Acupuncture can help alleviate nausea, constipation, and back pain. It can encourage breech babies to flip and labor to start. But how does it work, and what does it feel like? Acupuncturist, massage therapist, and birth doula Dr. Patrick Boswell talks with Adriana about how acupuncture gets to the root of the issue, with the happy result of improving more than the symptoms you came in for!
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- A New Life Acupuncture, Patrick’s practice
- Is acupuncture safe during pregnancy? BabyCenter
- Acupressure and Acupuncture during Birth, by Claudia Citkoviz, PhD, LAC
- Does Acupuncture Have a Place as an Adjunct Treatment During Pregnancy? A Review of Randomized Controlled Trials and Systematic Reviews, Birth: Issues in Perinatal Care
- Research on Acupuncture in Pregnancy and Childbirth: The U.S. Contribution, Medical Acupuncture
- Current state of clinical application of acupuncture therapy in maternity department in countries outside China, Acupuncture Research (Zhen Ci Yan Jiu)
- Acupuncture for pelvic and back pain in pregnancy: a systematic review, American Journal of Obstetrics and Gynecology
- Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial, British Medical Journal (BMJ)
- Cochrane Systematic Reviews Examine P6 Acupuncture-Point Stimulation for Nausea and Vomiting, The Journal of Alternative and Complementary Medicine
- Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy, Complementary Therapies in Medicine
- Acupuncture or acupressure for pain management in labour, Cochrane
- Effect of Acupuncture on Induction of Labor, The Journal of Alternative and Complementary Medicine
- Influence of Acupuncture on Duration of Labor, Gynecologic and Obstetric Investigation
- Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: A systematic review, Complementary Therapies in Medicine
- Ethical Considerations for Including Women as Research Participants, The American College of Obstetricians and Gynecologists committee opinion
- Off-Label Use: Licensed & Unlicensed Indication, Misoprostol: Safe usage guide for Obstetrics and Gynaecology
- Off-label use of misoprostol in gynaecology, Facts, Views & Vision: Issues in Obstetrics, Gynaecology and Reproductive Health
- Possible evidence for care and treatment in the Tyrolean Iceman, International Journal of Paleopathology
- What Ötzi the Iceman’s Tattoos Reveal About Copper Age Medical Practices, Smithsonian Magazine
- 5000-year-old ‘Iceman’ may have benefited from a sophisticated health care system, Science
Related Birthful episodes:
- The Induction Process
- Baby’s Position and Labor Flow
- Ways to Deal With Morning Sickness— Whether It’s Mild or Debilitating
Understanding Acupuncture From a Physiological Lens (and Why You Shouldn’t Fear the Needles!)
Adriana Lozada: Welcome to Birthful, Mighty Parent or Parent-To-Be! I’m Adriana Lozada and I’m delighted you are here listening today as we start getting toward the end of our series on Movement and Body Wellness in Pregnancy.
Now, if you’ve been listening to the podcast for a while now, you certainly have heard acupuncture come up as a common tool used to help with a multitude of symptoms, including nausea, flipping breech babies, and getting labor to start. But how does acupuncture work, and what does it feel like? To answer those questions and so much more, I will be talking today with Dr. Patrick Boswell, who is a board-certified acupuncturist, and massage therapist, as well as a birth doula. His broad skill set and experience give him a very unique perspective on how to best help his perinatal clients, based on his multifaceted approach to medicine and the body, and I can’t wait to get this conversation going.
One thing I want to mention in case you are wondering is that when Patrick talks about OP presentation he’s talking about a baby that is posterior— meaning the baby’s back is toward the birthing person’s back— and this is a fetal position that generally makes labor more difficult, usually with what’s called “back labor,” meaning pain in your lower back.
You’re listening to Birthful. Here to inform your intuition.
Adriana: Welcome, Patrick. I am delighted to finally do this conversation, and for you to tell us all about acupuncture!
Patrick Boswell: Me too!
Adriana: Let’s start off: Tell us who you are, how you identify.
Patrick: I’m Dr. Patrick Boswell. I go by he/him pronouns and I’m an acupuncturist, doctor of acupuncture, and a massage therapist and a birth doula. I’ve done all the postpartum training, postpartum doula trainings. I just say I’m an acupuncturist. I practice in Rochester and then I have hospital privileges with the University of Rochester at two local hospitals, Highland Hospital and Strong Hospital where my privileges are with the OB/GYN department. I do inpatient treatment during antepartum labor delivery postpartum at both of those hospitals.
Adriana: Which is huge— the fact that there is this recognition that the work you do, acupuncture, works and helps during labor. Full disclosure, you said you’re in Rochester, New York. For people to understand: Rochester, New York has a fantastic birth community.
Patrick: We really do!
Adriana: We are so lucky. Patrick and I are part of the doula co-op together and we’ve known each other for as many— eight years, I guess, or more? Acupuncture! We’re going to start thinking of approaching it from a person who’s never done acupuncture—
Adriana: —who’s even scared of needles. Let’s go with the basics: How does acupuncture work?
