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In this episode I kick off a new series on natural labor induction – starting with the evidence on acupressure, shiatsu or acupuncture, and breast stimulation. 

Natural induction techniques continue to be among our most searched and requested topics at Evidence Based Birth. I’ll continue to cover new methods over the next several months. 

Resources
  • Get the Evidence Based Birth Natural Labor Induction series here.
  • Follow Dan Dekker, the Birth Business Teacher, here.
  • Access Spanish translations of our one- and two-page handouts here.
Transcript

Rebecca Dekker: Hi everyone. On today’s podcast, we’re going to talk about the natural labor induction methods of acupressure, shiatsu or acupuncture as well as breast stimulation.

Rebecca Dekker: Welcome to the Evidence Based Birth podcast. My name is Rebecca Dekker and I’m a nurse with my PhD and the founder of Evidence Based Birth. Join me each week as we work together to get evidence based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details.

Rebecca Dekker: Hi everyone and welcome to the Evidence Based Birth podcast. Before we get started with today’s content, I do have some quick announcements. First, over the last week, I hosted two public webinars. One all about the evidence on inducing labor at 41 weeks and the other all about the most recent research on COVID-19. Those replays are now available and will be available through the end of the month. Just go to evidencebasedbirth.com/webinar to get instant access to the replays. Also, we’re continuing to update our COVID-19 resource page at evidencebasedbirth. Just go to ebbirth.com/covid19. In our most recent update, which was the webinar we covered the research that’s come out in the last week changes to several of the guidelines and what we see as some implications for birth including issues related to prenatal care, partner support, universal testing on admission to the hospital, universal masking, meaning everybody wearing a mask regardless of whether or not you have the virus in the hospital, some hospital policies related to separation and induction and some silver linings that I’m seeing related to the pandemic.

Rebecca Dekker: Also this week I’d love it if you could check out two of my colleagues have posted interviews with me; The Birth, our podcast this week, episode 461 featured an interview with me about birth implications and COVID-19. That’s hosted by [inaudible 00:02:07] and then Dr. Elliot Berlin, who’s been a guest on this podcast before and is the host of the Informed Pregnancy podcast, is releasing an interview with me this Thursday all about the evidence on group B strep. So I’d encourage you to check out our fellow podcasters there.

Rebecca Dekker: Also I want to make sure that you’re aware if you are a birth professional in the field, we have reduced the price of our professional membership at Evidence Based Birth for the entire month of April. So anybody who joins during this month of April will be locked in at a lower rate. We also have scholarships available. You can find more about joining our interprofessional community inside the professional membership by visiting ebbirth.com/membership.

Rebecca Dekker: Finally, I also want to just let you know that we have a big announcement coming Monday; a free gift or surprise that we’re going to make available to everyone around the world who wants it, and I will let you know next week what that surprise is. So make sure you’re subscribed to our email list. We’ll be sending out an email probably Monday afternoon of next week about this free gift that we are giving away to hopefully help people during this difficult time. And with that, let’s get to our topic all about the evidence on acupressure, acupuncture, and breast stimulation to naturally induce labor.

Rebecca Dekker: We don’t know exactly how many people around the world try to start their labor with natural methods however, we do know that probably about as long as people have been pregnant, they’ve been trying to get labor started for whatever reason. The latest survey data we have on this in the United States comes from the Listening to Mothers III survey, which was published in 2013. In that study, they found that 29% of US mothers reported that they tried to induce labor on their own.

Rebecca Dekker: Over the next several months, once a month, I’m going to be covering a couple of different methods that are sometimes used by people on their own at home. I’m going to start today at the beginning of the alphabet. We’re going to cover acupressure along with shiatsu or acupuncture, and then we’ll also cover the evidence on breast stimulation. By the end of this podcast, you’ll be able to discuss the evidence behind these induction methods as well as the limitations of the evidence on these methods, and we’ll also give you an example protocol for each of these methods.

