TCM Obstetrical

assessment and
treatment for labour
preparation

By: Dr. Emilie Salomons

Dr. TCM, FABORM, Doula
Obstetrical History
 Fu Qing Zhu Nu Ke
 Huo Tuo (140–208AD) was called by General Li,
whose wife had given birth to a still born baby. On
reading her pulses he declared a 2nd dead fetus
was still inside and ordered acupuncture and a
herbal infusion. This treatment successfully delivered
the twin.
 Sun Si Miao ( 581– 618 AD) was following the funeral
procession of a women who had died in labour. He
observed bright red blood. “ Come on! Move the lid
off. Why are you so sure of her death?” He promptly
administered acupuncture with a special twisting
method. Very soon the baby was born and the
women brought to life.
Current Obstetrical Oriental
Medicine research trailblazers
 Debra Betts : OB nurse, Acupuncturist, PhD
 Zita West : Midwife and acupuncturist
 Sarah Budd : Midwife and Acupuncturist
 Claudia Citzkovits : Researcher/Hospital
internships
 Sharon Weizenbaum : Chinese herbs in
pregnancy- Shan han lun
 Sabine Wilms : Translator (classical TCM)
 Genevieve Le Goff : Acupuncturist/academic in
classical Chinese theory (han dynasty and prior)
Challenges in Obstetrical
medicine
 Litigious
field – lawsuits can lead to
increased insurance costs, or worse, loss
of scope
Why you need to know more than just
TCM when treating pregnancy
 We are legally not allowed to be the primary
care giver/birth attendant without further
training and certification
 Whether you connect with the birth
attendant or not, it is important to understand
terminology
 Our role: Improve fetal health,
the birth outcome, as well as
the maternal and infant health
in postpartum.
So why do Acupuncture for
pregnancy and childbirth?
 Impact pregnancy. Relieve discomfort, aid
sleep, improve wellbeing and experience of
pregnancy
 Decrease chance of complications in
pregnancy and childbirth (reduce c-sections
and other medical interventions)
 Improve the health of the baby, both pre-
heaven and lasting well into childhood and
adulthood
 Improve the health of the mother during
pregnancy and postpartum
Common uses for Acupuncture
(and herbs) in pregnancy
 1st trimester: NVP, RPL, spotting/bleeding, threatened
miscarriage, fatigue, anxiety, and inevitable miscarriage
 2nd trimester: Headaches, pain, carpal tunnel, leg
cramps, gestational diabetes, emotional disorders, PIH,
placenta previa, IUGR
 3rd trimester: Edema, sciatic/low back pain,
midback/compensatory pain, breech presentation,
UTI*, vaginal candidiasis, low amniotic fluid, preterm
labour, false labour, birth preparation
 Labour: Prodromal labour, malposition, pain, fatigue,
failure to progress, precipitous labour, retained placenta
etc..
 4th trimester: mother roasting, lactation support,
postpartum depression, anxiety, pain etc…
Obstetrical information
needed for your clinical notes
 Name
 Age
 Gestational age and EDD
 Weight, height
 Gestational history (GTPAL)
 Current pregnancy and health history
 Primary care provider (OB, GP, MW)
 Birth location
 Position of baby
 Cervical status
 Membrane status
 TCM diagnosis (including, tongue and pulse)
Commonly accepted medical
reasons for an induction include:
 Postterm pregnancy, i.e. if the pregnancy has
gone past the 42 week.
 Intrauterine growth restriction (IUGR).
 There are health risks to the woman in continuing
the pregnancy (e.g. she has pre-eclampsia).
 Premature rupture of the membranes (PROM); this
is when the membranes have ruptured, but labour
does not start within a specific amount of time.
 Fetal death in utero.
 Twin pregnancy continuing beyond 38 weeks.
What DOES NOT require an
induction:
 Feeling‘ready for baby’
 General impatience of the doctor,
mother or anyone else
 Vacations, family visiting etc…
What is Acupuncture
induction?
 Theartificial stimulation of contractions
with the use of acupuncture needling,
with the intention of commencing labour
When is an Acupuncture
Induction appropriate?
 <3 days prior to a medical induction

 If earlier than 3 days, there is NO NEED

 If a medical induction is not
warranted, neither is an
acupuncture induction
 TCM- we don’t force nature,
we support it, not following
this rule is low level TCM.
Complications associated with
unwarranted acupuncture inductions
Inductions performed too early, ie. >3days
prior to a medical induction
 Exhausting the patient prematurely
 Causing disharmony between the yin and
yang transition occurring at the
commencement of the birth
 Leading to a cascade of intervention
including: oxytocin, epidural, foreseps, c-
section
Cervical ripening: AKA Birth
preparation
 What needs to happen?
Cervical ripening: AKA Birth
preparation
 More than cervical status
 Address the whole body, mind and spirit
 Look at diet, lifestyle
 Qi and blood levels
 Fetal position
 Predominant TCM patterns that could effect
labour
 Emotional state
 Personal issues and situations that could
impact the birth
Treatment strategies, patterns
and principles
 Be a high level doctor, always diagnose
your patient!
 Pregnancy and Childbirth are NOT
pathologies, they are natural normal
physiological functions
 Ask yourself, what is the root cause? Why
isn’t this pregnancy or birth progressing as
it should?
Common TCM patterns
associated with complications in
childbirth
 ‘Cervical ripening’, ‘induction’, ‘being
due’ are not TCM diagnoses.
 Many other patterns exist- these are just
examples
 Liver Qi stagnation
 Scattered qi (due to fear and anxiety)
 Qi and blood deficiency (w/ or w/o Jing
deficiency)
 Qi and blood disharmony/stagnation
Common points and (branch)
functions
 LI 4
 SP 6
 BL 32
 BL60
 BL 67
 LV 3
 GB 34
 Lu7/GB41
 8 Extraordinary
vessels
WHY DO ACUPUNCTURE for
Pregnancy and Birth?
 Pregnancy is a pivot
Resources and links
 Canadian Association of Oriental Obstetrical Meidcine
CAOOM.org
 Sarah Budd: Briefing paper
 Debra Betts research links
 Claudia Citkovitz research links

 Acupuncture Before Birth: To Induce or Not to Induce, That

is the Question by Debra Betts, Sarah Budd, Claudia
Citkovitz and Lorne Brown –

 Acupuncture Journal Club: Effects of Acupuncture during

Labor and Delivery - Citkovitz et al, 2009 by Debra Betts and
Claudia Citkovitz

 Acupuncture Journal Club: Acupuncture and Oxytocin --

Labor and Delivery Studies from Iran - Claudia Citkovitz,
Debra Betts and Sarah Budd