Abstract
The treatment and prevention of preterm labor is an ongoing medical challenge. The majority of preterm births occur after the spontaneous onset of labor. Babies born preterm are predisposed to many health complications. Chinese medicine can provide a valuable method of arresting preterm labor. This study presents a case of preterm labor ceasing after one acupuncture treatment that supported the patient’s deficient qi, yin, and blood. The patient continued receiving treatment throughout her pregnancy and delivered a healthy baby at term. This case study demonstrates the potential benefit of employing Chinese medicine to treat preterm labor and contributes to the growing body of research.
INTRODUCTION
Preterm birth is the leading cause of death in children under five.[1] Each year approximately 15 million babies are born before 37 weeks of gestation worldwide. The highest rates are in North America and Africa.[2] Sadly, each year nearly one million preterm births result in the death of the infant.[1] This case study reviews a 38-year-old woman whose preterm labor at 22 weeks of gestation was successfully halted by acupuncture in one treatment.
Preterm labor is defined as the opening of the cervix after 20 and before 37 weeks of gestation. Signs and symptoms include regular or frequent contractions, low backache that is constant and dull, lower abdominal or pelvic pressure, mucus-like or watery vaginal discharge, spotty or light vaginal bleeding, and preterm rupture of membranes.[3] A search on PubMed for “acupuncture AND preterm labor” yielded just 16 results. Only two of the results discuss using acupuncture to stop preterm labor. Both of these are from the 1970s and only one is in English. The study in English demonstrated a 91.6% success rate whereby 11 of the 12 women who experienced preterm labor had their labor halted.[4] The remaining search results ranged in focus and included turning a breech presentation, progressing an established labor, and treating labor pain using acupuncture. The treatment and prevention of preterm labor has been a long-standing challenge in allopathic medicine. Two-thirds of preterm births occur after the spontaneous onset of labor. Preeclampsia, intrauterine growth restriction, and other fetal complications account for the remainder.[2] Neonates born preterm face a heightened risk of complications linked to the immaturity of multiple organ systems, as well as neurodevelopmental disorders and vision or hearing impairments.[5] The annual cost for preterm birth in the United States is at least $26.2 billion per year.[2]
Acupuncture is growing in popularity in the United States. Although there is little scientific study on its effect to halt preterm labor, this case presents a clear success. Chinese medicine has long recognized various forms of fetal and maternal distress during pregnancy. It utilized both herbal medicine and acupuncture to support full term gestation and prevent preterm births. Herbal formulas to “calm a restless fetus” and prevent threatened miscarriage are discussed in many classical text dating back as far as two millennia. Acupuncture point combinations to support and maintain pregnancy found in modern texts are frequently and repeatedly referenced to the classical Chinese acupuncture point functions discussed and recorded in clinical practice throughout the last twenty centuries. The goal of this article is to add to the limited body of contemporary acupuncture research and trigger further study into this vital area.
PATIENT INFORMATION
A 38-year-old Caucasian female sought acupuncture treatment for preterm labor at 22 weeks of gestation. Her first trimester of pregnancy was characterized by intense fatigue, slight nausea all day, occasional vomiting, gas, and constipation. The patient had no other health or pregnancy complications. She reported a pattern of fatigue, overthinking, having many tasks to track, and some worry. Her earliest labor symptoms were light contractions that began at 18 weeks. At 20 weeks her treating obstetrician prescribed terbutaline and progesterone to slow the contractions. An off-label use of terbutaline is uterine relaxation.[6] Progesterone is used to inhibit preterm contractions.[7] The drugs lessened, but failed to stop the contractions. The patient was placed on bedrest. At 22 weeks the light contractions became stronger and more regular. Her cervix dilated to 2 cm and began to efface. Her belly lowered in profile and the baby moved deeper in the pelvis. Prior to receiving acupuncture, her obstetrician advised her to go home, nap, pack a bag, and return to the hospital to deliver the baby. She was informed the baby would not live long once delivered due to its early gestational age. In distress, the patient sought the counsel of a friend who advised her that acupuncture might be able to halt the labor. An emergent acupuncture appointment was set up several hours later.
