The word acupuncture is made up of the Latin word acus, meaning needle, and the word punctura, meaning to puncture. Acupuncture developed as a result of the fact that thousands of years ago the Chinese were forbidden to perform surgical procedures on the body (Yelland, 1996).
In acupuncture, health is defined by a person’s ability to maintain a balanced and harmonious internal environment. Illness occurs when the internal environment is disrupted and the normal processes that enable balance can no longer perform their function (Mills, 1997). It appears that acupuncture affects sensory and emotional components (Pajnar, 2004).
Meridians are virtual channels that connect an internal organ and its associated tissue into a whole of points, and these points are linked to the function of a specific internal organ (Altherrin et al., 2010). There are twelve main meridians that run down the body in pairs, six on the left and six on the right side of the body (Woodham and Peters, 1997). Qi flows through the meridians and reaches all organs and tissues (Jänicke and Grünwald, 2009).
Qi is the body’s invisible energy, or life force. When qi moves smoothly through the channels, the body is balanced and healthy; when it does not, illness or pain occurs (Yelland, 1996).
An acupuncture point is defined in Chinese medicine as a place on the surface of the body where qi and blood meet (Monod-Cassidy, 2002).
Among the most common acupuncture techniques is needle insertion. Acupuncture points can also be stimulated with moxibustion, electrostimulation, and laser stimulation (Jänicke and Grünwald, 2009).
ACUPUNCTURE IN FEMALE REPRODUCTIVE HEALTH
Acupuncture, which has been used in Chinese medicine for millennia, is also used in obstetrics (Pajntar, 2004). Some acupuncture points have the ability to maintain reproductive health and treat reproductive disorders (Monod Cassidy, 2002).
Acupuncturists can treat women even before conception to prepare the body for pregnancy (Yelland, 1996). Research also points to the beneficial effects of acupuncture treatment for dysmenorrhea, infertility, and premenstrual syndrome (Monod Cassidy, 2002). A more recent study from this year also describes the impact of acupuncture on insulin sensitivity in women with polycystic ovary syndrome. Hyperinsulinemia and insulin resistance are key features of polycystic ovary syndrome. The effect of a five-week course of acupuncture was examined. Electrostimulation in rats with insulin resistance showed improved insulin sensitivity (Zhung et al., 2015).
Acupuncture in the prenatal period
Maintaining an appropriate balance between qi and blood is key to a healthy pregnancy and normal fetal development. Pregnancy progresses normally when the pregnant woman’s qi and blood are in balance with the fetus’s qi and blood, and when qi circulates properly—especially in the kidneys, liver, and spleen, as these organs are considered very important in female reproductive health in traditional Chinese medicine. At the beginning of pregnancy, when the body has not yet fully adapted to the new state, the way qi circulates changes, which can cause nausea and vomiting. Likewise, altered qi flow, or qi deficiency, can cause vaginal bleeding, transverse fetal position, lower back pain, and other pregnancy discomforts (Monod Cassidy, 2002).
Acupuncture successfully treats many prenatal discomforts, such as nausea, varicose veins, hemorrhoids, constipation, vena cava syndrome, edema, and lower back pain.
Treating nausea with acupuncture
Traditional Chinese medicine finds that nausea in pregnancy can occur for various reasons. One of the most common is the cessation of menstruation during pregnancy. In this case, blood flow is obstructed and qi becomes too strong. The result is an accumulation of this qi and the qi produced by the fetus. Symptoms usually include nausea and vomiting, a feeling of weakness, reduced appetite, fatigue, and belching after eating. After making a diagnosis, the acupuncturist inserts a needle into an acupuncture point on the wrist called Neiguan (Figure 5) and leaves it there for about 20 minutes. The Zhongwan point is also often used (Acufinder.com, 2006). Some pregnant women feel improvement after two or three treatments, while others need more (Yelland, 1996).
Acupuncture treatment for pain in the lower spine
Lower back pain is one of the most common discomforts in pregnancy and is more frequent in the last months of pregnancy (Acufinder.com, 2006). Traditional Chinese medicine finds that the kidneys are key to reproduction, as they are believed to store the original source of qi. Pregnancy, combined with the energy of the growing fetus, causes excess heat, resulting in pain. In early pregnancy, during therapy the pregnant woman lies in a tilted position; later, due to the growth of the fetus and uterus, therapy is performed lying on the side with a pillow placed between the knees. Needles are inserted locally around the painful area. The therapy is performed to strengthen kidney qi with warmth and thereby reinforce the lower back (Yelland, 1996).
Although research shows an impact on quality of life in pregnant women with pain in the lower lumbar spine, pregnant women mostly have to manage this on their own. Despite research and recommendations, the use of acupuncture to relieve lumbar back pain during pregnancy remains relatively low (Waterfield et al., 2015).
