the mean duration of or doctor and trying to rest as much as possible.
labour in a group of women giving birth for the first time
was reduced from 8 hours and 2 minutes in the control Traditional Chinese medicine
group (70 women) to 6 hours and 36 minutes in the group Traditional Chinese medicine has a long history of advocating
of 70 women who had received pre-birth acupuncture. In that women modify their lifestyle throughout pregnancy, to
clinical practice acupuncture is an ideal method to help ensure healthy babies and efficient births. This has involved
women prepare themselves to have the most efficient labour advice on regulating physical activity, following dietary
possible. Feedback suggests that pre-birth acupuncture guidelines and maintaining a calm emotional state.
offers a range of positive effects in labour that goes beyond An early reference to this practice exists in the Records of
reducing the time spent in labour, with midwives reporting the Historian which tells how the mother of the first emperor
a reduced rate of medical intervention. This article outlines of the Western Zhou dynasty (11th century to 771 B.C.E.)
the use of pre-birth treatments in clinical practice in the refused to look upon adverse colours, hear indecent sounds,
hope that this will encourage practitioners to promote this or the utterance of any arrogant words, and because of this
practical treatment. she gave birth to a son who achieved great things2. Later
references to what became known as ‘foetal education’
Western medical information included recommendations that pregnant women abstain
In preparation for birth, a woman’s doctor or midwife will from the use of non-prescribed medications, all alcohol
usually recommend weekly visits when the gestational age of and lifting heavy objects. Advice was also given on taking
36-37 weeks has been reached. During these visits the foetus frequent leisurely walks and regulating sleep (avoiding both
is checked to detect its position and heartbeat. Monitoring is excessive sleep and undue fatigue). Abstaining from the
carried out for gestational diabetes (a form of diabetes that seven passions, the five unfavourable tastes and all sexual
can develop during pregnancy and will usually resolve post activity was also seen as essential2.
birth) and pregnancy induced hypertension (also known Dr. Xu Zi Cai (493-572 C.E.) detailed beneficial and
as pre-eclampsia, a collection of symptoms including high detrimental foods for each month of pregnancy. During
blood pressure, oedema and protein in the urine that if the second month of pregnancy, for example, the mother
left untreated can lead to problems such as small for dates should avoid pungent, hot or drying foods, and if women
babies and eclamptic fitting in the mother). experienced abdominal or umbilical fullness and a bearing
‘Minor’ discomforts that the women may be experiencing down sensation in the third month, rooster soup should
around this time, and which are considered normal, include be taken3. As a woman approached the completion of her
heartburn, constipation, varicose veins, haemorrhoids, pregnancy, Dr. Xu Zi Cai advised that she concentrate her
leg cramps, bleeding gums, nasal congestion, nosebleeds, qi in the lower dantian, three cun below her umbilicus, to
backache, swelling of the hands and feet, difficulty promote the growth of the foetus’s joints and its mental
in sleeping and increased anxiety and tiredness. It is development.
also considered normal for the woman to have profuse This interest in promoting optimal conditions during
transparent leucorrhoea, and to experience frequent pregnancy, and in preparing for an efficient birth has
urination as the baby drops and places further pressure on continued to the present day in traditional Chinese medicine,
her bladder. On the plus side her breathing should become with the emphasis on a women’s qi and blood prior to
easier at this time as the baby descends further into the delivery (“if the qi is correct and if the blood is circulating
pelvis. Termed ‘lightening’, ‘dropping’ or ‘engagement’, well labour is described as harmonious”4).
this descending typically occurs two to four weeks prior to Acupuncture sessions prior to labour provide an ideal
delivery in a first pregnancy, though it may not occur until opportunity to ensure that the qi and blood, the five emotions
birth in subsequent pregnancies. and the zangfu are all in harmony.

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 JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