CLINICAL FINDINGS
Upon arrival at the clinic, the patient was having contractions every 90 seconds, her belly was carrying low, she was experiencing downward pressure in her pelvis, and she was visibly anxious.
DIAGNOSTIC ASSESSMENT AND ANALYSIS
The patient’s blood pressure was slightly elevated at 138/85 mmHg. Her heart rate was 85 beats per minute. When analyzing her pulse in a traditional Chinese medical context, notable findings were as follows: Kidney yin pulse was deep and weak; Kidney yang pulse was deep; Spleen pulse was moderately deep, weak, and rolling; Heart pulse was tight. When analyzing her tongue in a traditional Chinese medical context, notable findings were as follows: pale body, swollen with teeth marks, no coat, and a red tip.
The patient’s diagnosis was Spleen qi deficiency, upright qi failing to hold, Kidney qi and yin deficiency, blood deficiency, internal wind due to deficiency, and Heart heat. From a Chinese medical perspective she was experiencing a resource issue. Her body did not have sufficient qi, blood, and yin to “finance,” or secure, her pregnancy.
According to Maciocia,[8] there is a gynecological relationship between Spleen and Kidney qi in regards to the function of “lifting”. The contents of the uterus descends when the qi of these organs no longer lifts effectively causing prolapse or labor. When the Spleen is weak, it is not able to nourish the rest of the body and generalized fatigue manifests. Excessive mental digestion, such as overthinking and worry, draws heavily upon the Spleen’s qi. The Kidneys’ yin, the root of the body’s yin substance, is consumed with pregnancy, excessive daily activities and lack of adequate rest. In the absence of yin’s cooling and calming effects, unanchored heat can develop. The Heart is easily affected by rising heat and lack of yin, qi, and blood from weakened Kidneys and Spleen. When the Heart is overheated and unsettled, such as from depletion, overthinking, and worry, it passes this pathology to organs with which it connects. The Heart and uterus are connected through the Bao Mai, or Uterine Vessel, and thus the Heart has a strong effect on uterine physiology.[8] A complication of yin and blood deficiency is the stirring of internal wind. Signs of wind with blood deficiency include muscle tightening and tremors (including contractions), dizziness that can manifest with or as nausea, fatigue, and mental restlessness.[9] In this patient’s case, these organs were significantly challenged, and their vital substances depleted. Severe pathologies developed and the security of her pregnancy was compromised. One of the founding principles of Chinese medicine is that deficiency can also result from the blockage of qi or blood flow. This blockage leads to a relative deficiency and lack of efficient regeneration of yin and blood. Removing the blockage reestablishes proper flow and the reservoirs of yin and blood refill.[9] Thus for any patient, ensuring the smooth flow of qi and blood is as vastly important to recovery as facilitating nourishment of these vital substances.
THERAPEUTIC INTERVENTIONS
The patient laid supine on the treatment table. Clean needle technique was followed, and acupuncture administered on the following points: Du 20, Lu 7 (left), P 6 (right), Ren 17, Ren 12, K 3 (bilateral), Ear Shen Men (bilateral), Yin Tang, St 36 (left) and Sp 10 (right). Manual stimulation of the points was performed until a da qi sensation (tingling, warmth, pulsing, heaviness, tightness, or achiness) was achieved. Acupressure was applied to the scalp immediately adjacent to Du 20 for 20 minutes while the patient was resting with needles. Approximately 20 minutes into the treatment, the patient’s belly rumbled and moved up several inches at once. The patient burst into tears and exclaimed, “I don’t know what just happened, but I know my labor has stopped and my baby will be ok.” Her contractions ceased. The acupuncture needles were then removed.
CONTINUED CARE AND OUTCOME
This patient’s preterm labor was halted with one acupuncture treatment. She continued with weekly treatments until 37 weeks of gestation. At this time, the patient was experiencing a slight headache, was found to have low amounts of protein in her urine and had minor swelling in her extremities. Her obstetrician felt she was in the early stages of preeclampsia and advised them to induce her labor. She came for acupuncture to promote labor which facilitated the onset within 24 hours of treatment. A healthy baby girl was born by vaginal delivery the following day.
