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Hi Kristen,
I often don’t know the status of the cervix for pre-birth treatments. Cervical checks by OOH midwives and at my local hospital are generally not done unless the patient requests it or if a provider feels it will provide helpful information AND the patient consents to it. However, where I practice, often by the time someone is facing a medical induction, especially if it is induction dt postdates pregnancy, a provider has done an internal exam to check the baby and the cervix and I have this information. If I’m doing a pre-induction treatment and don’t have information about the cervix I tend to err on the side of cervical readiness more than making contractions.
For pre-birth treatments (35-36 weeks onward) I believe that Debra’s textbook has a chapter and is a great resource.
I use very thin needles that are inserted only a few mm and not stimulated.
I also make a point to ask about baby position on recent ultrasounds or to feel baby myself (this is a great skill to have if you can find a midwife to teach you over time). We can do so much to get baby into a good position in this last month.
I tend to do:
a) a simple root treatment (I’m a Japanese-style acupuncturist), this is 1-2 points.
b) add a few points to help with labor preparation such as sp6, li4, ub60, lr3, st36, ub32, etc. I might choose 1 or 2 of these depending on what is most needed. 40 or 41 wk treatments tend to be stronger than 36wk treatments in terms of the number of points I choose. I always use Sp6 every treatment with primips as often the more cervical preparation that can happen before labor the better for this group. If baby is spending any amount of time posterior I always use Sp6/Ub60.
c) if I feel there is an issue that I haven’t been able to address with my root/pre-birth points I might add one or two more points to address that. This often ends up being a branch treatment with a point or two for insomnia, anxiety, back pain, malposition or other issues that are happening.
d) while needles are in I’ll do bodywork or moxa. Often I’ll work the htjj and inner shu line right down the length of the spine on both sides, or do liver gummies.
e) press tacks on 2-3 points to wear home.
f) I give everyone Debra’s handout on pre-birth acupressure at home
Labor “induction” style treatments are quite different from this in my clinic. This is generally only started within 48-72 hours with a person who is absolutely headed for a medical induction. I tend to be in communication with the primary care provider to make sure I clearly understand any risk factors and understand why the person is being induced. Sometimes the birthing person might have alot of emotions around induction and this can muddy their picture of why the induction is actually happening. If there is a medical reason and if we know why we can help them to understand.
I will see someone in my office every 24 hours until labor begins or they are admitted. I will sometimes go into the hospital to treat alongside the medical induction. I find the best times for this are in the evening before bed after Cervadil (prostaglandin) has been inserted and then first thing in the morning when pitocin (synthetic oxytocin) is started. If the person is on a monitor it can really help guide treatment because you can clearly see what is happening with contractions. If the person is in a last effort to have a homebirth and is doing castor oil or other home methods you can go in and treat along side that, but make sure you absolutely trust the midwife and have seen the records to ensure that there are no risks that have been overlooked. In my earlier days (long before there was MAMPS and before I did my midwifery mentorship) I got into some weird situations with a few OOH midwives who asked me to help start labor in their clients and now I really do my homework beforehand to make sure I’m comfortable.
My induction treatments tend to look like this:
a) Assessing WHY labor might not be starting from an EAM perspective is important. Claudia’s book is the best resource in the whole wide world on labor and EAM diagnosis and can really help guide treatment. Having a good grasp of that material can give you way more confidence in providing this type of treatment safely. So always make a differential diagnosis to base your treatment from.
b) I’ll determine the best position for the treatment. If someone is exhausted I have them side-lying. If someone’s energy seems reasonably good I’ll treat them sitting up in a chair and forward leaning on a stack of pillows on my treatment table. If someone is SUPER damp I might even have them moving (standing, squatting, walking) etc for some of the treatment.
c) I tend to use some combination of Sp6, Li4, Ub32, St36, Ub33, Lr3, Ub60, Du20, Ub67. I DON’T use all of these points at once. I generally choose 3-4 points depending on what is needed. It is helpful to know if baby is engaged and what the cervical situation is as this can help you decide if you need to focus on the cervix (more Sp6, Lr3, Gb34, Ub32 or Du20) or on contractions (more Ub32, Ub33, Li4, Sp6 or Ub67). I will insert needles about 1/2 cun where possible and stimulate them gently throughout the treatment. Often people will feel contractions consistently with a particular point and thats often a cue to spend more time with that particular point.
d) Assessing the emotions and mental state is also super important for these treatments. There is often alot of fear, grief, anxiety, etc. I use Lu7 and pressure to Kd1 if there is fear happening. Lr3/liver gummies if the person is anxious and tight. Pc6 and gentle pressure along the sternum in the intercostal spaces if there is alot of sadness and grief.
e) again more body work, either the htjj/inner shu line moving down the spine, liver gummies, sometimes I’ll do some gentle hip rocking during treatment if the person is lying down or standing. If there are weak ctx happening or if you’re treating alongside pitocin Claudia’s “contraction wrangling” using kd3 and ub67 is incredibly effective in getting ctx ramped up and coordinated.
f) tack the 2-4 most important points. I almost always tack Sp6 and Ub32.
g) provide Debra’s hand out for acupressure prior to a medical induction. I’ll sometimes have a partner do the acupressure at home while the birthing person is getting nipple stimulation either from a shower or pumping – this seems to be incredibly helpful.
I hope that is a helpful start and I’m sure I left some things out. There is alot to say on this subject, but we can be incredibly helpful.
Sarah