WHAT DO OUR PATIENTS THINK?

“Ben is a wonderful practitioner. I used his acupuncture services as a source of well-being throughout my pregnancy with my son – it really helped, particularly during early months battling crippling nausea. When it came to the birth, when my labour stalled for 12 hours, one brief session with Ben helped kick start the process – active labour recommenced within an hour and my son was born within another three. Best non-invasive induction ever! Highly recommend if you’re overdue and don’t want to go the medically induced route.”

Georgina, St Albans

“Well looks like it worked a treat!! Labour started at 3pm on Monday afternoon and she was with us at 8:30am On Tuesday!! Thank you!!”

Jodie, London

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Acupuncture for Induction of Labour: A Natural Approach

Acupuncture is increasingly being explored and utilised as a natural alternative for inducing labour. For pregnant women approaching or past their due date, acupuncture offers a gentle and non-invasive alternative to Western medical induction methods, one that is becoming increasingly popular with midwives, fertility clinics and other health practitioners for this reason and due to its effectiveness in practice.

Labour within Western Medicine:

What is a Western Medical Induction of Labour?

Medical induction of labour refers to the process of artificially stimulating the uterus to start labour. Within the Western medicine paradigm, this is generally recommended when there’s a medical reason to expedite delivery; for example, post-term pregnancy, maternal health concerns such as high blood pressure or gestational diabetes, or foetal health issues. The methods used in Western medicine for induction vary, depending on how ready the cervix and uterus are for labour. 

A First Port Of Call: The Membrane Sweep:

A membrane sweep, also known as a cervical sweep or stretch and sweep, is a method used to help stimulate labour naturally before resorting to medical induction. It is often offered to women who are past their due date or nearing full term to encourage the onset of labour without the need for medications.

What Happens During a Membrane Sweep?

A membrane sweep is performed during a vaginal exam by a healthcare provider, such as a midwife or doctor. During the procedure, the provider inserts a finger through the cervix. They then gently sweep around the inside of the cervix to separate the amniotic sac (the membranes surrounding the baby) from the cervix and the lower part of the uterus.

This sweeping motion helps release prostaglandins, natural hormones that soften and prepare the cervix for labour. In addition, the physical stimulation can also help encourage uterine contractions, potentially triggering the start of labour within a day or two.

When Is a Sweep Done?

A sweep is typically offered in the following instances:

• At c. 40 weeks of pregnancy (for women at or beyond their due date).
• From 38 weeks for women who are considered high-risk or have specific medical reasons (e.g., gestational diabetes, high blood pressure).

It is often performed when the cervix has already started to soften and dilate, as it is more likely to be effective when the body is naturally preparing for labour.

Benefits of a Membrane Sweep:

• Non-invasive: A sweep is a simple, low-risk procedure that does not require medication or medical equipment.
• Can reduce the need for medical induction: It may help avoid the need for medical interventions like oxytocin or prostaglandins, making it a gentler way to encourage labour.
• Helps prepare the cervix: Even if labour doesn’t start immediately, the sweep can help the cervix become more favourable for labour when it does begin.

Discomfort and Side Effects:

• Discomfort or pain: Many women report cramping, discomfort, or pain during and after the procedure, similar to menstrual cramps. The intensity varies based on the readiness of the cervix and the individual’s pain threshold.
• Spotting or bleeding: Light spotting or bleeding is common after a sweep, as the cervix is very sensitive and can be irritated during the procedure.
• Contractions: The sweep may cause mild, irregular contractions, known as Braxton Hicks contractions, which may or may not lead to labour.

Effectiveness:

Membrane sweeps are generally considered a less invasive option to help bring on labour naturally, but their effectiveness varies as follows:

• Studies suggest that a membrane sweep can increase the likelihood of going into labour within 48 hours, but it is not guaranteed to work.
• It is usually more effective when the cervix has already started to soften, dilate, and efface (thin out).
• Some women may need multiple sweeps, spaced a few days apart, to achieve labour.

Risks:

• Infection: Although rare, there is a small risk of infection since the procedure involves physical manipulation near the cervix.
• Premature rupture of membranes: In rare cases, the sweep could cause the water to break prematurely.