DISCUSSION
The circumstances which created this patient’s pathology are not uncommon. A prevalent Chinese medical etiology of preterm labor is exhaustion of resources. Pregnancy is energetically expensive. Many commitments and demands on a woman’s energy in America today are exhausting, and growing a human being is the energetic equivalent of another full time job. The pregnancy can become like a mortgage that is too expensive to finance.
The point prescription chosen for this patient can be applied to any preterm labor patient with a diagnosis of deficiency. Though this patient’s labor ceased after one session, to fully support a similar pregnancy to term and to adequately replenish low reserves, regular prenatal acupuncture is recommended. Acupuncture points each have several functions and, when used in combination, specific aspects work synergistically to achieve specific results. The purpose of this selection was to access and strengthen the patient’s internal resources. The human body is a deep well of potential and when these resources are tapped profound changes result.
Upon arrival at the clinic, the patient was in a state of Spleen qi deficiency with upright qi struggling to lift and hold the pregnancy. Lacking support from Kidney qi and yin; her blood was depleted, channels drained, experiencing the resulting Heart heat and wind in her body causing contractions. During gestation, if the mother’s body does not have sufficient resources, it may decide to release the pregnancy as a function of self-preservation. This patient was experiencing internal wind from the deficiency of blood and yin causing preterm contractions as a complication of her overtaxed resources. During her first treatment, the primary concern was unblocking the patient’s resources, helping build the Spleen’s capacity to lift and secure, accessing and building yin and blood, and assisting her body to secure the resources to sustain the pregnancy. Helping her feel calm and centered also prevented further depletion of vitality through excessive worry and overthinking. This is a common presentation of many women experiencing preterm labor due to deficiency for which the following treatment protocol is beneficial.
• Ear Shen Men (bilateral) – alleviates anxiety, regulates the central nervous system, treats inflammation.[10] This point was chosen to help the patient relax, feel calm and grounded, and reset her fight-or-flight response.
• Du 20 – pacifies wind, raises yang and counters prolapse, calms the spirit.[11] This is perhaps the most important pregnancy point and is regularly used in clinic before 37 weeks of gestation for its upbearing nature.
• Lu 7 (left) – opens and regulates the Conception Vessel, pacifies internal wind.[11] As the confluent point of the Conception Vessel, Lu 7 has a strong regulatory function on the uterus and the flow of qi in all the genitourinary organs.
• P 6 (right) – regulates and supports Spleen qi, clears heat, calms the spirit, and regulates the Heart.[11] It is the confluent point of the Yin Linking Vessel which circulates essence while supporting qi and blood in all the yin meridians.
• Ren 17 – regulates qi and unbinds the chest, benefits gathering qi.[11] “Gathering qi” provides both the nourishing and immune forces for the body. When it is deficient, the body weakens. Replenishing gathering qi restores the body’s reservoirs of qi and its innate ability to heal.
• Ren 12 – harmonizes the middle jiao, tonifies the Stomach and fortifies the Spleen, regulates qi.[11] Treats injury to the body by worry, anxiety, and overthinking. The important secondary action of Ren 12 is strengthening the Spleen in cases of deficiency. The Spleen’s ability to lift and hold, or “upbear”, is the function that enables pregnancies to remain secure and progress to full term. This is the same upbearing that is reinforced by the actions of Du 20. It is also the meeting point of various channels that regulate and circulate Source qi (stored in the Kidneys), further reinforcing the importance of selecting this point.
• K 3 (bilateral) – nourishes Kidney yin and clears deficiency heat, tonifies Kidney yang, strengthens the lumbar spine.[11] This is the Source point of the Kidney channel and thus the primary source of energy that nourishes pregnancy. It strengthens the lumbar spine which is the structure on which the pregnancy hangs.
• Yin Tang – pacifies wind and calms the shen.[11] This is a powerful and effective point for calming anxiety, agitation, and internal wind.
• St 36 (left) – fortifies the Spleen, tonifies qi and nourishes blood and yin, clears fire, and calms the shen.[11] As the organ’s elemental point on its channel, St 36 significantly strengthens the patient’s resources. It is viewed by the classic physicians as one of the most vital acupuncture points and is the single most important point for stimulating the Spleen to generate qi and blood.
