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Part 1 Debra Betts

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Acupressure:
Promoting Pain Relief and Partner Involvement
Betts 2008

Acupressure

Non evasive technique Accessible, effective safe birthing tool Support people -providing general pain relief through woman's feedback Midwives use for treating specific conditions pre, during and post labour

Acupressure

Application of pressure to acupuncture points Acupuncture points situated on meridians containing qi that flow through the body

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Qi Women Giving Birth 9/10th C “In my household all women and girls are taught personally how to doctor themselves. It is proper for families to instruct orally so the households know this” this” Prescriptions from the birth treasury (Chan bao zhufang) zhufang) anonymous author 1167 CE 3 . Then in childbirth they all know how to save the situation.

IngramJ.term pregnancy 4 . LI 4 and SP 6 Women encouraged to use points as often as it felt comfortable IngramJ. The effects of shiatsu on postpost.Research Research Since 2003 research published in nursing journals Important to promote discussion about the effectiveness and safety of acupressure with Health professionals Pregnant women Support people Acupressure Induction Acupressure taught to 66 women at 40 weeks Control group 76 women Taught by midwife (15 minute session) Points used GB 21.

038) more likely to labour spontaneously than those who did not.There were no statistically significant differences between the groups for: Parity Maternal age Gestation at delivery Type of delivery Number of Caesarean deliveries Length of labour Birth weight Audit questionnaire 30 women (from the 66) completed follow up questionnaire 87 % used the acupressure 80 % found points helpful 63 % used all 3 points and all these women went into spontaneous labour Conclusion Post term women who used acupressure were significantly (17 % p=0. 5 .

Effects of Acupressure on Labour Time 75 women were randomly assigned to received either acupressure or touch (control) to Sp 6 during labour for 30 minutes Acupressure used for 30 minutes time period during each contraction For touch group thumbs placed over point Lee MK. No significant difference between the two groups for the variables of Parity Maternal age Gestation age Childbirth preparation Husbands attendance No oxytocin augmentation or administration of analgesics during the study period On admission to the Labour ward women were told that either treatment could alleviate their pain Acupressure applied bilaterally with midwives thumbs on SP 6 – pressure gravity was calculated by a medical engineer to be 2150 mm Hg for right thumb and 1911 mm Hg for left 6 . Effects of SP 6 acupressure on labour pain and length of delivery time in women during labour.

3 6.3 7 8.3 Labour pain measured using a subjective labour pain scale (visual analogue scale) Measured before intervention Immediately after intervention (p=0.8 6.9 Acupressure Touch P=0.021) 60 minutes after intervention (p=0.7 7.6 5.012) 30 minutes after intervention (p=0.4 Acupressure Touch Pre Post 30 Mins 60 Mins 7 .Percentage Anxiety Pre and Post Intervention 7 6 5 4 3 2 1 0 Pre Post 4.012) Analgesic effects lasted 60 minutes Labour Pain Scores 10 9 8 7 6 5 4 3 2 1 0 8.5 4.9 7.03 6.5 4.

006 Conclusion SP 6 acupressure was effective for decreasing labour pain and shortening the length of delivery time Sp 6 acupressure can be an effective nursing management for women in labour Effects of Acupressure on 1st Stage of Labour 127 women randomly assigned Acupressure to LI 4 and BL 67 Light touch No intervention Time of intervention 20 minutes (five minutes each acupressure point) Chung UL. Effects of LI 4and BL 67 Acupressure on Labour Pain 8 .Labour Time in Minutes 250 200 150 100 50 0 3-10 cm 10 cm delivery 3 cm delivery 30 45 146 108 191 138 Acupressure Control P=0.

Acupressure Thumb pressure to LI 4 Pressure from the eraser end of pencil for BL 67 Touch Effleurage (preformed to left and right upper outer arms for total of 20 minutes) Control Midwife stayed in room conversing Originally intended to include SP 6 but… but….. Withdrawn after pilot test due to high rejection rates by women Intolerable pain brought on by stimulation of this point There was no significant difference in demographic and obstetric data between the groups of women for Parity Prenatal training Gestation Husband present Weight of newborn 9 .

17 0.9 0.33 Acupressure Effleurage Control P=0.41 0.13 8.5 0.3 0.2 0.66 Acupressure Effleurage Control P=0.81 Mean Time in Hours First Stage of Labour 9 8 7 6 5 4 3 2 1 0 6.1 0 0.6 0.45 There was no significant difference amongst the three groups in terms of Pain relief in second or third stage of labour Uterine contractions (as measured by external foetal monitoring) 10 .8 0.4 0.19 7.Mean Pain Relief Score VAS Active Stage of Labour 0.7 0.