Rebecca Dekker: Let’s start with acupressure, shiatsu and acupuncture to start labor. Acupuncture has been used for more than 2000 years in China and Japan. In traditional Chinese medicine or TCM, QI, which is spelled Q-I in English, is the energy that flows through the body’s 14 meridians, which are pathways like rivers or branches in the body. With acupuncture very fine acupuncture needles are inserted into specific acupuncture points along the meridians to stimulate the circulation of QI and blood in order to restore balance between yin and yang and improve health. There are 361 acupuncture points located along the 14 meridians throughout the body. Acupuncture can be administered only by a licensed acupuncturist.

Rebecca Dekker: Acupressure uses the same points as acupuncture but applies manual pressure, usually using the thumbs or fingers and you press those thumbs or fingers on these specific acupuncture points of the body. Acupressure can be administered by pretty much anyone in any setting, both in and out of the hospital. No license is necessary to administer acupressure, although appropriate training, practice and judgment are usually advised.

Rebecca Dekker: The underlying mechanism for acupuncture or acupressure isn’t well understood, but it may involve stimulation of the uterus by stimulating hormonal changes or the nervous system.

Rebecca Dekker: Shiatsu, spelled S-H-I-A-T-S-U, is similar but distinct from acupressure. It’s an ancient Japanese practice and its name means finger pressure. Both disciplines assess for imbalances in the body and use pressure to restore balance and health. Some Shiatsu styles but not all use traditional Chinese medicine meridians that coincide with acupressure. It’s really only been recently that Western researchers have started to define a distinction between acupressure and shiatsu.

Rebecca Dekker: There’s several key technical differences including the type of a pressure applied, the way in which the thumb is positioned and the way in which body weight is used. With acupressure, the type of pressure tends to be circular or pumping action. The thumb is flexed as it applies pressure and the strength of the arms or hands are used to apply pressure. With shiatsu the type of pressure that is applied is stationary and sustained. The thumb is extended while it applies pressure and the whole weight of one’s body is used to apply pressure.

Rebecca Dekker: I know we’re talking about natural labor induction, but I wanted to share with you some personal correspondence we had with Dr. Kate Lavette, who’s a licensed acupuncturist and PhD in Australia. She said, “In the acupuncture community, we talk mostly about cervical ripening. I would hesitate to use the words “induced labor” because the evidence is not good enough. You cannot create hormones out of nothing if the woman is not ready to go.”

Rebecca Dekker: So what is this ripening of the cervix that Dr. Lavette was talking about in her communications with us? Ripening the cervix is a process that helps the cervix soften and thin out in preparation for labor. Medications or devices are sometimes used to soften the cervix so that it will stretch or dilate for labor, but also some natural induction methods are used more with the purpose of cervical ripening rather than starting contractions.

Rebecca Dekker: Before we go any further I also wanted to define a Bishop Score for you. The Bishop Score is often used to measure that ripening of the cervix. To prepare for labor and birth the cervix begins to soften, thin and open, and these changes sometimes start a few weeks before labor begins. Healthcare professionals use the Bishop Score to rate the readiness of the cervix for labor. With this scoring system a number ranging from zero to 13 is given to rate the condition of the cervix. In a Bishop Score of less than six means that your cervix may not be ready for labor. If you want to learn more about the Bishop Score there are a lot of calculators online where you can just Google Bishop Score calculator and find different versions.

Rebecca Dekker: So just keep this information in mind about the purpose of acupuncture or acupressure maybe being more to ripen the cervix rather than to start contractions.

Rebecca Dekker: In 2017 Smith et al published a Cochran review of 22 randomized controlled trials with a total of 3,456 participants. Four of those 22 randomized trials were on acupressure and the rest of the randomized trials were on regular acupuncture, which we call manual acupuncture or electroacupuncture when electrical stimuli is applied to the needles for induction of labor. Let’s look at those four randomized trials on acupressure.

Rebecca Dekker: Acupressure is something that can be done in or out of the hospital, including at home.

Rebecca Dekker: Out of the four trials on acupressure, three found no difference between groups and one study found a possible benefit from acupressure.