When Is A Membrane Sweep Not Recommended?

A membrane sweep may not be suitable for women in the following instances:

• Unfavourable cervix: If the cervix is not dilated or effaced, the procedure may be difficult or ineffective.
• Placenta previa: A condition where the placenta is covering the cervix, making a sweep unsafe.
• Infections: Active genital infections would contraindicate performing a sweep to avoid spreading infection.

A medical induction will generally be considered the next option if a membrane sweep is unsuccessful. Standard approaches, along with their associated side effects and risks, are as follows:

Methods of Medical Induction:

1. Prostaglandins:
   • What they are: Medications (usually inserted vaginally) that help soften and ripen the cervix, preparing it forlabour.
   • How they work: Prostaglandins mimic natural hormones produced at the end of pregnancy to help the cervix dilate.
   • Side effects: They may cause cramping, nausea, vomiting, diarrhoea, or fever.
   • Risks: In some cases, prostaglandins can lead to uterine hyperstimulation, in which case contractions may become too frequent or intense. In turn, this can be stressful for the baby and increase the risk of complications such as reduced oxygen supply.
2. Oxytocin (Pitocin):
   • What it is: Pitocin is a synthetic version of the hormone oxytocin, which the body produces naturally to stimulate contractions.
   • How it works: Administered through an IV, pitocin causes the uterus to contract, initiating or strengthening labour.
   • Side effects: Pitocin can cause contractions to be more intense and frequent than natural labour, leading to discomfort or pain. It can also lead to lowered blood pressure, nausea, vomiting, and headaches.
   • Risks: The primary risk is uterine hyperstimulation, where contractions become too intense or too close together. This can lead to reduced blood flow to the placenta, causing fetal distress. In rare cases, it may also cause uterine rupture, particularly if the mother has had a prior caesarean section. Additionally, it may increase the likelihood of needing further interventions like epidurals or cesarean deliveries.
3. Amniotomy (Breaking the Water):
   • What it is: Amniotomy is a procedure in which the amniotic sac is ruptured manually using a small instrument to release the fluid, often used when labour has already started but needs expediting.
   • How it works: Amniotomy can help the baby’s head put pressure on the cervix, stimulating more intense contractions.
   • Side effects: Once the water is broken, contractions usually intensify, and labour may become more painful, resulting in a greater need for pain relief medications.
   • Risks: If labour does not start within a few hours, there’s a risk of infection, as the protective amniotic sac is no longer in place. Additionally, if the baby is not well-positioned, an amniotomy can increase the risk of complications like cord prolapse (when the umbilical cord slips into the birth canal ahead of the baby, compressing it and cutting off oxygen).
4. Mechanical Cervical Dilators:
   • What they are: Devices such as Foley catheters are inserted into the cervix to mechanically dilate it by applying pressure.
   • How they work: The pressure from the balloon on the cervix stimulates the release of prostaglandins, helping it to dilate.
   • Side effects: Women may experience discomfort, cramping, or bleeding with mechanical dilators.
   • Risks: Any mechanical intervention carries a risk of infection. In rare cases, the procedure may cause significant discomfort or injury to the cervix.
5. A Membrane Sweep: Also known as a cervical sweep or stretch and sweep, a membrane sweep is a method used to help stimulate labour naturally before resorting to medical induction. It is often offered to women who are past their due date or nearing full term to encourage the onset of labour without the need for medications.

Risks and Side Effects of Medical Induction:

1. Increased Pain: Induced labour often leads to more intense, frequent, and painful contractions than natural labour. This is especially the case with oxytocin (Pitocin), which can result in an expedited and more painful progression of labour. Many women induced in this way may require additional pain relief measures, such as epidurals.
2. Longer Labour: If the cervix isn’t fully ripe or dilated for labour, the induction process can take a long time, sometimes lasting more than 24 hours. This prolonged labour can be exhausting and increase the likelihood of needing interventions, such as epidurals or caesarean sections.
3. Increased Likelihood of Other Interventions: Medical induction often sets off a cascade of interventions. For example, stronger contractions from oxytocin may lead to the need for an epidural for pain relief, which in turn may slow labour down, requiring higher doses of oxytocin or even a caesarean section. When compared to spontaneous labours, data shows that induced labours result in a higher rate of caesarean interventions.
4. Foetal Distress: Uterine hyperstimulation is a significant concern with medical induction, particularly when oxytocin or prostaglandins are utilised. Contractions that are too strong or too frequent can reduce the oxygen supply to the baby, leading to fetal distress. This often requires close monitoring of the baby’s heart rate and may result in emergency interventions if the baby shows signs of distress.
5. Increased Risk of Infection: With methods such as amniotomy, there is a risk of infection for both mother and baby if labour does not progress after the water is broken. The longer the membranes are ruptured, the higher the risk ofinfection.
6. Postpartum Haemorrhage: Induction, especially with oxytocin, can increase the risk of postpartum haemorrhage (excessive bleeding after birth). This happens because overstimulating the uterus can make it less likely to contract effectively after delivery, leading to more bleeding.
7. Uterine Rupture: Though rare, uterine rupture is a serious risk, especially in women who have had a prior caesarean section or uterine surgery. Strong contractions from oxytocin can put excessive pressure on a scarred uterus, causing it to tear.

When Medical Induction is Necessary:

Despite the risks and side effects, medical induction is often necessary and can be lifesaving for both mother and baby. Common reasons for induction include:

• Post-term pregnancy: (more than 41-42 weeks), where risks to the baby, such as stillbirth, statistically increase.
• Maternal health issues: for example, preeclampsia or gestational diabetes.
• Foetal health concerns: for example, growth restriction or abnormal heart rate patterns.
• Premature rupture of membranes without the onset of labour increases the risk of infection.

Conclusion:

Medical induction is often planned based on external factors such as age, health conditions, or statistical risks rather than the body’s natural readiness. It uses medications or mechanical interventions to bring about labour, regardless of whether the baby or the body is fully ready. While necessary in some cases, it doesn’t take into account the individual timing of each pregnancy and can sometimes lead to more intense or challenging labour experiences.

While medical labour induction can be highly effective and necessary in some instances, it is not without risks. Induction often leads to more intense contractions, more significant pain, and a higher likelihood of needing additional interventions such as caesarean sections. Additionally, the risks of uterine hyperstimulation, foetal distress, and postpartum complications make it essential for induction to be carefully monitored by healthcare professionals. Understanding these risks helps expectant mothers make informed decisions about their labour and delivery options, balancing the need for medical intervention with its potential side effects.

How Acupuncture May Help:

From a Chinese medical perspective, labour is a natural process that requires a smooth and balanced flow of qi and blood, particularly in the lower abdomen and reproductive organs. If energy becomes blocked or stagnant, labour may not progress. By stimulating specific acupuncture points throughout the body, acupuncture aims to balance the flow of energy, or qi, promoting both physical and emotional well-being. Within the context of labour induction, acupuncture targets specific points believed to influence the reproductive system and is said to help prepare the body in the following ways:

• by stimulating uterine contractions,
• by encouraging cervical dilation, and
• by promoting relaxation and reducing anxiety.

As acupuncture, like any medicine, is about dosage, it may take several sessions to see results. However, many women report feeling more relaxed and ready for labour after treatment.

Research and Evidence:

Although acupuncture as a treatment modality is over two thousand years old, it doesn’t easily fit within the current Western research model, and acupuncture research is critically underfunded as a whole. With this in mind, scientific studies into its effectiveness for labour induction are still evolving. Some studies suggest that acupuncture can reduce theneed for medical interventions, while others are inconclusive. However, anecdotal evidence and small trials show promising results in encouraging the body’s natural readiness for labour.

Recommended by Midwives and Fertility Clinics:

While acupuncture is still being researched for its role in inducing labour, it’s telling that many midwives, fertility clinics, GPs and other health professionals frequently recommend it as an alternative to medical induction. Their first-hand experiences with patients often show encouraging results, which is why they continue to advocate for it despite the limited large-scale clinical evidence currently available.