Turning a breech baby with moxibustion
One of the more interesting ways to use acupuncture point stimulation is turning the baby with moxibustion. The optimal time for successful use of this technique is between the 32nd and 34th week of pregnancy (Acufinder.com, 2006). The technique involves warming the Zhiyin point for 15 minutes twice a day for ten consecutive days. Zhiyin is located on the outer side of the little toe. Stimulating this point with moxa increases the flow of qi through the urinary channel all the way to the uterus, resulting in increased fetal activity and relaxation of the uterine muscle layer (Yelland, 1996). If the baby successfully turns into the correct position, the therapy should be stopped. The Zhiyin point must not be stimulated in pregnant women with high blood pressure, infections, elevated body temperature, or multiple pregnancy (Akufinder.com, 2006).
In the Department of Gynecology and Obstetrics in Geneva, a randomized controlled study was conducted to assess possible negative effects on the well-being of the mother and fetus. Pregnant women between the 34th and 36th week of pregnancy were included. In the first twelve participants, the fetus was additionally observed with electronic monitoring. A cardiotocogram was performed 10 minutes before each moxibustion session, 20 minutes during it, and 10 minutes after it. The effect of moxibustion on the fetus was assessed with the cardiotocogram, and the effect on the pregnant woman by checking blood pressure, checking for any onset of contractions, the pregnant woman’s report of how she felt, and her recording of fetal movements. The researchers did not observe any negative effects on the well-being of the mother and fetus, and based on the collected data they conclude that moxibustion is safe for both the fetus and the pregnant woman (Guitter et al., 2008).
Despite numerous studies on turning a baby with moxibustion, Lee, Kang, and Ernst (2010) found that the quality of the studies was poor, so it is difficult to draw conclusions about the effectiveness or ineffectiveness of moxibustion.
source:Spinning babies
Acupuncture during labor
Acupuncture is often used to induce labor, stimulate contractions, and relieve labor pain. There are eight specific channels that are used during labor. They are divided into the ren and chong channels (Thomas, 2001).
Inducing labor with acupuncture
A pregnancy that lasts more than 40 weeks of gestation can pose a higher risk for the baby and the mother. Due to insufficient placental function, intrauterine growth restriction, meconium aspiration, and intrauterine infection can occur. Labor induction also carries certain risks and complications, such as operative delivery. Therefore, alternative methods of inducing labor are being explored that would pose a lower risk of complications while also being more cost-effective (Asher, 2009).
In China, acupuncture has been used for labor induction for centuries, but it is increasingly being replaced by newer methods of inducing labor, such as oxytocin. Experience shows that successful labor induction requires at least three to five sessions lasting half an hour. The greatest success is seen in women who have given birth before (Yelland, 1996). Figure 8 shows the points used for labor induction.
Acupuncture for labor induction is mostly used after the 40th week of pregnancy.
Dr. Caroline A. Smith and her colleagues in Australia conducted a study and described it in Obstetrics & Ginecology. For the purposes of the study, 364 pregnant women were divided into two groups. One group received real acupuncture treatments, while the other group received sham treatment. Each pregnant woman had two treatments two days before the planned induction of labor. Dr. Smith’s team found that standard methods of labor induction had to be used to initiate labor in pregnant women who received real acupuncture, just as in the sham acupuncture group. Nevertheless, the researchers found that the result does not prove that acupuncture has no effect on labor induction. Further research with more repetitions and a larger number of pregnant women would be needed (Smith et al., 2008).
In a 2015 study, Dr. Amir and colleagues showed that using acupuncture in combination with conventional methods of labor induction significantly shortened labor duration. The study included eighty pregnant women who needed labor induction. Fifty had labor induced using acupuncture and shiatsu, and thirty with conventional methods. The study shows that using a traditional Chinese method of labor induction, with or without conventional methods, reduces the number of interventions during labor and also reduces the number of complications in completing the birth (Amir et al., 2015).
Stimulation of contractions
Acupuncture is often used to stimulate uterine contractions and speed up labor (Tureanu, Tureanu, 2002). The same points are used to stimulate contractions as for labor induction (Hegu, Sanjian, Tsusanli). It should be emphasized that these points are contraindicated before 37 weeks of gestational age, as they can cause preterm labor. In combination with syntocinon, excessively strong contractions or uterine rupture are possible, so extra caution is required here. Apart from that, acupuncture has rare side effects when used to stimulate contractions. Some researchers say it is difficult to monitor and control changes in the frequency and intensity of contractions caused by acupuncture. Stimulation of contractions can last up to seven hours, which is often unacceptable for women in labor (Yelland, 1996).
Relieving labor pain
Even a brief review of online literature shows that women in labor fear labor pain and want to plan a pain-free birth (Lopuh, 2007). On average, 50% to 70% of women experience pain during labor that they describe as severe and unbearable. Intense labor pain can result in a prolonged active phase of labor, a low APGAR score, and a higher likelihood of operative delivery (Allameh et al., 2015).
Acupuncture for relieving labor pain and pain in general is a popular topic of research and studies due to the desire to understand the physiology of acupuncture’s effect on pain (Tureanu, Tureanu, 2002). It is suitable for women in labor who want to avoid invasive pain relief methods (Carr and Lythage, 2014). The point used to relieve labor pain is BL-32. More recent research suggests that needle insertion acts as a stressor on cells, causing them to produce adenosine. Adenosine binds to the pain nerve receptor, reducing its excitability (Palmgren, 2011).