Rebecca Dekker: The first randomized trial had 132 first time mothers in the United Kingdom who were 41 weeks or greater gestation. They randomly assigned expecting parents to either have acupressure on two designated acupressure points or what we call a sham treatment, which is like a fake acupressure. Midwives are trained to locate and correctly apply 20 intermittent presses to the two designated acupressure points; large intestine four, which is on the hand and spleen six, which is on the inner lower leg. The sham control group received 20 intermittent presses to the kneecap and the elbow. Following treatment both groups were asked to continue the treatment at home by continuing to stimulate the points as above four times a day. The researchers found no differences between the outcomes of these two groups.

Rebecca Dekker: The second study was 162 first time mothers in Iran who were 39 to 40 weeks pregnant. They had 30 minutes of acupressure applied to three acupressure points every other morning and that was alternated with the other mornings the acupuncture was done by the partner and the mother. They also had a sham group in this study as well where three ineffective acupuncture and acupressure points were pressed. Again, they found no differences in this group.

Rebecca Dekker: In the third study that did not find a difference, both groups received standard clinical care and their intervention group received verbal and written instructions on how to self-administer three acupressure points; spleen six, large intestine four and gallbladder 21. Again they found no difference in any outcomes between these two groups.

Rebecca Dekker: Those three trials found no evidence of benefit from acupuncture for any of the following outcomes, including cesarean rate, rate of Pitocin given during labor, meconium, epidurals, any newborn outcomes, time from beginning the trial intervention to the birth of the baby or use of any other induction methods. However, the fourth study did find some improvement in the acupressure group.

Rebecca Dekker: This study had a total of 150 first time mothers giving birth in Iran who were 39 to 41 weeks pregnant. They were randomly assigned into three groups of 50 people. One group had acupressure by the researcher, one group had acupressure by the mother herself and the other group had routine care. These were all low risk women who had a low Bishop Score of four or lower and they had not had any sex 24 hours before and up to the end of the study.

Rebecca Dekker: In this study, acupressure was applied to spleen six, which is the inside of the leg above the ankle for a 20 minute session between 9:00 AM and 11:00 AM on the right foot, and it was repeated every 24 hours until labor began. In their protocol, acupressure was applied for 10 seconds to two minutes until half the fingernails turned white and then it was rested for the same amount of time. All groups had a vaginal exam every 48 hours to measure their Bishop Score. There was a significant difference in the average Bishop Score at 48 hours after the intervention. The average Bishop Score was greater in the researcher group and the mother performed acupressure group compared to the control group. This study only looked at the outcome of cervical ripening, not actual labor initiation.

Rebecca Dekker: I did want to mention that although there is not a lot of evidence supporting acupressure before labor for labor initiation, there’s just that one study looking at beneficial effects on cervical ripening. However, there’s a lot more evidence on benefits from acupressure during labor.

Rebecca Dekker: In a Cochrane review done by Smith et al in 2011 looking at the effects of acupressure during labor, they found that randomized controlled trials have shown that acupressure during labor has been linked to reduced pain intensity and anxiety, lower cesarean rates, less need for Pitocin augmentation and shorter labors. Most of these studies use the acupressure points to spleen six and large intestine four. The Cochrane authors note however, that the risk of bias was high in the majority of trials and that recommendations for practice cannot be made until further high quality research has been undertaken. Another know about these randomized trials is that they tend to be protocolized, meaning that they are not individualized to each laboring person. In real life a person would need different acupressure techniques in response to what is happening during labor.

Rebecca Dekker: Moving onto shiatsu for induction of labor, we found two studies on this topic. One randomized trial with 288 people in Iran who are 42 weeks or greater, randomly assigned people to acupressure with gallbladder 21, large intestine four and spleen six versus standard care. They found lower rates of Pitocin use with the shiatsu group. There’s also a non-randomized study with 66 people in the United Kingdom who were 40 weeks or greater pregnant. They used again gallbladder 21, large intestine four and spleen six and compared that to standard care and found lower Pitocin rates with the shiatsu group.

Rebecca Dekker: However, there was no mention of blinding in either of the studies and no mention of criteria about when people had their labor induced, so we don’t know if these studies were biased towards simply using Pitocin less often among the people who had shiatsu. We need more research on shiatsu that includes a sham control, meaning a fake treatment in the control group.

