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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

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QiQi

 Women Giving Birth 9/10 Women Giving Birth 9/10thth CC

““In my household all women and girls are taughtIn my household all women and girls are taughtpersonally how to doctor themselves. Then inpersonally how to doctor themselves. Then inchildbirth they all know how to save thechildbirth they all know how to save the

situation. It is proper for families to instructsituation. It is proper for families to instructorally so the households know thisorally so the households know this””

Prescriptions from the birth treasury (ChanPrescriptions from the birth treasury (Chan baobao zhufang zhufang  ) anonymous author ) anonymous author1167 CE1167 CE

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ResearchResearch

ResearchResearch

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

Important to promote discussion about theImportant to promote discussion about the

effectiveness and safety of acupressure witheffectiveness and safety of acupressure with

Health professionalsHealth professionals

Pregnant womenPregnant women

Support peopleSupport people

 Acupressure Induction Acupressure Induction

 Acupressure Acupressure taughttaught toto 6666 women women atat 4040 weeks weeks

ControlControl groupgroup 7676 women women

 Taught Taught by by midwifemidwife (15(15 minuteminute session)session)

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

 Women Women encouragedencouraged toto useuse pointspoints asas oftenoften asas ititfeltfelt comfortablecomfortable

IngramJ IngramJ .. The The effects effects of of shiatsu shiatsu on on  post  post - - term term  pregnancy  pregnancy 

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 There were no statistically significant differences There were no statistically significant differences

between the groups for:between the groups for:

Parity Parity 

Maternal ageMaternal age

Gestation at delivery Gestation at delivery 

 Type of delivery  Type of delivery 

Number of Caesarean deliveriesNumber of Caesarean deliveries

Length of labourLength of labour

Birth weightBirth weight

 Audit questionnaire Audit questionnaire

30 women (from the 66) completed follow up30 women (from the 66) completed follow up

questionnairequestionnaire

87 % used the acupressure87 % used the acupressure

80 % found points helpful80 % found points helpful

63 % used all 3 points and all these women went63 % used all 3 points and all these women went

into spontaneous labourinto spontaneous labour

ConclusionConclusion

Post term women who used acupressure werePost term women who used acupressure were

significantly (17 % p=0.038) more likely tosignificantly (17 % p=0.038) more likely to

labour spontaneously than those who did not.labour spontaneously than those who did not.

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Effects of Acupressure on LabourEffects of Acupressure on Labour

 Time Time

7575 women women were were randomly randomly assignedassigned toto receivedreceived

eithereither acupressureacupressure oror touchtouch (control)(control) toto SpSp 66during during labourlabour forfor 3030 minutesminutes

 Acupressure Acupressure usedused forfor 3030 minutesminutes timetime periodperiodduring during eacheach contractioncontraction

ForFor touchtouch groupgroup thumbsthumbs placedplaced overover pointpoint

Lee Lee  MK. MK. Effects  Effects of of SP SP 6 6 acupressure acupressure on on labour labour  pain  pain and and length length of of delivery delivery time time in in women women during during labour.labour.

NoNo significantsignificant differencedifference betweenbetween thethe twotwo groupsgroupsforfor thethe variables variables of of 

Parity Parity 

MaternalMaternal ageage

GestationGestation ageage

ChildbirthChildbirth preparationpreparation

HusbandsHusbands attendanceattendance

NoNo oxytocinoxytocin augmentationaugmentation oror administrationadministration of of 

analgesicsanalgesics during during thethe study study periodperiod

OnOn admissionadmission toto thethe LabourLabour ward ward women women were were

toldtold thatthat eithereither treatmenttreatment couldcould alleviatealleviate theirtheir

painpain

 Acupressure Acupressure appliedapplied bilaterally bilaterally  with with midwivesmidwives

thumbsthumbs onon SPSP 66  –  – pressurepressure gravity gravity  was was

calculatedcalculated by by aa medicalmedical engineerengineer toto bebe 21502150 mmmm

Hg Hg forfor rightright thumbthumb andand 19111911 mmmm Hg Hg forfor leftleft

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Labour Time in MinutesLabour 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

ConclusionConclusion

SPSP 66 acupressureacupressure was was effectiveeffective forfor decreasing decreasing 

labourlabour painpain andand shortening shortening thethe lengthlength of of delivery delivery 

timetime

SpSp 66 acupressureacupressure cancan bebe anan effectiveeffective nursing nursing 

managementmanagement forfor women women inin labourlabour

Effects of Acupressure on 1Effects of Acupressure on 1stst Stage ofStage of

LabourLabour

127127 women women randomly randomly assignedassigned

 Acupressure Acupressure toto LILI 44 andand BLBL 6767

LightLight touchtouch

NoNo interventionintervention

 Time Time of of interventionintervention 2020 minutesminutes (five(five minutesminutes

eacheach acupressureacupressure point)point)

