CMAC311

Session 7
Acupuncture and herbal
treatment in Midwifery
• Breech presentation
• Difficult labour
• Retention of Placenta
• Retention of urine after
delivery

Chinese Medicine Department

www.endeavour.edu.au
 Session Contents
o Briefly introduce Western medical information
regarding abnormal labour process and retention of
placenta.

o Discuss TCM views and treatment for abnormal

labour process and retention of placenta.

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 Learning Outcomes
After this session study, students should be able to:

o Understand the normal process of labour.

o Describe and explain the aetiology & pathology of each

disorder in this session.

o Outline the safe & effective TCM treatments

(Acupuncture and Moxa) for prolonged labour, and
retention of placenta.

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MALPOSITION OF FOETUS
 Normal Foetus Position

o A baby settle into a head-down position within the pelvis

around the 34th-36th week of pregnancy.

o The best position for foetus / baby is termed as ‘well-

fixed anterior position’.

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 Malposition of foetus
 Common Types:
o Breech presentation
o Transverse and unstable lie
o Face presentation
o Brow presentation
o Shoulder presentation

 Risks:
Malposition of foetus is closely linked with difficult labour or
other abnormal labour process, and may potentially harm
the mother and foetus health.

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Malposition and Malpresentation

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 TCM Pathology of Malposition of
Foetus
o Excess: Qi stagnates blocking movement of the
foetus

o Deficiency: Inadequate qi & blood to move the foetus

o Growing foetus: Too big, disrupting Qi & retaining

water

Note: The root cause of both malposition and malpresentation

is considered to result from kidney deficiency.

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BREECH PRESENTATION
 Breech Presentation

o 25% of all pregnancies are breech at 30 weeks

gestation

o Most of these spontaneously revert at 32-34

weeks

o 3-4% of all pregnancies are breech at term

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 Presentation of fetus
Normal fetal presentation
(cephalic presentation)

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Variations of breech position
Notice the angle of the legs, knees & hips

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 Dangers to the baby from a breech
delivery
o Intracranial haemorrhage
o Hypoxia
o Injuries to the baby’s body

o Management of breech baby

external cephalic version (ECV)
Risks

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CHINESE VIEWPOINT OF
BREECH
 Reasons for not turning breech
o Twin pregnancies
o Previous caesarean section for breech position
o Raised blood pressure
o Bleeding in pregnancy
o Rhesus negative

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 Treatment of Breech Presentation
Moxa Zhiyin Bl 67
o Optimal time: Beginning of 34th week until 37th week

o Moxa Bl 67 for 15/20 mins for 10 days (Golden Mirror of

Medicine)

o Moxa Bl 67 for 20 mins for 5 days, repeat if not corrected

(Maciocia)

o Can advise knee-chest exercises

to compliment the treatment

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Treatment of Breech Presentation
Moxa BL67

o Treat every day, initially for 5 days, then wait for

a few days.
o If the breech position has not corrected, continue
treatment for another 5 days.
o One course equal 10 days of treatment.

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Treatment of Breech presentation
If any of the following occurs, advise client to go to her mid-
wife or obstetrician (to check to see if position has
changed):
o Feels her baby has done a somersault turn
o Feels she can feel different parts of the baby in
different locations i.e. – feet now kicking her ribs
o Feels more pressure in the pubic area or more
pressure on the bladder

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 Research on BL67

“acupuncture plus moxibustion was able to reduce fetal heart rate and fetal movements,
while moxibustion without needle affects just fetal movements and
acupuncture without moxibustion do not affect fetal behaviour.”

Neri, I; et al. Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus
moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation. American
Journal of Chinese Medicine. Hackensack, New Jersey, 35, 1, 27-33 7p, Jan. 2007. ISSN: 0192-
415X.

© Endeavour College of Natural Health www.endeavour.edu.au 19

 Labour

• Normal Labour

https://youtu.be/jFdXx35VR-o

Other resources :
https://www.youtube.com/watch?v=w0iDfcAYZWc

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• Abnormal Labour

o https://www.youtube.com/watch?v=KHdausjbBz4
o https://www.youtube.com/watch?v=TWVU80jK_Wo

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 Western Viewpoint of Labour
 The average length of human gestation is 280 days /40
weeks. The release of prostaglandins & hormones brings
on labour.

 A normal labour process / natural delivery includes 3

stages.

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 TCM Viewpoint of Labour

o In TCM, labour is expected to commence when 3 factors

occur simultaneously:
 Yang activity replaces Yin material growth
 Qi flows freely and move blood
 The door of the uterus opens

If either is problematic can lead to prolonged, delayed or

other difficult labour.

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 Stages of Labour
1. Pre labour 2 hrs. to 2 days duration
irregular contractions/twinges last less than 1 min

2. First stage active labour (cervix 0-4 cm dilated)

regular contractions every 10 mins; 1 min long
baby’s head presses on coccyx
Ear pts.: uterus; end; sm; lumbar; st (electro)
Bl 32, 31; Co 4; Liv 3
3. Transitional strong/hard contractions up to 2 mins long intense back
stage pain (cervix 8-10 cm dilated)
Bl 31, 32 (massage or acu); Liv 3; GB 34
4. Second stage short contractions
waters may break
crowning of head
Birth
GB 21; Bl 60 if slow to descend
5. Third stage time between birth & expulsion of placenta
.