Rebecca Dekker: We’ve talked about acupressure and shiatsu. What about acupuncture? Researchers have found that acupuncture administered by trained professionals may promote a more favorable state of the cervix within 24 hours in the two trials that looked at this outcome.

Rebecca Dekker: One of the studies took place in Denmark and they randomly assigned 125 mothers to acupuncture versus sham or fake acupuncture. All the mothers in the study were 41 weeks and six days or greater. The acupuncture points they used were bladder 67, large intestine four, spleen six and governor vessel 20. This was manual acupuncture and it was delivered by trained midwives. Both mothers and care providers caring for the women in labor were blinded to who received what treatment. The intervention was administered over 30 minutes and the needles were stimulated every 10 minutes. The treatment started at 8:00 AM and it was repeated at 2:30 PM if the mother was not in labor. The researchers found that mothers who received the acupuncture had a higher average Bishop Score over the next 24 hours compared to the sham group.

Rebecca Dekker: The other study was smaller. It was 67 mothers in Brazil who all had a Bishop Score of less than seven. This was an electroacupuncture study where they stimulated six different acupuncture points. The electric current intensity was slowly increased until it could be felt by each participant without discomfort. The stimulation was performed every seven hours in one to three sessions in a 24 hour period of hospitalization. Only one physician with 10 years experience in providing acupuncture to pregnant women provided the acupuncture. The control group received misoprostol intervaginally every six hours up to four tablets within a 24 hour period. There was no blinding in this trial. So in this trial they were comparing electroacupuncture to a medication that is known to ripen the cervix. Again, they found a higher average Bishop Score over 24 hours with acupuncture compared to misoprostol.

Rebecca Dekker: When the Cochrane reviewers combined the findings, they found no evidence of any difference between groups for Pitocin augmentation, epidural use, meconium, any newborn outcomes, postpartum hemorrhage, time from the intervention beginning to the time of birth, use of induction methods, length of labor and more. So really the only differences between the groups was the cervical ripening in the acupuncture group.

Rebecca Dekker: A question some people ask is, is it safe? Is acupuncture safe during pregnancy? Two recent systematic reviews published by Park et al in 2015 and Clarkson et al in 2015 both found a low incidence of adverse effects from acupuncture during pregnancy. They stated that most adverse effects are minor and not related to pregnancy such as fainting, drops in blood pressure, drowsiness, discomfort, and localized bleeding or bruising, all of which licensed acupuncturists should be used to dealing with in clinical practice. There were no miscarriages, no pre-term births and no other obstetric complications attributed to acupuncture in either review.

Rebecca Dekker: Similarly, a large 2019 retrospective study from Korea included 1,030 people who received acupuncture during pregnancy and found no increase in the risk of stillbirth. And we did not find any published case reports on stillbirths or deaths occurring after acupuncture during pregnancy.

Rebecca Dekker: So acupuncture appears to be a safe procedure when performed by well trained professionals. However, there have been rare documented cases of severe injury and death occurring from acupuncture in the general non-pregnant population.

Rebecca Dekker: In one study published by Lee et al in 2017 they stated, “Traumatic events associated with acupuncture are usually caused by improper insertion or manipulation at high risk acupuncture points. To maximize the safety of acupuncture specific training that gives precise guidance on the depth, direction and angle of needle insertion, especially in the chest region is crucial.”

Rebecca Dekker: So it seems like the evidence on acupuncture, acupressure, and shiatsu mostly supports the use of these interventions for ripening the cervix or getting the cervix ready for labor.

Rebecca Dekker: Next I want to talk about breast or nipple stimulation to start labor. Nipple stimulation causes the release of oxytocin from the posterior pituitary gland in the brain, which can start or increase uterine contractions.

Rebecca Dekker: A 2005 Cochrane review looked at breast stimulation for cervical ripening and induction of labor compared to no intervention in oxytocin alone. The researchers state that this induction method has the advantage of being cheap, non-medical and gives pregnant people more control over the induction process. Breast stimulation and nipple stimulation have historically been used to induce and augment labor in many different cultures around the world.