Midwives, fertility specialists, GPs and other health professionals who work closely with expectant mothers have seen the calming effects acupuncture can have, along with its potential to promote cervical ripening and stimulate contractions naturally. This real-world evidence, observed in practice, provides growing confidence in acupuncture’s ability to support the body’s readiness for labour. It also reflects a broader trend in healthcare, where holistic and non-invasive methods are increasingly being considered alongside conventional treatments. Even though scientific research within a Western medicine context still has a way to go, these endorsements from experienced professionals add significant weight to acupuncture’s credibility as a complementary approach to labour induction.

Benefits:

• Non-invasive: Acupuncture is a gentle and non-invasive method that doesn’t involve drugs or aggressive and uncomfortable procedures.
• Fewer Side Effects: Compared to medical induction, the risks of adverse effects are minimal.
• Holistic Approach: It supports both the physical and emotional aspects of labour, helping to reduce anxiety.

Considerations:

While acupuncture is considered safe when administered by a professional, it’s important to consult your healthcare provider, especially before inducing labour. Working with a certified acupuncturist experienced in pregnancy care is crucial to ensure safety.

For mothers seeking a natural method to encourage labour, acupuncture could be a valuable option. It helps the body prepare for birth in a calm, supportive environment—allowing for a more peaceful start to labour.

The Research:

Several studies have explored the potential benefits of acupuncture in labour induction, though the findings remain mixed. Some research highlights positive outcomes, suggesting acupuncture could be helpful in this area:

1. Zamora-Brito et al. (2024): A systematic review and meta-analysis by Zamora-Brito et al. reviewed seventeen studies, including 3262 women, and cited a statistically significant increase in the spontaneous onset of labour rate favouring acupuncture versus no acupuncture (relative risk, 1.12; 95% confidence interval, 1.03−1.23; I2, 25%). This study suggests that acupuncture may be beneficial in reducing the rate of induction of labour but acknowledges that further well-designed randomised controlled trials are necessary.
2. Smith et al. (2017): A systematic review included 22 trials, reporting on 3456 women, showed that acupuncture may increase cervical ripening and reduce the need for formal labour induction. In the study, women who received acupuncture were less likely to require medical interventions for labour induction. However, more well‐designed trials are needed to explore the results further.
3. Siregar et al. (2020): A systematic review entitled “The Effect of Acupressure and Acupuncture as Natural Induction Methods for Spontaneous Labour: A Systematic Review” reviewed 1.365 articles including 1,656 women. Overall, studies demonstrated the positive effect of acupressure and acupuncture on cervical maturation and increasing the frequency of initiations of spontaneous labour. In addition, it may reduce the need for medical induction and its associated risks and side effects.

While more large-scale, high-quality trials are needed to establish acupuncture’s effectiveness, this growing body of research, combined with clinical observations, shows acupuncture as a promising alternative for labour induction.

What Acupuncture Points?

In Traditional Chinese Medicine (TCM), an acupuncturist will generally select acupuncture points for treatment based on an individual’s presenting complaints and other constitutional factors. However, several points are often chosen based on their ability to influence the uterus, cervix, and overall energy flow, helping prepare the body for labour. The goal of treatment is to balance the body’s internal environment to encourage labour in a gentle and non-invasive manner. Some of the most commonly used acupuncture points for inducing labour are as follows:

Bladder 67 (BL67) – Zhiyin is considered one of the primary acupuncture points for labour induction in TCM. It is explicitly known for its powerful influence on turning a breech baby and stimulating labour.

Location: BL67 is located on the outer corner of the little toe, at the junction where the skin meets the nail. It is easy to access but can be very sensitive, as it sits at the end of the Bladder meridian, which runs from the head down the entire length of the body.

Function in TCM: BL67 is associated with the movement and regulation of qi and blood along the Bladder meridian—closely linked to the reproductive organs. It is said to encourage the downward flow of energy and is an essential point for the following:

• Turning a breech baby: One of BL67’s unique applications is helping to turn a baby in a breech position. Stimulating this point from weeks 34 to 36 encourages the baby to rotate into the proper head-down position. Within this context, moxibustion (the burning of mugwort near the point) is often used in practice to enhance this effect.
• Stimulating labour contractions: BL67 is believed to have a strong influence on initiating and regulating uterine contractions. It stimulates the qi in the uterus, encouraging labour to begin.

