Claudia Citkovitz - Acupressure and acupuncture during birth : an integrative guide for acupuncturists and birth professionals

ACUPRESSURE
AND
ACUPUNCTURE
DURING BIRTH

An Integrative Guide for Acupuncturists and Birth Professionals

CLAUDIA CITKOVITZ

Contents

Foreword

It was a joy meeting Claudia in 2006 when we lectured together in New York. It was obvious Claudia had built on my earlier acupressure pamphlet and textbook on using acupuncture in pregnancy to develop her own unique and practical applications. As the director of the acupuncture program at NYU Langone HospitalBrooklyn, her experiences teaching students and supporting women in a busy US hospital have resulted in a practical approach that can be used by health professionals, acupuncturists and support people to assist women prior to and during labor.

In 1992, as an acupuncturist working with midwives in New Zealand, it seemed logical to teach support people and midwives how to use pressure on the points acupuncturists needle to provide pain relief in labor. I could not have foreseen that positive feedback from this simple approach would have resulted in an acupressure booklet that has now been translated into nine different languages, a textbook on using acupuncture in pregnancy, and the opportunity to run workshops with acupuncturists and midwives around the world. It is a great pleasure to see these initial ideas on using acupressure expanded to provide a more detailed East Asian medicine toolkit of hands-on techniques.

My textbook focused on using acupuncture for pregnancy, with midwives sharing their experiences of using acupressure and acupuncture during birth. Claudia takes East Asian medicine during childbirth to a deeper level, providing an integrative guide for health professionals, acupuncturists and support people on assisting women during their labor. The layout is particularly useful, with is a systematic guide to differential problem-solving throughout the labor course. The Appendices that complete this book are particularly valuable, giving information about how East Asian medicine can be used for birth preparation, breech, postpartum and recovery post-Cesarean section.

I am grateful Claudia has taken the time and care to share her expertise through this publication. Acupressure and Acupuncture during Birth stands out as a leading text in this field, providing the information health professionals, acupuncturists and support people need to bring East Asian medicine into the birthing room. I can only hope it stimulates further interest in the potential East Asian medicine has to offer women during this crucial time of their lives. Having read this book, I have no hesitation in recommending it as an essential text for any practitioner working in childbirth.

Debra Betts
Author The Essential Guide to
Acupuncture in Pregnancy and Childbirth
Wellington, New Zealand, 2019

Chapter 1

INTRODUCTION

I offer this book to acupuncturists, midwives, doulas, physicians and physician assistants, obstetrical nurses and residents, shiatsu practitioners, massage therapists, and anyone else who works or wants to work in the glorious, messy, occasionally terrifying and eternally inspiring world of birth. My purpose in writing is twofold. First, I see the principles of Yin and Yang as powerful lenses that can shed much-needed light on how the birth experience unfolds differently for different body and emotional types, helping birth team members to anticipate challenges and provide optimal support. And second, using those principles, I want to share the powerful tools I have learned for identifying and addressing the specific physical and emotional challenges that arise in difficult labors.

The insights and technical approaches in this book grew out of my experience practicing, teaching and conducting research in acupuncture and associated techniques during labor and delivery over the past 15 years. In 2003 I started teaching acupuncture students at Lutheran Medical Center in Brooklyn, New York. Now called NYU Langone Hospital-Brooklyn, it is a so-called safety net hospital treating a diverse and underserved population that includes many recent immigrants from China and Mexico. With a minimal budget supplemented by various educational programs and occasional grants, the team size has fluctuated over the years from just me to seven experienced acupuncture practitioners. This Acuteam provided prenatal care in the hospitals womens health clinic for some of that time, and in the early days I also codirected an AcuDoula service, attending home and hospital births throughout New York City.

In 2006 the Acuteam produced the countrys first study on acupuncture during labor and delivery. We treated 45 patients with acupuncture during labor, and only three of them (7%) went to Cesarean section, versus 20 percent in 127 previous cases taken from the hospitals records. We systematically matched the two groups on characteristics that might affect labor progress The study had been planned to explore whether acupuncture was effective for pain in American labor and delivery settings, as a series of studies in Scandinavia had shown reductions in mothers experience of pain and use of epidural. There was some thought at that time that acupuncture might shorten the duration of labor, but seeing our study results was the first time I thought about presenting labor progress as a primary goal of acupuncture treatment. If a 7 percent Cesarean section rate was the result of treating for pain, what would we see if we treated for progress?

Circumstances have not been right to do a follow-up clinical trial, but in continuing to host acupuncture students in the years since, the programs preceptor Tzivya Kraus and I saw a number of cases where it seemed quite clear that the acupuncture had greatly accelerated labor progress, in many cases making the difference between vaginal and Cesarean birth. I was going to cut her open, I remember one doctor saying with mixed gratitude and sadness, when a patient scheduled for C-section due to lack of progress delivered vaginally. We had done a mere 20 minutes of acupuncture, acupressure and gentle rocking of the hips a treatment opportunity we only had because the patient was held in queue for an available operating room as we started our shift.

What struck me most about this case was how difficult the situation had looked when we started, and how easy it had been to get back on track. The mom well call her Leticia was young and strong but had a dry, pinched look to her face; likely some combination of a difficult labor and long hours at her work as a house cleaner. The labor was being induced due to low levels of amniotic fluid, and had stalled with the cervix dilated to 78 cm; at the time we met her there had been no change for over 4 hours, other than the cervix swelling slightly. Our analysis of the case had been that the cervix was just like the mom strong, but with a dry, tight quality that could not easily relax and yield during painful contractions. The first element of our treatment was targeted labor support to help her system relax: turning down the lights, rocking her hips, and rubbing her feet and inner ankles. The second element was a set of specific acupressure and electro-acupuncture techniques to reduce the cervical swelling and help the tissue to soften and dilate. during the contractions from agitated to purposeful and over the next 15 minutes her bump moved visibly downward. Her reflexive pushes, which had been spasmodic now seemed inexorable. It took some convincing for the doctor to come in and recheck her progress, as the last exam had been at shift change perhaps 30 minutes before. But indeed the previously swollen cervix had reduced to only a slight lip, which the doctor was able to push out of the way. I was going to cut her open, like a flounder, the doctor said repeatedly, shaking her head thankfully out of earshot of the patient.