Rebecca Dekker: The Cochrane review from 2005 by Kavanaugh et al included six trials with a total of 719 participants. The studies took place in Nigeria, India, Singapore and the US. In all of the studies, the participants performed self-breast and nipple stimulation, stimulating one side at a time. In two trials, stimulation was done for one hour per day for three days in a row. In three trials, it was done for three hours per day. To get the three hours a day the participants did the stimulation one hour at a time, three times a day, alternating sides every 10 to 15 minutes. In one study the stimulation was done with the use of a breast pump instead of hand massage. The pump was set at normal and alternated every 15 minutes sides until contractions were three minutes apart.

Rebecca Dekker: In the five trials that compared breast stimulation to no intervention, there was a significant increase in the number of people in the breast stimulation group who went into labor over 72 hours. 37% of the participants who stimulated their nipples went into labor within the following three days, compared to just 6% of those who did not stimulate their nipples. The results applied equally to first time mothers and experienced mothers, but the results were not significantly different in women who had an unfavorable cervix. So if your cervix was not ripe at the start of the study, the intervention did not make a difference.

Rebecca Dekker: They also found a major reduction in the rate of postpartum hemorrhage. The rate of people having postpartum hemorrhage was 0.7% in the breast stimulation group versus 6% in the group that received no intervention. Researchers also noted that there were no differences between groups in the cesarean rate or meconium staining and there were no cases of something called uterine hyperstimulation. Uterine hyperstimulation was generally understood in these studies to mean more than five contractions per 10 minutes for at least 20 minutes, a contraction lasting at least two minutes or fetal heart rate changes consistent with uterine hyperstimulation syndrome. So you don’t want to see uterine hyperstimulation and they did not see that in any of these studies.

Rebecca Dekker: Now that Cochrane review was published in 2005, so we wanted to see if we could find more recent research on this topic. We found a recent randomized control trial from India published by Singh et al in 2014. This was a pilot study to determine if breast stimulation could help low risk first time pregnant mothers achieve spontaneous labor and vaginal birth. 100 participants were randomly assigned to watch a video and they were advised to perform breast massage starting at 38 weeks. The other hundred participants were not assigned to the intervention. So at 38 weeks gestation, half of the participants began massaging their breasts for 15 to 20 minutes each side, three times a day, and the other half of the participants did nothing.

Rebecca Dekker: Bishop scoring of the cervix was done in both groups at 38 weeks and again at 39 weeks. They found that the Bishop Score changed significantly after one week in the breast stimulation group but not in the control group. The breast stimulation group also went into labor sooner. They gave birth at an average of 39 weeks and two days of pregnancy versus 39 weeks and five days of pregnancy. And they also had significantly fewer cesarean births; 8% versus 20%. There was no significant difference in postpartum hemorrhage between the groups. There was one case of uterine hyperstimulation in the breast stimulation group. There were no significant differences between the groups and the length of labor, meconium staining or any newborn outcomes. 92% of women in the breast stimulation group stated that they were satisfied with that induction method.

Rebecca Dekker: In summary, the breast stimulation group had a higher Bishop Score, they went into labor sooner and they had fewer cesareans.

Rebecca Dekker: We found an interesting study out of Japan by Takahata et al published in 2018. Interestingly in Japan, about 50% of pregnant people use breast stimulation to help induce labor. A small feasibility study in Japan included 16 low risk pregnant people between 38 and 40 weeks gestation. They did not include any mothers with medical problems or those with a prior cesarean or who were breastfeeding during pregnancy.

Rebecca Dekker: These 16 women stimulated each breast for 15 minutes for a total of one hour each day over three days. A midwife demonstrated how to perform the breast stimulation using a breast model and a pressure measuring instrument. The recommended pressure was 20 to 50 millimeters of mercury, which is a gentle pressure. They used a metronome to show the mother a rhythm of 69 beats per minute and there was a YouTube video that had that timing with it. The stimulation was performed by pinching the chest to a degree that did not hurt. Started from the outer areola to the nipple using the thumb, forefinger and middle finger. They taught the women to use oil and gave them a nursing cover and they put on a movie for the mothers to watch while they did the breast stimulation.