Why BL67 Is Used for Labour Induction:

BL67 is particularly powerful for labour induction because it sits at the very end of the Bladder meridian, acting as a terminal point to stimulate the entire energy pathway before joining the Kidney meridian at KI1. During labour, the body’s qi needs to flow freely and downward. Any obstruction or stagnation in the Bladder meridian can delay labour or cause irregular contractions. BL67 may help in the following ways:

• Move stagnant energy: If labour is delayed or the body isn’t progressing naturally, BL67 helps shift any blocked qithat could prevent the uterus from contracting effectively.
• Enhance uterine contractions: This point is used when labour needs a gentle push to get started or to regulate the contractions if they are irregular or weak. It encourages the smooth flow of energy necessary for steady labour progression.
• Balance yin and yang: As a terminal point on the Bladder meridian, BL67 is said to balance yin and yang in the body, which is essential during labour. The balance of these energies ensures that the body is in harmony, aiding the natural process of childbirth.

Other Acupuncture Points:

Spleen 6 (SP6) – Sanyinjiao (Three Leg Yin):

• Location: On the inner side of the lower leg, about three thumbs’ breadth above the ankle.
• Function in TCM: SP6 is a key point in gynaecological and obstetric treatment. It harmonises the Spleen, Liver, and Kidney meridians, which are critical for reproductive health. In labour induction, it’s used to encourage uterine contractions, aid cervical ripening, and promote a smooth flow of qi and blood to the reproductive organs.
• Why it’s used: SP6 is an important point for drawing qi and blood downwards and managing conditions related to the reproductive system, making it a primary point for initiating labour.

Large Intestine 4 (LI4) – Hegu (Joining Valley):

• Location: On the hand, in the webbing between the thumb and index finger.
• Function in TCM: LI4 is a powerful point for moving qi and blood throughout the body. It is known to relieve pain and stimulate the body’s energy flow. When used for labour induction, it helps increase contractions and manage pain during labour.
• Why it’s used: This point is believed to promote the downward movement of energy, helping to trigger uterine contractions and facilitate the birth process. LI4 is also effective in reducing labour pain.

Bladder 32 (BL32) – Ciliao (Second Crevice):

• Location: On the lower back, in the sacral area near the dimples of the buttocks.
• Function in TCM: BL32 is closely associated with the uterus and reproductive organs. It helps regulate the qi and blood flow in the lower abdomen, stimulating uterine contractions and aiding in the dilation of the cervix and loosening of the hips and sacrum.
• Why it’s used: This point directly influences the uterus and cervix, helping initiate contractions and supporting the body’s readiness for labour.

Gallbladder 21 (GB21) – Jianjing (Shoulder Well):

• Location: On the top of the shoulder, midway between the neck and the outer shoulder.
• Function in TCM: GB21 is said to move stagnant qi and is particularly effective for descending energy, which is important during labour. It also helps relieve tension and stress, which can block the natural progression of labour and effectively reduce labour pain.
• Why it’s used: By encouraging the downward flow of energy, GB21 helps initiate labour by promoting the body’s natural expulsion of the fetus. It also releases shoulder and neck tension, which can help alleviate stress during labour.

Bladder 60 (BL60) – Kunlun (Kunlun Mountains):

• Location: On the outer ankle, in the depression between the tip of the lateral malleolus and the Achilles tendon.
• Function in TCM: BL60 is said to promote labour by stimulating the flow of qi in the Bladder meridian, which runs through the back and connects to the reproductive organs. It also helps ease labour pain and is used to address delayed labour.
• Why it’s used: This point stimulates uterine contractions and supports the baby’s descent. BL60’s strong influence on the body’s energy flow makes it an effective point for assisting in labour induction.

Kidney 3 (KD3) – Taixi (Supreme Stream):

• Location: On the inside of the ankle, between the medial malleolus and the Achilles tendon.
• Function in TCM: KD3 is the source point of the Kidney meridian and helps strengthen the body’s vital energy (jing), which plays a crucial role in reproductive health. It also nourishes the blood and balances the body’s energy during labour.
• Why it’s used: KD3 helps to fortify the body’s overall energy and is used to ensure the mother’s strength and vitality during labour. It is beneficial in cases where labour is slow to start or the mother feels weak.

