Pregnancy & Obstetrics

Pregnancy & Obstetrics

mom11The concept of healthy pregnancy management consists of the management of pregnancy based on a monthly program which may include a protocol for diagnosis, nutritional evaluation and supplementation including herbal medicine and acupuncture treatment.

Conditions such as nausea and vomiting, fatigue, depression, back ache, fluid retention and other presenting symptoms are monitored. The Traditional Chinese Medicine approach to pregnancy treatment is to manage at an early stage conditions such as fluid retention, carpal tunnel syndrome, gestational diabetes and preeclampsia, conditions that are most commonly western medically related to auto immune activity.

Acupuncture is increasingly being adapted and applied alongside western medicine and has seen increased promotion in the medical community by organizations such as the British Medical Acupuncture Society. Subsequently, there is increasing research-based evidence to support the use of acupuncture in obstetrics and gynaecology.

Leading up to the due date of pregnancy acupuncture may be used to facilitate the movement of the foetus into an optimal position for the impending labour.

The turning of breech babies using moxibustion from week 33 onwards is a natural method that may assist in cephalic version.

Moxibustion involves burning a fragrant herb in the form of a moxa stick over one acupuncture point on the feet to relax the muscles in the uterus allowing the baby to turn.

This consists of any position where the foetus is not sitting with the head positioned downwards towards the hips (cephalic).

Breech Presentation

 

frankFrank

  • Bottom down legs extended and up near the headline
  • Most common type of breech
  • Most Favourable outcome in vaginal delivery

 

 

completeComplete

  • Babies hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.

 

 

 

FootlingFootling

  • One or both feet down in the hips
  • Bottom sits higher than the hips
  • Least common type of breach

Transverse Presentation

 

transverse

  • Baby lies sideways
  • If not turned will need a Cesarean Section

 

Shoulder Presentation

 

shoulder

  • Can be arm or shoulder at hips
  • If not turned will need Cesarean Section

Reasons For Malpositions

 

AFTER THIRTY (30) WEEKS

  • Baby is under of over weight
  • Previous C-Section
  • Oligohydramnios (Inadequate volume of amniotic fluid) or Polyhydramnios (too much amniotic fluid)
  • Bicornuate (heart shaped uterus, with a deep indentation at the top) or separate uterus with hard septum
  • Mother has a thyroid dysfunction
  • Mother is stressed
  • Having twins
  • Unknown

 

WHY MIGHT IT NOT TURN

  • Weak condition of the baby
  • Short umbilical cord
  • Footling breech with both legs
  • Frank breech with both legs extended
  • Baby is uncomfortable with its head down

 

WHY DOES IT MATTER

  • Potential difficultly during birth
  • Prolapsed umbilical cord (In a prolapse, the umbilical cord drops through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby’s body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births)
  • Fewer breech presentations at term = Fewer Caesarean Sections at term = Fewer Complications or mother and foetus at delivery = Fewer complications for mother in next pregnancy.

 

CONTRAINDICATIONS FOR TURNING

  • Multiple pregnancy
  • Previous Caesarean Section (within two (2) years)
  • High Blood Pressure / Pre-Eclampsia
  • Placenta Previa
  • History of ante-partum haemorrhage
  • History of premature labour (this pregnancy)
  • Known abnormality of the uterus or pelvis
  • Oligohydramnios
  • Known hydrocephalic foetus

 

IDEAL CANDIDATE FOR TURNING

  • 30 – 36 weeks and having your first baby
  • 30 – 40 weeks for subsequent baby (If had via a vaginal birth)
  • No Bleeding during pregnancy, especially the last months of pregnancy
  • No previous Caesarean section
  • Considered a “low risk” pregnancy
  • No Placenta Previa

 

Treatment Options

Acupuncture and Moxibustion have traditionally been used to successfully turn breech babies with the use of Bl 67 (Zhi yin) in combination with other acupuncture points.

Acupuncture and moxibustion may be effective in helping a women to progress to go to an efficient labour as it may assist in turning the foetus from a posterior position to an anterior one.

momThese treatments are designed to help the foetus descend and engage, ripen the cervix and soften the muscles of the pelvic floor through points that soften the tendons and ligaments surrounding the uterus and cervix.

At this stage acupuncture may facilitate the body’s natural readiness for labour and allow the foetus to engage fully on the cervix, thereby allowing a smooth transition into labour through the body’s natural production of oxytocin. Induction of labour specifically is not required at this point.

Treatment regimes for pre-birth preparation have been found to be more successful when commenced in week 36 of pregnancy and a minimum of 4 acupuncture treatments administered, according to a case control study published in the Journal of Gynecologic and Obstetric Investigation (1998). The study further found women treated with acupuncture in the 4 weeks prior to their due date had a more rapid maturation of the cervix, requiring less oxytocin augmentation during labour, and the duration of Labor was significantly shortened.

Through the treatment process questions are asked to ascertain the degree to which the cervix would be favourable to induction. If known, the Bishop score is used to help determine which patients are most likely to achieve a successful induction.

Once it has been determined that a patient is ready for induction, the acupuncturist utilises points designed to help the foetus descend, ripen the cervix and additionally stimulate the production of oxytocin within the body. At this stage treatment may also include the use of an electro-stimulation machine that emits short pulses into specific points.

In the 3rd trimester, six weeks of pre-birth treatment and cervical ripening may follow on as part of a healthy pregnancy program and this includes specific protocols and assessment in preparation for a normal incident-free birth. The final part of the program is the application of acupuncture for induction, either as a follow-up to the healthy pregnancy program or as a one-off treatment for induction post-40 weeks of gestation.

Pre-birth acupuncture management and treatment is undertaken in preparation for healthy labor and child birth. This program begins at six weeks prior to due date and continues up to due date.

A sequence of weekly treatment is undertaken, which also includes re-assessment of their general health and a fresh diagnosis each week.

baby1From Six Weeks Prior to Due Date weekly treatments are recommended.During this time an obstetrician or midwife will establish foetal position and whether anterior or posterior presentation including malposition.

Information on the bishops score will be gathered and a calculating sheet will be given to the client so that their obstetrician or midwife can keep the acupuncturist informed on the progress,which is then reassessed regularly.

The acupuncture treatments during this time includes:

  • Treatment of position
  • Management of general anxiety
  • Soften the muscles of the pelvic floor
  • Assisting the foetus to descend and engage
  • Ripening the cervix
  • On the due date the patients and their partners are given information on the location of specific points and stimulation techniques for acupressure if required. Other techniques to assist in labour preparation are included in a patient handout.

    The protocol for induction in most cases includes at least three (3) acupuncture treatments. Treatment if possible is normally undertaken over a 3-7 day period. The impact of acupuncture on induction is gradually built up with the intention of the final treatment being the major inductive application. The treatment of any anxiety and tension is also important in preparation for labour induction.

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