• Sp 10 (right) – invigorates the blood and dispels stasis, cools the blood.[11] This point also has the function of nourishing the blood based on the saying, “if blood stasis is not transformed, new blood cannot be generated”.[11]
• Acupressure applied to the scalp adjacent to Du 20 reinforcing its actions.[11]
Equal in importance to upbearing qi to secure the pregnancy was the need to help the patient feel calm, secure, and grounded. Emotions are recognized in Chinese medicine as a cause or contributor of physical pathology.[9] Besides the physical exhaustion of internal resources, she was experiencing additional strain from a distraught emotional landscape. Concern about losing her baby was real and intense. Panic further depletes the body and scatters the qi, thus worsening the crisis. It is important for the practitioner not to join the patient in a place of panic or anxiety. Staying calm, centered, and focused on the solution provides the best opportunity for a positive resolution. In a space of healing and reassurance, the patient is reminded of their own body’s amazing ability to rebalance. If there is one thing all practitioners of medicine should hold central, it is to never underestimate the power of kindness in healing. Patients who feel heard, cared for, and safe have better outcomes.
CONCLUSION
Based on successfully halting the preterm labor presented in this case study and the similar results reported in the Tsuei study,[4] further investigation is warranted into the treatment of preterm labor using acupuncture. However, the small number of published cases that are currently available showing benefit are not sufficient to make broad conclusions. Initial indications are that acupuncture can be a safe and effective means of stopping preterm labor. Terbutaline has caused serious side effects including death in mothers and babies and is no longer recommended for stopping preterm labor.[12] With diminished allopathic options available, alternative means to address this crisis must be explored.
References
1. Malania, I., Martinez L., Matorras, R., Bringas, C., Aranburu, L., Fernández-Llebrez, L.,
Gonzalez, L., Arana, I., Perez, M. B., & Martínez De La Fuente, I. (2017). Estimation of preterm labor immediacy by nonlinear methods. PLOS ONE, 12(6), Article e0178257. https://doi.org/10.1371/journal.pone.0178257
2. Romero, R., Dey, S. K., & Fisher, S. J. (2014). Preterm labor: one syndrome, many causes.
Science, 345(6189), 760-765. https://doi.org/10.1126/science.1251816
3. Mayo Clinic Staff. (2019, December 24). Preterm Labor. Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/preterm-labor/symptoms-causes/syc-20376842
4. Tsuei, J. J., Lai, Y. F., & Sharma, S. D. (1977). The influence of acupuncture stimulation
during pregnancy: The induction and inhibition of labor. Obstetrics & Gynecology, 50(4), 479-488. https://www.ncbi.nlm.nih.gov/pubmed/904813
5. Poehlmann-Tynan, J., Gerstein, E. D., Burnson, C., Weymouth, L., Bolt, D. M., Maleck, S., &
Schwichtenberg, A. J. (2015). Risk and resilience in preterm children at age 6. Development and Psychopathology, 27(3) 843-858. https://doi.org/10.1017/S095457941400087X (Original work published 2014)
6. Prescriber’s Digital Reference. (n.d.). Terbutaline Sulfate – Drug Summary.
https://www.pdr.net/drug-summary/Terbutaline-Sulfate-Tablets-terbutaline-sulfate-1659.2088
7. Garfield, R.E., Shi, L., & Shi, S.Q. (2012). Use of progesterone and progestin analogs for
inhibition of preterm birth and other uterine contractility disorders. Facts, Views and Vision in Obstetrics and Gynaecology, 4(4), 237-244. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987481/
8. Maciocia, G. (2011). Obstetrics and gynecology in Chinese medicine (2nd ed.). Elsevier Ltd.
9. Deng, T. (1999). Practical diagnosis in traditional Chinese medicine (M. Ergil & Y. Sumei,
Trans.; K. Ergil, Ed.). Churchill Livingstone. (Original work published 1988)
10. Frank, B.L. & Soliman, N. (n.d.). Shen men: a critical assessment through advanced auricular
therapy. Acupuncture, Auricular Therapy and Auricular Medicine. https://www.auriculartherapy.com/articles/shenmen.html
11. Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture (2nd ed.).
Eastland Press.
12. American Society of Health-System Pharmacists. (2017, May 15). Terbutaline. Medline
Plus. https://medlineplus.gov/druginfo/meds/a682144.html
