Prolonged Delivery
Parturition lasting over twenty - four hours is defined
as prolonged labor. It is often due to weak contraction
and forceless contraction of the womb, or narrow pelvic
fetal and malposition of fetus.
Etiology and Pathogenesis
a) Deficiency of qi and blood: Weak constitution
with insufficient qi, exhaustion through premature contraction,
premature amenorrhea, and depletion of blood due to
hemorrhage, all lead to prolonged labor. In Understanding
of Childbirth, it says, Physical weakness and early
exertion of force have exhausted the mother before the
baby is delivered and thus the baby gets stuck. Dryness
in the vagina also brings about difficult delivery.
b) Qi stagnation and blood stasis: Fear or too much
worry over the forthcoming delivery retards qi and stagnates
blood. Extreme leisure during gestation leads to impaired
flow of qi and blood. Affection of external cold during
delivery hinders the circulation of qi and blood. All
of them are causative factors of prolonged labor. Just
as Golden Mirror of Medicine says, “Prolonged labor
derives from various factors such as seeking comfort
and ease and too much sleep, both of which lead to retarded
flow of qi; or from fright and worry over the oncoming
labor... and obstruction of vagina by blood stasis from
an injured uterus.
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Deficiency of qi and blood
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Main manifestations:
Dull and paroxysmal labor pains with mild weighing and
distending sensation, or profuse hemorrhage in light
color, pale complexion, lassitude, palpitation, shortness
of breath, pale tongue, and weak pulse.
Analysis: Since both qi and blood are deficient and
the puerperant is too weak to have uterus contraction,
there are mild abdominal pain, mild heavy and distending
sensation, and the delivery duration is prolonged. In
other words, there is not enough Qi to push
baby out, water breaks too early leaving no lubrication
to the birth canal, contractions are not powerful, woman
is pale, exhausted, woman feels like they can’t do it!
Qi
deficiency leads to profuse hemorrhage in light color,
pale complexion, lassitude, palpitation, and shortness
of breath. Pale tongue and weak pulse are signs of deficiency
of qi and blood.
Method: Points are
chiefly chosen from the Foot - Yangming and Foot - Taiyang
Meridians. Acupuncture is given with the reinforcing
method with moxibustion to tonify qi and blood, and
quicken the delivery.
Prescription:
- [ST36 - BL67 - SP6].
- [ST36 - BL67 - SP6 &
KI7 -
BL67 - LI4 - GB21]
Explanation: ST36 and SP6 may generate qi and blood
and tonify the spleen and stomach, while BL67 is an
effective and empirical oxytocic point. The three points
thus used together fulfill the set purpose of tonifying
qi and blood and quickening the delivery.
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Stagnation of qi and blood
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Main manifestations:
Sharp pains in the waist and abdomen, scanty hemorrhage
in dark red color, prolonged delivery course, dark bluish
complexion, depressive mood, fullness in the chest and
epigastruim, frequent nausea, dark tongue, deep forceful
pulse. This can also be about the first delivery, very nervous,
may have been a lack of exercise throughout pregnancy, before
labor, too cold in delivery room, delivery room is
not a comfortable tranquil environment, severe abdominal
pains but the baby is not moving well, blood is dark red,
woman is very irritable
Analysis: The retarded circulation of qi and blood
gives rise to the sharp pain in the waist and abdomen
and prolonged course of delivery. The stagnated qi does
not ascend as usual, bringing about the dark bluish
complexion, fullness and distension in the chest and
epigastrium, and frequent nausea. The dark tongue and
deep and forceful pulse indicate qi stagnation and blood
stasis.
Method: Points are
chiefly chosen from the Hand - Yangming and Foot - Taiying
Meridians. Acupuncture is given with the reducing method
to regulate qi and blood, activate qi so as to quicken
the delivery.
Prescription:
Explanation: LI4 is the yuan-source
point of the
Hand - Yangming Meridian and SP6 is an intersecting
point of the three foot yin meridians. The two paired
together may regulate qi and blood, clear off stasis
and speed up the delivery. BL67 is an effective and
empirical oxytocic point.
Note:
Duyin is located on the second distal phalangeal
joint on 2nd toe.
Remarks
Acupuncture and moxibustion carry an oxytocic effect
to the prolonged labour due to weak uterine contraction.
Measures other than acupuncture and moxibustion should
be taken in case of prolonged labor caused by uterine
deformity or contracted pelvis.
Delivery that lasts
more than 24 hours. Usually caused by either Qi and Blood
deficiency or stagnation.
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Alternative Treatment
Methods
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- auricular- uterus, subcortex,
sympathetic, KI abdomen, intestines, BL, medium to strong
stimulation every 3-5 minutes.
- electrical- BL 31, 32,
LI 4, SP 6, tens pads (not as effective), strong intermittent
frequency