Clinical practice Point prescription

Acupuncture can be used in two main ways in the later Treatment was given by midwives once a week, from 37
stages of pregnancy. Firstly, specific pre-birth treatments, or 38 weeks until delivery. The acupuncture points used
in the form of a standard set of points, can help prepare a were taken from research1 concluding that the use of the
woman’s body for birth, with an emphasis on preparing acupuncture points Zusanli ST-36, Yanglingquan GB-34,
the cervix and pelvis for labour. Secondly, treatment can be Shenmai BL-62 and Sanyinjiao SP-6 once a week for several
given to deal with medical conditions such as pregnancy weeks prior to a woman’s due date effectively reduced the
induced hypertension, and symptoms such as heartburn time women spent in labour.
and haemorrhoids. All points were needled bilaterally, with the woman
Using a standard set of acupuncture points once a week sitting over a chair, or unilaterally, with the woman lying
for three weeks prior to the woman’s due date is an accepted comfortably on her side. They were used with an even
practice in German hospitals where acupuncture is practised. needling technique and usually retained for 20 minutes.
Midwives who have trained in a special acupuncture course Jiaoxin KID-8 could be substituted for Sanyinjiao SP-6 if
use Yanglingquan GB-34, Zusanli ST-36 and Sanyinjiao the midwife was concerned about using Sanyinjiao SP-6
SP-6, with Zhiyin BL-67 as an added point on the woman’s (see below).
third visit. If the baby’s position was not optimal (that is posterior
or remaining high) Kunlun BL-60 or Zhiyin BL-67 was
substituted for Shenmai BL-62 by some midwives.
Traditional Chinese medicine has a long I was initially concerned that although Sanyinjiao SP-6
was used in the above research, it might potentially have
history of advocating that women modify the effect of promoting a premature labour or a labour
their lifestyle throughout pregnancy, to that was excessively rapid in certain women. It must be
ensure healthy babies and efficient births. noted that although women may be under the impression
that the faster labour is, the better they will feel about
the experience, this is not necessarily true. Extremely
intense rapid labours (for example three hours from start
Other formulas used elsewhere for this purpose are i. to finish in a woman having her first baby) can be very
Zusanli ST-36, Yanglingquan GB-34, Sanyinjiao SP-6 and shocking for the mother, so much so that women often
Shenmai BL-625, and ii. Zusanli ST-36, Yanglingquan GB-34, describe feelings of panic and thoughts that they were about
Shenmai BL-62 and Jiaoxin KID-86. to die. These extreme labours can also contribute to acute
For many years my use of pre-birth treatments in medical problems such as foetal distress and postpartum
clinical practice involved women who had experienced haemorrhage. There is therefore a vast difference between
problems with a previous birth, and were seeking to make a labour that is short and efficient, and a rapid uncontrolled
their subsequent delivery as natural as possible. While my labour, potentially resulting in medical problems.
own follow-up of these women’s resulting birth experiences For this reason, midwives were advised to follow the
was positive (with the majority reporting an efficient guidelines I use in clinical practice when a woman presents
labour), I remained reluctant to promote the general use with a labour history that includes a previous rapid birth
of pre-birth treatments. My concern was that women or premature labour, which is to substitute Jiaoxin KID-8
seeking acupuncture had prepared for their birth in many for Sanyinjiao SP-6, to give a reduced number of pre-birth
other ways, for example finding supportive midwives, treatments to the woman, or to omit the use of Sanyinjiao
practising yoga for pregnancy and taking homoeopathic SP-6 from the pre-birth treatment.
medicines, and I was unsure how to accurately measure However, in treating women without a history of a
the effects of pre-birth treatment against these. However, previous rapid or premature labour where Sanyinjiao
after running an acupuncture course for midwives in I997, SP-6 is routinely used, no untoward effects have been
I received feedback suggesting that pre-birth treatment noted. Midwives report that the use of Sanyinjiao SP-6
was more than just a useful support to reassure concerned noticeably helps the cervix soften and dilate prior to labour
women. The midwives suggested it should be offered to all commencing, a desirable outcome and one that is a positive
birthing women, reporting that it consistently increased the indicator for an efficient labour.
chances of women experiencing a natural efficient labour. Midwives also commented that they had observed a trend
They commented that the time women spent in active in women who received pre-birth treatment to either go into
labour was notably shorter than in those that did not receive spontaneous labour around their due dates, or, if an induction
treatment, and felt that the effect of introducing pre-birth was required, to respond well to acupuncture treatment for
acupuncture as part of midwifery care had contributed to induction and progress efficiently to a natural birth.
reduced intervention rates, including medical inductions This confirms my own clinical observation of a noticeable
and caesarean sections. reduction in the number of women seeking induction
treatments since I began offering pre-birth treatments.

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 JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