Rebecca Dekker: They collected samples from their saliva before and after the intervention to measure oxytocin levels. The median oxytocin level went up 30 minutes after breast stimulation began and was highest on day three after breast stimulation. Six of the 16 women went into labor within 72 hours.

Rebecca Dekker: In our literature search we also found one recent study of nipple stimulation during labor. This was a randomized trial by Demerol and Guler published in 2015 out of Turkey. In this trial, they randomly assigned 390 people in labor who had a Bishop Score of six or higher to nipple stimulation, uterine stimulation by hand or control. In the first phase of labor people who were randomly assigned to perform nipple simulation did it once every half hour. In the case of having contractions, they would wait until after the contraction stopped. One nipple at a time was rolled and gently pulled forward with the thumb and index finger for two minutes, alternating sides for four to five minutes.

Rebecca Dekker: The group that was randomly assigned to something called uterine stimulation the researchers described it like this, “All fingers of one hand touched and pulled away from the uterine tissue concurrently and rhythmically for two to three minutes for uterine stimulation starting from the fundus. This stimulation was applied on the whole uterus.” So it’s a kind of rhythmic massage on the abdomen.

Rebecca Dekker: In this study, nipple stimulation led to shorter phases of birth compared to the uterine stimulation group and the control group. The average duration of the first stage of birth was 3.8 hours for those who used nipple stimulation. For those in the control group, their first stage lasted an average of 6.8 hours. The average length of the second stage of labor was also shorter in the nipple simulation group; 16 minutes versus 27 minutes for the control group. The control group had an 8.5% cesarean rate and none of the people on the nipple or uterine stimulation groups had a cesarean. The control group also had extremely high rates of Pitocin augmentation; 89% versus 7% with nipple stimulation and 12% with the uterine stimulation. The authors did not mention if uterine hyperstimulation occurred in any of the groups.

Rebecca Dekker: So in summary, in this study they found shorter labors, a lower cesarean rate and less usage of Pitocin in the nipple stimulation group. In terms of safety issues with breast or nipple stimulation, since the amount of oxytocin released during breast stimulation is not controlled, there is a risk of over stimulating the uterus.

Rebecca Dekker: [inaudible 00:27:34] in 2015 published a case report warning of the potential dangers of uterine tachysystole with prolonged fetal heart rate decelerations following nipple simulation for labor augmentation. In this single case a 37 year old mother in the US with two prior vaginal births had an uncomplicated pregnancy. She was experiencing regular contractions and leaking amniotic fluid at 40 weeks. The mother walked around for a few hours but was still at three centimeters when she returned to the unit. Shortly after she returned to the unit, she developed tachysystole with contractions happening every minute and prolonged deceleration. The tachysystole was resolved and the fetal heart rate recovered when they injected her with terbutaline, a drug used to stop contractions. This was after there had been five minutes of the baby having a very slow heartbeat.

Rebecca Dekker: The mother revealed that she had performed breast stimulation when she was three centimeters dilated as she had been instructed to do so by a medical professional during a prior birth in China. After this episode resolved, the contractions increased over the next several hours and the baby was born healthy.

Rebecca Dekker: There have also been a few reports of similar complications while performing nipple stimulation during contraction stress testing back in the 1980s.

Rebecca Dekker: Now since breast stimulation in late pregnancy has been proposed as a means of inducing labor, some people are concerned that a suckling baby could induce a pre-term birth. In 2017 Lopez Fernandez et al conducted the first systematic review to identify outcomes related to breastfeeding during pregnancy. They found seven studies that examined breastfeeding during pregnancy and rates of pre-term birth. None of the studies reported significant differences in the rate of pre-term birth between mothers who breastfed during pregnancy and those who did not. The authors speculate that nipple stimulation may only induce labor in late pregnancy once the oxytocin receptors are fully present in the uterus. And they say there’s no evidence that breastfeeding is harmful in earlier pregnancy or that it can cause pre-term birth.