Chung Chung UL.UL. Effects  Effects of of LI LI 4and 4and BL BL 67 67  Acupressure  Acupressure on on Labour Labour Pain Pain 

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 Acupressure Acupressure

 Thumb Thumb pressurepressure toto LILI 44

PressurePressure fromfrom thethe erasereraser endend of of pencilpencil forfor BLBL 6767

 Touch Touch

EffleurageEffleurage (preformed(preformed toto leftleft andand rightright upperupperouterouter armsarms forfor totaltotal of of 2020 minutes)minutes)

ControlControl

MidwifeMidwife stayedstayed inin roomroom conversing conversing 

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 ofIntolerable pain brought on by stimulation of

this pointthis point

 There There was was nono significantsignificant differencedifference inin

demographicdemographic andand obstetricobstetric datadata betweenbetween thethe

groupsgroups of of  women women forfor

Parity Parity 

PrenatalPrenatal training training 

GestationGestation

HusbandHusband presentpresent

 Weight Weight of of newbornnewborn

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Mean Pain Relief Score VAS ActiveMean Pain Relief Score VAS Active

Stage of LabourStage 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 ofMean Time in Hours First Stage of

LabourLabour

6.33

7.13

8.45

01

2

3

4

5

6

7

8

9

 Acupressure

Effleurage

Control

P=0.19

 There There was was nono significantsignificant differencedifference amongstamongst thethe

threethree groupsgroups inin termsterms of of 

PainPain relief relief inin secondsecond oror thirdthird stagestage of of  labourlabour

UterineUterine contractionscontractions (as(as measuredmeasured by by externalexternal

foetalfoetal monitoring)monitoring)

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ConclusionConclusion

Confirm the effect of LI 4 and BL 67 inConfirm the effect of LI 4 and BL 67 in

lessening labour pain during the active phase oflessening labour pain during the active phase ofthe first stage of labourthe 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 MassageIce Massage

Ice used on LI 4 to reduce labour pain duringIce used on LI 4 to reduce labour pain during

contractionscontractions

Ice massage carried out for 20 minutes or fourIce massage carried out for 20 minutes or four

contractions whichever occurred firstcontractions whichever occurred first

Based on a study that showed ice massage toBased on a study that showed ice massage to

LI 4 resulted in a 50% reduction in acute dentalLI 4 resulted in a 50% reduction in acute dental

painpain

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

One third a cup of ice was crushed and placed inOne third a cup of ice was crushed and placed inthe corner of a washcloththe corner of a washcloth-- the 4 corners werethe 4 corners werelifted to the centre and twisted to make a smalllifted to the centre and twisted to make a smallice bag ice 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 andended when the contraction endedended when the contraction ended

Pressure comparable to light scratching Pressure comparable to light scratching 

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Mean Pain Response VASMean 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

ConclusionConclusion

 The The authorsauthors concludedconcluded thatthat iceice massagemassage toto LILI 44

isis aa safe,safe, nonnon--invasive,invasive, nonnon pharmacologicalpharmacological

methodmethod of of reducing reducing labourlabour painpain

 Acupressure Acupressure --Practical use in LabourPractical use in Labour

Partner/support person begins use early inPartner/support person begins use early in

labourlabour

Guided by womanGuided by woman’’s feedback as to points feedback as to point

selectionselection

Pressure not massagePressure not massage

Pressure to woman's comfort levelPressure to woman's comfort level

Move on to different points if acupressure noMove on to different points if acupressure no

longer appears effectivelonger appears effective

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 Women Women who who hadhad supportsupport during during labourlabour (advice,(advice,

assistance,assistance, emotionalemotional support)support) were were moremore likely likely toto havehave aa spontaneousspontaneous vaginal vaginal birthbirth

 Associated Associated with with greatergreater benefitsbenefits when when providerprovider

 was was notnot aa membermember of of staff staff andand when when itit beganbegan

early early inin labourlabour (12,000(12,000 women) women)

Hodnett Hodnett  ED. ED. (2003)(2003) Continuous Continuous support support  for  for women women in in labour labour  Cochrane Cochrane 

review review 

GB 21GB 21

Illustration from The Seirin Pictorial Atlas of Acupuncture

GB 21GB 21 Most tender pointMost tender point

along pathwayalong pathwaybetween T1 and tip ofbetween T1 and tip ofshoulder jointshoulder joint