Point discussion middle ground to the two prevalent approaches found

• Zusanli ST-36, needled perpendicularly 1 to 1.5 cun, in modern western culture: that pregnancy is a medical
Used as a pre-birth point, due to its qi tonifying and blood problem that medicine should control, on the one hand,
nourishing properties. and that pregnancy is something that no healthy woman
• Yanglingquan GB-34, needled with a perpendicular or should let change her daily life, on the other.
slightly oblique posterior insertion 1 to 1.5 cun. Used as a The often-subtle pressure to be a “super pregnant mum”
pre-birth point to help relax and soften the ligaments prior comes from a perception (from the woman herself or from
to labour. those surrounding her), that all any woman really requires for
• Sanyinjiao SP-6, needled with a perpendicular or oblique a “healthy” pregnancy is a few antenatal visits. In contrast,
proximal insertion 1 to 1.5 cun. Used as a pre-birth point to the advice from the Chinese classic Admonitions to Ladies
aid in cervical dilatation. states, “A pregnant woman carries with her the finest piece
• Jiaoxin KID-8, needled perpendicularly 0.5 to 1 cun. Used of jade. She should enjoy all things, look at fine pictures and
as part of a formula for pre-birth together with Zusanli ST-36, be attended by handsome servants”8
Yanglingquan GB-34 and Shenmai BL-62, possibly due to While the advice concerning servants may today be
its ability to regulate the Conception (Ren) and Penetrating somewhat impractical, this passage does convey a great
(Chong) vessels and assist the uterus. respect for pregnancy
• Shenmai BL-62, needled with an oblique inferior insertion
0.3 to 0.5 cun. Used as part of a formula for pre-birth Physical activity
treatment together with Zusanli ST-36, Yanglingquan GB-34 In terms of physical activity, it is important for a woman to
and Jiaoxin KID-8, possibly due to its influences over the find a form of gentle, stamina building exercise that suits
lumbar region and hip. her lifestyle. This should be invigorating but not exhausting.
• Kunlun BL-60, needled perpendicularly 0.5 to 1 cun or Suggestions include walking, swimming, Tai Chi or yoga
directed superiorly to join with Taixi KID-3, 1.5 to 2 cun. classes designed for pregnancy. It is also just as important
Used as a pre-birth point due to its descending action. for women to be able to rest before becoming exhausted. In
• Zhiyin BL-67, needled with a perpendicular or oblique the latter stages of pregnancy it is suggested that a woman
insertion directed proximally 0.1 to 0.2 cun. Used as a pre- creates a “down time” during the day when she can just
birth point for its action in promoting the optimal position rest or have a sleep. Whatever a woman’s experience of
of the baby for birth. labour is going to be, it will not be enhanced by feelings of
As pre-birth treatments offer the advantage of seeing a tiredness and exhaustion.
woman regularly for several weeks prior to labour, points
can be carefully added to the standard treatment to deal Diet
with presenting problems such as pregnancy induced Dietary recommendations include avoiding spicy, pungent
hypertension, insomnia, heartburn or posterior positioned and greasy foods. I often find there is a problem with
babies. Help can also be offered for emotional problems such excessive mucus production in the later stages of pregnancy,
as frustration over a unwanted mother-in-law or friend that as women tend to increase their consumption of damp
wants to be present for the birth, or fear and anxiety that producing foods (for example dairy products, rich meats,
this birth will follow the pattern of a previous birth (or a bananas and concentrated juices, especially orange and
friend’s birth), for example a 36-hour labour ending with tomato) in the belief that these are healthy and that they
an emergency caesarean section. need the extra calcium or iron these foods provide.
Care should be taken, however, not to scatter the woman’s
energy, and thus the number of points used should be kept Emotions
to a minimum. While women may not want to go to the extent of avoiding
This is also an excellent time to advise on the benefits of all of the “seven passions” (which includes avoiding sex until
preventive rest, explaining the traditional Chinese ideas on after the birth), it is useful to ask women to pay attention to
regulating physical activity and trying to maintain emotional activities that upset them, instead of dismissing these feelings
balance to ensure that she enters birth in the best possible as “just hormonal”. It might be helpful to avoid watching
energetic state. disturbing films, reading sad books, or listening to negative
I have also found these pre-birth visits provide an ideal news reports and instead where possible concentrate on
opportunity to discuss the use of acupressure points in more positive events.
labour for pain relief7, and the role Chinese medicine can
play in postnatal recovery. Clinical experience from midwive’s practice

Patient advice One

The traditional Chinese medicine view is that a healthy One aspect of the acupuncture course for midwives that
pregnancy depends on adequate rest, a suitable diet and has been particularly useful in my practice is the use of
emotional well being. This provides a welcome alternative pre-birth treatments. I believe that this has made an impact