Why These Points Are Used for Labour Induction?

The selected acupuncture points help to do the following:

• Move stagnant energy: Points like LI4 and GB21 help move qi and promote the downward movement of energy needed for the onset of labour.
• Support uterine contractions: Points like SP6 and BL32 are directly associated with the uterus and are used to encourage contractions and assist with cervical ripening.
• Alleviate pain and tension: LI4 and GB21 are also commonly used to reduce pain, which can block the natural flow of labour and make the process more difficult.

By targeting these specific acupuncture points, TCM aims to restore balance and activate the body’s natural ability to initiate and progress labour.

Acupuncture is often viewed as a natural and gentle intervention for inducing labour, especially compared to more invasive medical methods. The critical aspect of acupuncture is that it works with the body’s energies rather than forcing it into labour. Acupuncture will only initiate labour if the body and baby are ready. This means it doesn’t override the body’s natural timing but instead encourages the body to move toward labour in a balanced way and in harmony with the natural process in hand. If the body isn’t ready, the cervix isn’t softened, or the baby isn’t positioned correctly, acupuncture won’t push labour forward artificially.

Why Acupuncture is Considered Gentle and Natural:

• Supports the body’s natural rhythms: Acupuncture stimulates key points throughout the body to enhance blood flow, encourage uterine contractions, and prepare the cervix for labour. It’s a method that respects the body’s readiness, only acting when labour is naturally imminent.
• No external chemicals: Unlike medical induction, which introduces synthetic hormones (like oxytocin or prostaglandins) to initiate contractions, acupuncture involves no external substances. It works by prompting the body’s own hormonal and neurological processes.
• Reduces stress and tension: Acupuncture has a calming effect, reducing stress hormones that can inhibit the onset of labour. This relaxation is crucial to encouraging the body to naturally enter labour without forcing it.
• No risks of overstimulation: Since acupuncture supports natural processes, there is no risk of overstimulating the uterus or causing contractions that are too strong, too frequent, or dangerous for the baby, unlike the risks associated with medical interventions.

Acupuncture and Timing:

• Labour only starts when the body is ready: One of acupuncture’s main benefits is that it aligns with the body’s timing. If the baby isn’t ready for birth, acupuncture won’t force the body to go into labour prematurely. It works in synergy with the natural readiness of the mother’s body, ensuring that labour only starts when the cervix is ripened and the baby is in an optimal position.
• Promotes a smoother labour: When used in the later stages of pregnancy, acupuncture can help prepare the body for a smoother labour, making the process more efficient when it begins.

The Contrast in Approach

• Acupuncture respects the body’s timing, allowing labour to start when the baby and mother are physically ready. It’s a process that gently encourages the natural onset of labour without forcing the body into it. As a result, the labour that begins with acupuncture is more likely to progress smoothly, minimising the need for other interventions.
• Medical induction, in contrast, is a scheduled intervention that is often decided based on external medical guidelines and risk factors rather than the natural readiness of the body. While it can be lifesaving and necessary in some cases, it carries a greater risk of side effects, such as stronger, more painful contractions and the need for further medical interventions.

By providing a non-invasive, natural approach to labour induction, acupuncture offers a middle ground for women who want to avoid medical interventions but are also looking for a way to gently encourage labour when the time is right. It is a practice that honours the body’s ability to bring forth labour naturally, without pushing or forcing it before it’s ready.

Disclaimer:

Remember that these recommendations are general guidelines, and individual needs may vary. It’s essential to consult with a healthcare professional and/or registered acupuncturist to work out the best approach for each patient.

WHAT DO OUR PATIENTS THINK?

“I had a few sessions over the space of a few days as I understood that it might not be an immediate fix. But our little boy came after the third session, which was such relief. I was very relieved to be able to avoid the caesarian. Thank you so much for your help and support.”

Maggie, London

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Can acupuncture help me?

For the most up-to-date research and evidence on the efficacy of acupuncture, please visit the British Acupuncture Council (BAcC) website.

If you would like to learn more about how acupuncture may be able to help you, please contact us today.

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