acupressure handout1
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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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