Strong pressureStrong pressure –  – notnotmassagemassage

Knuckles/elbowsKnuckles/elbows

 with body weight with body weight

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How to Locate GBHow to Locate GB--2121

Clinical ApplicationsClinical Applications

Pain relief Pain relief 

 Aid the baby to descend into pelvis Aid the baby to descend into pelvis

Promote efficient pushingPromote efficient pushing

Promote efficient delivery of the placentaPromote efficient delivery of the placenta

Breast feedingBreast feeding –  – let down reflexlet down reflex

BL 32BL 32

Illustration from The Seirin Pictorial Atlas of Acupuncture

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BL 32BL 32

LocationLocation –  – 22ndnd sacralsacral

foramenforamen

Use of lower sacralUse of lower sacralforamen as labourforamen as labourprogressesprogresses

Dull/achy sensationDull/achy sensation –  – if sharp sensationif sharp sensationbonebone

How to Locate BlHow to Locate Bl--3232

Clinical ApplicationsClinical Applications

PromotePromote anan efficientefficient labourlabour

 Aid Aid inin cervicalcervical dilationdilation

RelieveRelieve aa cervicalcervical liplip

ProvideProvide painpain relief relief inin labourlabour ( ( especially especially early early labour)labour)

PrePre labourlabour preparationpreparation with with massagemassage fromfrom 3737 weeks weeks

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CombsCombs

How to use CombHow to use Comb

Combs IICombs II

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KID 1KID 1

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate KidHow to locate Kid--11

Clinical ApplicationsClinical Applications

Fear/panicFear/panic issuesissues

SeaSea sicknesssickness bandsbands

during during labourlabour

ForFor useuse during during transitiontransition

InductionInduction

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BL 60BL 60

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate BlHow to locate Bl--6060

BL 60BL 60

Used by holdingUsed by holding

ankle and applyingankle and applying

firm pressure withfirm pressure with

thumbsthumbs

Often used as womenOften used as women

approachingapproaching

transitiontransition

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BL 60 Clinical ApplicationsBL 60 Clinical Applications

 To To provideprovide painpain relief relief inin labourlabour asas women women

approachapproach transitiontransition  With With SPSP 66 toto repositionreposition aa baby baby inin aa posteriorposterior

positionposition

PromotePromote efficientefficient labourlabour

 To To promotepromote thethe efficientefficient delivery delivery of of thethe

placentaplacenta

SP 6SP 6

Illustration from The Seirin Pictorial Atlas of Acupuncture

How to locate SpHow to locate Sp--66

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SP 6SP 6

Four of the womanFour of the woman’’ss

finger widths abovefinger widths above

tip medialtip medial malleousmalleous

Sensation sharp,Sensation sharp,

pressing on bonepressing on bone

Infrequently usedInfrequently used

pain reliefpain 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 labourEncourage efficient labour

 After pains post delivery After pains post delivery

PC 6PC 6

Illustration from The Seirin Pictorial Atlas of Acupuncture

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How to locate PcHow to locate Pc--66

PC 6PC 6

Pressure or seaPressure or sea

sickness bandssickness bands

Nausea/anxietyNausea/anxiety

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SummarySummary

Pain reliefPain relief –  – all pointsall points

 Will depend on the individual woman and her Will depend on the individual woman and herpreferencepreference

Essential to try out differing points and listen toEssential to try out differing points and listen to

the womanthe woman’’s feedbacks feedback

Specific Actions during LabourSpecific Actions during Labour

 To enhance contractions LI 4 To enhance contractions LI 4

 To dilate cervix To dilate cervix SP 6SP 6

For cervical lipFor cervical lip BL 32 and SP 6BL 32 and SP 6

 To aid descent into pelvis To aid descent into pelvis GB 21 and BL 60GB 21 and BL 60

For posterior positionFor posterior position SP 6 and BL 60 / BL 67SP 6 and BL 60 / BL 67

 To help deal with fear To help deal with fear KID 1KID 1

For nauseaFor nausea PC 6PC 6

For efficient delivery placentaFor efficient delivery placenta

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

Pro D SeminarsPro D Seminars

 This course was a Pro This course was a Pro--D SeminarD Seminarproduction.production.

For more information on this or otherFor more information on this or other

ProPro--D Seminar courses, please visitD Seminar courses, please visit

 www.prodseminars.com www.prodseminars.com

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LabourLabour