Patrick: When we’re getting into the physiology of acupuncture and the basic science data and research that’s available at this point, a lot of it is based on some research done by a woman named Helene Langevin. She studies fascia and stretching and muscle and all that stuff. She was very fascinated by acupuncture and what its action was and especially this concept of deqi, which is the tissue almost grabbing the needle.
It doesn’t necessarily feel like it’s grabbing, but you get this hold on the needle, there’s a little bit of resistance. She did some research and found that what happens to the actual tissue is the fascial tissue, the connective tissue that wraps our whole body. It’s under our skin, it wraps our muscle cells and the bundles and the whole muscle. It’s on our organs, it goes into the brain, everywhere. It’s this webbing that holds us all together and creates this lubrication between tissue because all these layers are on top of each other.
When we want to move, we want that good lubrication so that everything slides and moves around. It goes into the fascial tissue, the muscle tissue, and creates a stretch reflex. The tissue, the collagen fibers, actually grab hold of the needle and twist as we’re inserting, manipulating. Then it creates this stretch reflex about two centimeters (is what the study showed), where you’re getting a passive stretch in the tissue for about two centimeters. That’s part of the basic science.
Then we know that drops cortisol levels (which is a big stress hormone), also in pertaining to birth and all this stuff, antagonist oxytocin. Drop cortisol levels, release endogenous opioids from the brain that are like painkillers, endorphins, all this stuff. Increase local circulation and local immune system response. To me, that kind of stimulation where we know– it’s a passive stretch. You’re not engaging one muscle to stretch another muscle, it’s just passive.
We know from congruent stretching research (like yoga and all these other things) that you’re getting that sympathetic-parasympathetic (fight-or-flight, rest-digest) coming back into order so that our body just does the normal functions it’s supposed to do under less stress. To me, that’s a big part of the physiologic actions of acupuncture, is restoring that balance and the nervous system and getting the body to just function the way it’s supposed to. We’re not making the body do anything it’s not supposed to do or it can’t do. We’re just trying to optimize the function you already have.
Adriana: That’s really an interesting point of view, because I’ve never heard acupuncture described from that physiological neurological perspective. I think it would be remiss of us to not speak also of the East Asian medicine tradition of where this all really originated and what the lens that it’s seen through there so that people get a full holistic view of acupuncture.
Patrick: From a Chinese medicine perspective, what we’re doing with the needles and the insertion and the stimulation, very specific and have the qi do what we want or have the body do what we want, get certain stimulation in the area. When we’re talking in a Chinese medicine perspective, we are inserting the needle into a channel. I don’t like meridian. I think it’s a bad translation. I like “channel,” and channel, almost like “river, a stream,” because we say in Chinese medicine, qi and blood flow through the channels.
Adriana: Qi would be— the “bad” translation is “energy”?
Patrick: To me, “energy” or even “vital energy” and everything like that is a bad translation that comes from a Frenchman in the turn of the century who went to China and studied with some doctors and came back and thought he knew everything. He said qi equals “energy” but now we’re taking classic Chinese into modern Chinese into French into English. There’s this game of telephone where we lose a lot of the cultural understanding of what qi is.
Realistically, the answer to what is qi is a two-page paper. It’s a cultural concept. It’s not a one-to-one translation. Qi is a word that’s just used in the language. The word for weather is tiānqì or “heavenly” qi. It’s not necessarily this vital energy. It’s: What’s the sky doing? What’s the weather? What’s the sky doing? If it has to be a one-to-one, I prefer a translation more of “function.” When we’re referencing qi, we’re referencing the function or the functioning of whatever we’re associating it with.
If we say spleen and stomach qi deficiency, basically what we’re saying is the function of the spleen stomach or even translating that into more digestive system. The digestive function is limited or it’s less or it’s not functioning at optimal. To me, qi equals function is a much better translation than qi equals energy. I think it’s definitely one of those things where we lose a lot by translating.
Adriana: Translation’s not only in language, but also in lived experience and worldview. When you talk about this Frenchman, he was looking at it from that perspective and then co-opting it.
Patrick: Absolutely. It’s a whole ‘nother topic, but cultural appropriation of Asian medicine, Ayurvedic, Chinese medicine, Japanese, Korean, all these things. Even taking these concepts out of context and going like, “That sounds really interesting. Let me use that for something else,” and not understanding the full context of where it came from, who wrote it, why it was written. The context is super important for all of this stuff. That’s a different conversation.
Adriana: Absolutely. I’d so appreciate your lens of looking at it that way and understanding that the context is different and not just going with, “Oh, qi, it’s energy,” we’ll just translate it like that but really going deeper and trying to get as close to the original text and concepts as possible. For people who have never approached acupuncture and are maybe even afraid of the needles, can you speak to that in terms of: How tiny are these needles? And: What do people feel?
Patrick: What I use in practice is typically somewhere between 0.2 and 0.3 millimeters wide. We’re talking about the width of a human hair, except for it’s just sterile stainless steel one-time use. Then all the nerve endings for, really, pain are right on that surface level. The objective is to get through that surface level, that top layer of skin, real fast— because if we can get through it real fast, your body doesn’t have a chance to have a nervous system response or a pain response.