Due to conflicting results in research on pain relief with acupuncture, Allameh and his colleagues from Isfahan University of Medical Sciences decided to conduct their own study. They compared the effects of acupuncture and pethidine on labor pain. Women in labor were divided into three groups: control, pethidine, and acupuncture. A visual analogue scale (VAS) was used to assess pain. The results showed a significant reduction in pain 30 minutes after acupuncture; however, at full cervical dilation, acupuncture had no effect on labor pain. The active phase of labor was shortened in the group that received pethidine as well as in the group that received acupuncture therapy compared to the control group (Allameh et al., 2015).
Acupuncture in the postpartum period
In this sensitive period, acupuncture can be very helpful in restoring balance in the body and overcoming postpartum discomforts (Yellnd, 1996).
Lactation disorders
It is known that acupuncture has a major impact on hormone levels in the body, and its success in addressing lactation problems is a result of increased levels of oxytocin and prolactin. Traditional Chinese medicine says that lactation disorders arise due to qi deficiency and anemia, as well as stagnation of liver qi. Liver qi becomes stagnant due to fatigue and anxiety, which affects milk production. Treatment focuses on promoting the renewed flow of qi in the liver, which stimulates lactation (Yelland, 1996).
In a 2012 study, Yu and Zhou divided 107 women in labor into two groups. The observed group received needling at an ear point (Figure 11) three times a day for five consecutive days, starting as early as one hour after birth. The control group did not receive acupuncture therapy. Yu and Zhou recorded the onset of lactation, lactation volume, and prolactin. Lactation volume in the control group was significantly lower (27.3%) than in the group that received acupuncture therapy (51.9%). Lactation began later in the control group, and prolactin levels were also lower in the control group (Yu and Zhou, 2012).
Constipation
Constipation is a common discomfort affecting women after childbirth. It occurs due to hormonal changes after birth, altered abdominal muscle tone, and fear of pain during bowel movements (Yelland, 1996). It presents as a feeling of a full bowel, abdominal pain, and nausea (Ivanuša and Železnik, 2000).
Wu and colleagues conducted a study comparing deep and shallow needling with an acupuncture needle, and also comparing the effects of acupuncture and lactulose on constipation. A total of 475 patients participated. Deep acupuncture therapy was received by 237 study participants, shallow by 119, and the control group (119 participants) received the laxative lactulose. Patients in the acupuncture groups were needled at the Tianshu point five times a week for four weeks. Patients in the control group received lactulose for sixteen weeks. The researchers did not observe differences in the effectiveness of either acupuncture approach and lactulose. Participants in all three groups had bowel movements, but this occurred faster in the lactulose group than in the acupuncture groups. The therapeutic effects of both acupuncture approaches are equal to the effects of lactulose, but after therapy ends they last longer than the effects of lactulose. Deep and shallow needling at the Tianshu point have the same effect. The researchers concluded that acupuncture quickly and safely stimulates intestinal function (Wu et al., 2014).
Hemorrhoids
Hemorrhoids are an unpleasant and common discomfort during pregnancy and in the postpartum period. Because discomfort and pain interfere with proper sitting, the back muscles are additionally strained, and bowel movements are also more difficult, which can lead to further issues such as constipation and fear of bowel movements. The point used to treat hemorrhoids is called Chengsan and is found on the midline of the calf.
This point reduces edema and pain within twenty minutes. For more severe pain and swelling, the acupuncturist uses a point at the top of the head called Baihui. This point helps draw the body’s yang up to the head, which reduces swelling around the anus (Yelland, 1996).
CONTRAINDICATIONS
Acupuncture is not performed if the patient does not want this type of treatment. It is also not performed in patients with unexplained medical conditions or who do not have an established accurate diagnosis, in patients with heart valve disease, and in patients with sepsis or severe inflammation. Electroacupuncture must not be performed in patients with a pacemaker. Special caution is needed in patients with blood clotting disorders and in patients receiving anticoagulants, as well as in patients who have an weakened immune system. Local contraindications for acupuncture are infections and skin injuries and skin lesions (White et al., 2008). Acupuncture is also not performed on the site of a wound, on varicose veins, or in the case of a bone fracture (Thomas, 2001).
Some acupuncture points should be avoided during pregnancy, as they have a strong effect on the uterus. Most importantly, all points that cause a sudden downward movement of qi should be avoided, as this causes expulsion of uterine contents (Yelland, 1996). Certain points are not used because of their location, as an acupuncture needle could injure the enlarged uterus or one of the vital organs (Monod Cassidy, 2002).
When performing acupuncture, pain at needle insertion, infection, pneumothorax, and worsening of symptoms can occur (Cooper et al., 2009).
Watch the acupressure video too:
Thank you to Doris Matjašič, author of the thesis “Acupuncture in Midwifery (2016)” under the mentorship of Senior Lecturer Teja Škodič Zakšek, BSc Radiology Eng., BSc Midwifery, MSc (UK).