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 JOURNAL OF CHINESE MEDICINE • NUMBER 76 • OCTOBER 2004

on the birth experience of the primigravida women who inductions for 2 of them. She was very keen to try pre-birth
have received the treatment. All first-time mothers under acupuncture for this pregnancy, as in her opinion it could
my care, from October 2000 to February 2001, agreed to only help.
have pre-birth acupuncture, once a week for three weeks. At 37 and 38 weeks Zusanli ST-36, Yanglingquan GB-34,
These were their outcomes: Shenmai BL-62 and Jiaoxin KID-8 were used.
Janice: normal birth, five-hour labour. At 39 weeks Sanyinjiao SP-6 was substituted for Jiaoxin
Andrea: normal birth, nine-hour labour. KID-8 and Jianjing GB-21 was added.
Robin: normal birth, six-hour labour. At 40 weeks Jianjing GB-21, Zusanli ST-36, Sanyinjiao SP-6,
Suzette: normal birth, seven-hour labour. Hegu L.I.-4, Taichong LIV-3 and Ciliao BL-32 were used.
Nicky: water birth, seven-hour labour. Beverly went into spontaneous labour 2 days later. I used
Rachael: normal birth, seven-hour labour. Hegu L.I.-4 and Sanyinjiao SP-6 when she arrived in the
Janice went overdue and received two consecutive days delivery suite, as the contractions seemed to have spaced
of acupuncture treatment for induction (Ciliao BL-32, out. Within half an hour they were coming more frequently
Sanyinjiao SP-6 and Hegu L.I.-4). She went into labour and more regularly.
spontaneously on the third day. Ciliao BL-32 was used with She had her quickest ever labour (8 hours and18 minutes)
success for an anterior lip during her labour. (Anterior lip and it was her first-ever drug-free labour.
is when during the later part of the first stage of labour Karen Wakelin – Midwife
the cervix becomes swollen, and is unable to fully dilate
to allow the baby to descend. As the women is in the later Conclusion
stages of labour she will have the urge to push but will be Pre-birth acupuncture offers acupuncturists the opportunity
told by her midwife not to as she is effectively just making to promote a safe and effective treatment to promote
the lip more swollen by forcing the baby’s head onto the natural labour. It is ideally suited for western style private
cervix. This becomes a problem during labour as it is very practice and overcomes the limitations of being on call
uncomfortable for the woman and delays progress). when providing acupuncture for women during labour.
During labour Andrea remained 6cm dilated for three With acupuncturists able to use their training to provide
hours. Ciliao BL-32, Sanyinjiao SP-6 and Hegu L.I.-4 were individualised treatments, they have the possibility of
used, and one hour later she was actively pushing. offering holistic care on top of a set of prescribed treatment
Nicky Costello – Midwife points. I would encourage all acupuncturists interested in
supporting women through the birthing process to promote
Two this treatment, allowing women access to the benefits of
I have been using Zusanli ST-36, Yanglingquan GB-34, acupuncture as part of their preparation for labour.
Sanyinjiao SP-6 and Kunlun BL-60 as pre-birth treatments
at 37, 38 and 39 weeks gestation. Notes and references
I also often include Taichong LIV-3, Yintang (M-HN-3) and 1 Kubista E, Kucera H, Geburtshilfe Perinatol 1974; 178 224-9.
Baihui DU-20 to help relaxation and enhance the woman’s 2 Zhang Ting-Liang. A Handbook of Traditional Chinese Gynaecology,
Blue Poppy Press, 1987, p4.
calmness in this anticipatory time.
3 Maciocia, G., Obstetrics & Gynecology, Churchill Livingstone 1998,
I have found that this is also a great time to chat while pp. 447-449.
waiting for the treatment to be completed. 4 Auteroche, B., Navailh, R., Acupuncture en Gynecologie et Obstetrique,
I have found that the women who have had this preparatory Chapter 11, Maloine 1996.
acupuncture usually come into labour before 42 weeks gestation 5 Beal, M., Journal of Nurse Midwifery, vol 37, no. 4, July/August 1992,
and have an efficient labour. They make good progress and do p263.
6 Alison, J. 1993 in a lecture given to the New Zealand Register of
not usually stop and start. The cervix is usually quite effaced by
Acupuncturists.
the time they reach 3cm dilatation and progress is often swifter 7 Betts, D. Acupressure Analagesia: Providing Pain Relief During
than in those women who have not had any acupuncture. I do Labour, The Journal of Chinese Medicine, issue 59, January 1999,
notice a difference between those who have had the pre-birth pp25-27 and http://home.clear.net.nz/pages/debra_betts
acupuncture in that even if the head is ‘high’ and will not come 8 Gascoigne, S., The Manual of Conventional Medicine for Alternative
down (despite using Jianjing GB-21), or if the position is posterior Practitioners, Jigme Press, 1996, p 371.

(and has not responded to Zhiyin BL-67) so that women end

Debra Betts practises in New Zealand. She is also a tutor at the New
up having a caesarean section, those women who have had Zealand School of Acupuncture in Wellington. Her booklet on using
acupuncture will have a much more favourable cervix than acupressure for pain relief in labour can be downloaded at http://
those who have not. home.clear.net.nz/pages/debra_betts. She may be contacted at debra.
Liz Brunton - Midwife [email protected]

Three
Beverly had a history of long labour, going 2 weeks overdue
with all her previous 3 children and requiring medical