PROLONGED AND DIFFICULT

LABOUR
 Prolonged and difficult labour

Causes:
o Weak uterine contractions
o Foetal head too big
o Malposition or mal-presentation

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 TCM Aetiology and Pathogenesis of
difficult labour

constitutional
weakness; lack of strength
premature qi weak & for labour
contractions consumed
Difficult
labour
lack of exercise
during qi flow
pregnancy; obstructed blood flow
nervous about & stagnate impeded
labour;
pathogenic cold

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 DIFFERENTIATION OF DIFFICULT
LABOUR
PATTERN SIGNS & SYMPTOMS

Qi & Blood Xu Mild short uterine contractions; slow

progression of the stages of labour; heavy
bleeding
Accompanying S/S:

Stasis of Blood & Severe abdominal pain; back pain;

Stagnation of Qi irregular uterine contractions; slow
progression of stages of labour; scanty
bleeding with dark blood
Accompanying S/S:
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 Pathogenesis of Prolonged
Labour

o Xu due to constitutional weakness; premature

contractions weaken & consume qi

o Stagnation due to lack of exercise, nervousness, or

pathogenic cold

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 Acu-Points to help labour
o Bl 67 is oxytocic pt (reduce); follow 10 mins after with Bl
60
o GB 34 influential pt of tendons helps cervix dilate
o LR3 softens cervix
o Co 4, Sp 6 stimulates uterine contractions

o (Yellend: Co 1,2,3,5; St 35,36,37,38,40; Sp7,8,9)

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Acupressure points for labour
Giovanni Maciocia

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 Retained Placenta
o Expulsion of the placenta is termed 3rd stage of
labour. Placenta is usually delivered a few minutes
after the birth.

o Considered prolonged if exceeds 20 minutes.

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 Retained placenta
Causes:
o Exhaustion of mother leading to Qi Xu: fatigue, pallor,
dizziness, shortness of breath, pale tongue, hollow &
weak pulse

o Invasion of cold during labour leading to Blood

stagnation in uterus & general Qi weakness (cold leading
to stasis of blood): dark bluish complexion, pain in low
abdomen, perhaps vomiting, pale tongue, wiry & slow
pulse

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 Retained Placenta
Treatment
o Empirical point for retained placenta is GB 21
o St 31 moves the Qi
o Sp 8 regulates uterus

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PATTERN SIGN TONGUE PULSE
Qi Xu Fatigue, pallor, Pale with thin Hollow and
fear of cold, coat weak
TP: Tonify Qi, nourish Blood dizziness,
shortness of
SP 6, Co 4 promote Qi and breath
Blood circulation
Ren 3 strengthens Uterus
Ren 4 nourishes and moves
Blood
Ren 6 moves and tonifies Qi
GB 21 empirical pt for
retained placenta, moves Qi
Also St 31 moves Qi
Kid 6, Lu 7

Cold leading to stasis of Dark bluish Pale body Deep, wiry

Blood complexion, pain and slow
in lower abdomen,
TP: Expel Cold, promote flow maybe vomiting
of Qi

GB 21 and Bl 60 descend Qi
Sp 8 regulate Uterus moves
Blood, stops pain
Ren 4 regulate Uterus moves
Blood

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 Retention of urine after delivery
o Caused by bruising or prolonged overstretching of
the urethra

o Over-distension of the bladder during the labour

o “Retention with overflow”

o Acupuncture treatment can occur immediately after

delivery

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 Retention of urine after delivery
 Deficiency of Qi
 Deficiency of the kidneys

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Break

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Practical section

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 Session 7 Practical Activity

o Session review questions: assessment,

diagnosis and management plan for each
menstruation disorder in this session

o Case study based practical skills building

up

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 Case study

o Campus Lecturer prepared relevant case and activities

for students practical tutorial.

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 Case Questions
• What is the TCM diagnosis (Disease and Pattern)?
• What is the TCM treatment principle based on your
diagnosis?
• What TCM treatment methods will you choose to
combine in the management for the patient’s condition?
• Choose at least five acu-points for your acupuncture
prescription to treat this condition based on your
diagnosis.
• Give the rationale for the above acupuncture points &
demonstrate your appropriate needling techniques.
• Recommend suitable lifestyle/dietary advice for this
condition based on Chinese Medicine theory.

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 References
o Neri, I; et al. Effects of three different stimulations
(acupuncture, moxibustion, acupuncture plus
moxibustion) of BL.67 acupoint at small toe on fetal
behavior of breech presentation. American Journal of
Chinese Medicine. Hackensack, New Jersey, 35, 1, 27-
33 7p, Jan. 2007. ISSN: 0192-415X.
o West Z, 2008 Acupuncture in Pregnancy and Childbirth,
2nd edition Churchill Livingstone
o Maciocia, G 2011 Obstetrics and Gynecology in Chinese
Medicine 2nd Ed, Elsevier, London
o Betts, D 2006 The essential guide to Acupuncture in
Pregnancy and Childbirth, Eastland Press, USA
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