One third a cup of ice was crushed and placed in the corner of a washclothwashcloth.Conclusion Confirm the effect of LI 4 and BL 67 in lessening labour pain during the active phase of the first stage of labour There were no verified effects on uterine contractions (external foetal monitoring) Ice Massage Ice used on LI 4 to reduce labour pain during contractions Ice massage carried out for 20 minutes or four contractions whichever occurred first Based on a study that showed ice massage to LI 4 resulted in a 50% reduction in acute dental pain Waters B.the 4 corners were lifted to the centre and twisted to make a small ice bag Ice bag placed on their palm side of hand The massage started with the contraction and ended when the contraction ended Pressure comparable to light scratching 11 . 2003 Ice massage for reduction of labour pain.

Mean Pain Response VAS 70 60 50 40 30 20 10 0 49. nonnon-invasive.5 Conclusion The authors concluded that ice massage to LI 4 is a safe.6 33. non pharmacological method of reducing labour pain Acupressure -Practical use in Labour Partner/support person begins use early in labour Guided by woman’ woman’s feedback as to point selection Pressure not massage Pressure to woman's comfort level Move on to different points if acupressure no longer appears effective 12 .3 Pre Test Ice Right Hand Ice Left Hand 61.

assistance.000 women) Hodnett ED. Women who had support during labour (advice. (2003) Continuous support for women in labour Cochrane review GB 21 Illustration from The Seirin Pictorial Atlas of Acupuncture GB 21 Most tender point along pathway between T1 and tip of shoulder joint Strong pressure – not massage Knuckles/elbows with body weight 13 . emotional support) were more likely to have a spontaneous vaginal birth Associated with greater benefits when provider was not a member of staff and when it began early in labour (12.

How to Locate GB-21 Clinical Applications Pain relief Aid the baby to descend into pelvis Promote efficient pushing Promote efficient delivery of the placenta Breast feeding – let down reflex BL 32 Illustration from The Seirin Pictorial Atlas of Acupuncture 14 .

BL 32 Location – 2nd sacral foramen Use of lower sacral foramen as labour progresses Dull/achy sensation – if sharp sensation bone How to Locate Bl-32 Clinical Applications Promote an efficient labour Aid in cervical dilation Relieve a cervical lip Provide pain relief in labour ( especially early labour) Pre labour preparation with massage from 37 weeks 15 .

Combs How to use Comb Combs II 16 .

KID 1 Illustration from The Seirin Pictorial Atlas of Acupuncture How to locate Kid-1 Clinical Applications Fear/panic issues Sea sickness bands during labour For use during transition Induction 17 .

LI 4 Illustration from The Seirin Pictorial Atlas of Acupuncture How to locate Li-4 LI 4 Clinical Applications To enhance the efficiency of contractions Provide pain relief Aid women through transition For use during second stage to encourage effective pushing Promote delivery of the placenta and reduce blood loss in the third stage 18 .

BL 60 Illustration from The Seirin Pictorial Atlas of Acupuncture How to locate Bl-60 BL 60 Used by holding ankle and applying firm pressure with thumbs Often used as women approaching transition 19 .

BL 60 Clinical Applications To provide pain relief in labour as women approach transition With SP 6 to reposition a baby in a posterior position Promote efficient labour To promote the efficient delivery of the placenta SP 6 Illustration from The Seirin Pictorial Atlas of Acupuncture How to locate Sp-6 20 .

SP 6 Four of the woman’ woman’s finger widths above tip medial malleous Sensation sharp. pressing on bone Infrequently used pain relief Clinical Applications Irregular contractions with LI 4 Clinically used to aid cervical dilation Encourage efficient labour After pains post delivery PC 6 Illustration from The Seirin Pictorial Atlas of Acupuncture 21 .

How to locate Pc-6 PC 6 Pressure or sea sickness bands Nausea/anxiety 22 .

prodseminars. For more information on this or other ProPro-D Seminar courses. BL 60.Summary Pain relief – all points Will depend on the individual woman and her preference Essential to try out differing points and listen to the woman’ woman’s feedback Specific Actions during Labour To enhance contractions LI 4 To dilate cervix SP 6 For cervical lip BL 32 and SP 6 To aid descent into pelvis GB 21 and BL 60 For posterior position SP 6 and BL 60 / BL 67 To help deal with fear KID 1 For nausea PC 6 For efficient delivery placenta GB 21. LI 4 Pro D Seminars This course was a ProPro-D Seminar production.com 23 . please visit www.

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