Rebecca Dekker: So in summary, we found that acupressure, shiatsu and acupuncture may assist with cervical ripening. The acupressure protocol in the one study that found an effect on cervical ripening included the use of spleen six for a 20 minute session repeated every 24 hours in the morning until labor began. Acupressure was applied to spleen six for 10 seconds to two minutes until half the fingernails turned white and then the person doing the acupressure rested for an equal amount of time. With acupressure, it’s important to remember to wait until term to try acupressure.

Rebecca Dekker: In the one study that found benefits with first time mothers, they were between 39 weeks to 41 weeks pregnant. The two studies that looked at shiatsu found less of use of Pitocin to induce labor. A sample protocol from those studies included the use of spleen six, gallbladder 21 and large intestine four. Thumb pressure was used for as deep as was comfortable for a 15 minutes session and it was repeated as desired.

Rebecca Dekker: Although some of this research may be promising, more high quality research is needed before we can be confident that acupressure or shiatsu are effective for cervical ripening. However, they appear safe and may offer benefits and provide a hands on way for pregnant people with partners to get their partners involved in the pregnancy.

Rebecca Dekker: Similarly, our research review found that receiving acupuncture from a trained and licensed acupuncturist may help promote cervical ripening. In our literature review we also found that breast or nipple stimulation may also assist with cervical ripening and increases the chances of starting labor over the next three days.

Rebecca Dekker: With breast or nipple stimulation protocols it’s important to remember that these protocols for breast or nipple stimulation should be used with healthcare provider guidance and since the amount of oxytocin released is not controlled, there is a risk of over stimulating the uterus.

Rebecca Dekker: In most of the studies on nipple stimulation care providers carefully monitored the fetal heart rate during and after the stimulation intervention.

Rebecca Dekker: In most of the studies, participants stimulated each breast for 15 minutes alternating sides for a total of one hour. So it’s important to note that they did not do both sides at the same time. Oil was used to gently massage the breast starting at the outer areole and going around the nipple.

Rebecca Dekker: In one study a breast pump was used.

Rebecca Dekker: In most research studies they taught women to pause during a contraction and to stop breast stimulation if contractions are closer than three minutes apart or lasting longer than one minute.

Rebecca Dekker: In this podcast episode, we covered the available evidence on acupressure, acupuncture, shiatsu, and breast or nipple stimulation for ripening the cervix or inducing labor without the use of medications. Although the research on these methods is promising, we do need more studies. And please keep in mind that the research studies that we do have probably do not apply to higher risk people who have additional medical or pregnancy complications. It’s extremely important for anyone thinking about or planning to use these techniques to discuss your plans with your care provider so they can help you decide if the evidence applies to your unique situation, and also to talk about important safety precautions with you. For example, you may want to discuss whether or not you want fetal heart rate monitoring during breast or nipple stimulation with your care provider. You may also want to go over your risk factors or history of your prior pregnancies and births to discuss whether or not there are factors that make it less safe for you to use these methods.

Rebecca Dekker: This concludes our podcast episode all about the evidence on using acupuncture, acupressure, shiatsu and breast stimulation to naturally induce labor. Check back in about a month, we will do another episode all about the evidence on using castor oil and eating date fruit to induce labor or ripen the cervix.

Rebecca Dekker: If you want to learn more about today’s topic, just go to evidencebasedbirth.com/125 for our complete show notes including a transcript of this podcast and links to all of the references that I talked about.

Rebecca Dekker: Again thank you so much for joining with us today to cover the evidence on this topic. As a quick reminder, our professional membership is available at a reduced price for the rest of the month of April. You can learn more at evidencebasedbirth.com/membership. And make sure you’re subscribed to our email list. You can just go to our homepage, evidencebasedbirth.com if you’re not already subscribed because we have a surprise announcement coming Monday afternoon about a free gift we are giving to everyone in our community. Thanks everyone and I’ll see you next week. Bye.

Rebecca Dekker: Today’s podcast was brought to you by the courses in the Evidence Based Birth professional membership. The free materials that we provide to the public at evidencebasedbirth.com are supported by our professional members. Evidence Based Birth professional members get to take continuing education classes on hot topics in the field. We offer more than 20 continuing education contact hours for nurses, doulas, child birth educators, midwives and physicians. To learn how you can become a member, visit ebbirth.com/membership.

 

 

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