Thoughts on Acupuncture and Cervical Ripening

Having spent the majority of my practice focusing on Obstetrics, I have had ample time to consider what we as acupuncturists are doing to help prepare the body for labour. In the past we referred to this as cervical ripening, which allowed us to easily translate the benefits of pre-birth acupuncture for our clients and for other care providers. While it is certainly true that acupuncture can help promote positive changes in the cervix leading up to labour, I think that exactly what we are doing in acupuncture with regards to cervical ripening has become misunderstood.

Acupuncture is based in Chinese Medicine, which is by design a holistic approach. It approaches health differently than allopathic medicine does, and while I am by no means saying that one is better than the other, it is important to note the differences. In Chinese Medicine we are looking at how permeable the body is. Are we able to take in outside influences, allowing that which is useful to permeate or to be absorbed, and excreting that which is not useful? If someone has, say, a nasal infection, the Chinese Medicine approach is not to consider which acupuncture points or herbs will treat the infection. Instead, we consider what is happening in the body as a whole that is inhibiting it from being able to resolve the infection. The idea is always to come back to strengthening the body so that it can resolve the problem itself.

This brings me to cervical ripening. I have heard people’s reservations about cervical ripening, based around three concerns. Some feel that the body shouldn't be interfered with and, I believe, are thinking of cervical ripening as an intervention similar to giving a woman cervidil (a western medication used to induce and soften the cervix). Others are frustrated that they did cervical ripening and still went to 41 weeks+ days, while still others are scared that after just one treatment they will have their baby too early. This is entirely the opposite of what Chinese Medicine is intended to do. If practitioners are following the principles of Chinese Medicine, we will look at the individual in front of us, knowing what needs to be permeable and what needs to be absorbed in order to prepare the body for labour, and then will ask ourselves what blocks this individual might be presenting that could slow down that process. When labour actually begins is up to the complex hormonal interplay between mom and baby. I will repeat that. When labour happens is up to mom and baby. We, as practitioners, are looking at it in the same way as we did the person with the nasal infection. We consider what is happening in the mother's body as a whole that could inhibit labour or become problematic during labour, and we consider how we can strengthen the body so it can resolve it itself.

In Chinese Medicine, we want to make sure that the digestive tract (referred to as the Yang Ming confirmation)  is open. Even western medicine understands this in a certain way by giving a mother castor oil, which strongly moves the bowels to start labour. We also look at what's referred to as the Tai Yang surface, which means we want to make sure the expectant mother's ability to process and resolve outside influences is strengthened.  Birth workers can attest to how common it is that certain clients get a cold or flu-ish symptoms leading up to labour, and sometimes this slows down the commencement of labour. In Chinese Medicine we want to make sure that "the Shao Yang is able to pivot," which loosely can translate to understanding how stressors and the sympathetic nervous are interfering in the body's ability to begin labour. Most birth classes will note how important it is to have a calm, dimly-lit room  for labour or that women can be in a good labour pattern but then have that stall upon arriving at the hospital, because their sympathetic nervous system gets activated. In addition to these “3 Yang Confirmations” we also address the “Yin confirmations” which involves how well the body is absorbing nutrients, the absorption and distribution of fluids, and how well the blood is circulating. My point is that the goal is to help the body prepare for labour. When we do this, we often notice that the cervix ripens more efficiently, but not because we gave it something like a natural version of cervidil. Instead it is because the body is more efficient when it is working optimally. The hormonal signals determining when labour commences are still up to mom and baby.

Induction treatments with acupuncture are different and more like an intervention. There is a lot of effort right now by our college here in BC and by the Obstetric association [OBAA], trying to educate practitioners about the difference between the two and about when it is appropriate to induce. I personally define induction as stimulating the uterus with an intention to create contractions. This can be done more subtly or more strongly and is usually done when a western medical induction is looming in the next few days; however, there are some exceptions. For example, is women's waters break but labour hasn't commenced or  induction is sometimes an appropriate treatment for a mom who is experiencing prodromal labour, whose body seems on the cusp of labour, in order to prevent her from getting too tired. 

It's also important to note that what may be emphasized in an induction treatment to get one woman's uterus to contract can be different from another's case, because it goes back to the same principle that Chinese Medicine is holistic. There are lists of acupuncture points that may be used together in certain ways to make up protocols for cervical ripening or induction. In general, they all touch on the issues discussed above in order to address what we know in Chinese Medicine needs to permeable and absorbed in support of labour. We have these protocols as guidelines, and they are great for newer practitioners to use for cervical ripening, but usually the more experienced practitioners take these protocols and tailor them to each individual to increase treatment efficacy.

Having worked as a doula and as a TCM practitioner, I really do support the idea that the ideal is the least interference possible in the birth process. I truly believe the body has a wisdom and a knowing. I believe a woman's body is strong and capable. I don't want women doubting their body's ability to labour, and nor do I want a woman to think that if she doesn’t use acupuncture to prepare for labour that she will have trouble in labour. 

My hope is that after reading this it can help create a better understanding of exactly how acupuncture and Chinese Medicine are used in helping the body prepare for birth and to support mothers in their journeys to motherhood.

Shannon Larson