Then once it’s through there, the sensation can be— what I tell people is normal to feel is a heavy sensation, a deep sensation, sensation that moves, temperature changes, a buzzing or a tingling, and then sometimes just a weird sensation that’s hard to put words to where you’re like, “This feels weird. It doesn’t hurt but it just feels weird.” That’s okay. I think we live in the weird and that’s totally fine for me. The other thing especially with pregnancy or an end of pregnancy is increased fetal movement.
Feeling your baby move a lot more while you’re getting acupuncture can be totally normal. Then the things we don’t want are sharp pain or uncomfortable, because it’s not supposed to be an uncomfortable process. It’s supposed to be relaxing. You’re supposed to try and get that sympathetic-parasympathetic balance back.
Adriana: How long is the treatment?
Patrick: From person in the door to out the door, it’s usually about an hour for me. It can be different for different providers. Especially on first visit, I do a lot of talking, where we really chat about these things and dive into bigger concepts, because I’m a firm believer that education is 50% of any medical treatment because you’re only seeing that person for a short period of time. To me, knowing what’s going on and knowing the concepts and understanding further about what your body’s doing, why it’s doing it, is important to truly understanding what’s going on.
You come in, we chat about what’s going on, health history, dig into some stuff. Most providers will look at your tongue and we do a diagnostic thing there where we just look and it gives us some ideas of what’s going on. We’ll take the pulse. We’re taking the pulse, not just for how fast it’s going, but the quality of the pulse and so we’re assessing the quality of the pulse, and that can tell us a bunch within Chinese medicine and then asking the questions and into all different systems.
Even if you’re coming in for, “My low back hurts” we’re going to dig into menstrual cycle, we’re going to dig into “Do you feel warm or cold? How’s your digestion? Do you sweat a lot?” All these things that don’t necessarily seem like they connect but within our system, we’re building a larger picture of what your body’s doing, instead of just going like, “Oh, low back pain, let me put a needle in there.”
It’s going, “Well, why is there low back pain?” and “What’s contributing factors? Where’s the root of the problem?” We still will probably put needles in your back but we want to figure out the larger picture so that the body can heal, and resolve the issue as well as a bunch of other issues. Even if you come in with low back pain, and it turns out, like, “Oh, well, I get a little acid reflux, and I get a little nausea and I’ve got a rash over here. I get headaches sometimes,” we’re putting that all together and trying to treat you as a person, rather than just treat your list of symptoms. Most of the time, those symptoms are coming from a very similar root and so we want to find that.
Adriana: Right, and when you get to the root of the cause, then those symptoms probably change—
Adriana: —in some way and you might get benefits that are beyond, are more holistic, are more systemic. Rather than just your lower back pain, it might fix your insomnia as well.
Patrick: Absolutely. A person will come in and we’ll chat about all this, and then put in some needles like you’ll lay down, put in some needles. Then usually, we’re letting you sit for 15, 20, 30 minutes with needles in, checking on you regularly, making sure that everything’s still comfortable, and giving you that chance to relax and let that tissue stretch because that’s really—
If we’re talking about that, physiologically, you’re getting the stretch reflex. When was the last time you sat down and you did a single stretch of a single muscle for 20 minutes?
Patrick: I don’t do that. It’s giving the tissue a chance to slowly unwind and relax and get the time it needs to respond.
Adriana: I find that sitting there for 20 minutes, letting the needles do their thing, it’s a beautiful opportunity for meditation and nap.
Adriana: I think 8 out of 10 times, I fall asleep.
Patrick: Yes, a lot of people fall asleep, a lot of people go like, “Really? It’s over already? I feel like I was in here for 5 minutes,” and it’s been 30 minutes. It really gives your mind a chance to calm down. Actually, there’s some really neat research that showed that— we call it acupuncture sleep, where when you fall asleep, you get into this deep meditative state during acupuncture and they show that it’s very similar to meditation where 15 minutes of it, 20 minutes, almost counts as two hours of sleep.
Adriana: Let’s ground it in the pregnancy realm, say some symptoms that people may come to you for during pregnancy, what would those be?
Patrick: Talking early pregnancy, it can be mild nausea to severe nausea— vomiting many times a day. I’ve had patients that they can’t keep water down to that extent where they’re going in for IV—
Patrick: Yes, twice a week and they’re on all these medications that just aren’t doing anything. With super severe stuff, we’re trying to treat sometimes even two, three times a week, just because of that, most of the time, it’s once, twice a week. I tend to do more just once a week, but for really severe chronic stuff, sometimes twice a week, especially in the beginning. Then what I tend to say about almost all modalities is, if you’re not seeing a marked change within three to four visits, either the provider is missing something, or it’s probably not the right thing for you or not the right provider for you.
Especially with acupuncture, it’s what we call a “slow” medicine, but it’s not a snail. You should be seeing changes even within a few visits. If the diagnosis is correct, if the treatment is correct, then things should change. Maybe it’s “I threw up only once every day,” instead of three times a day. Wonderful, that’s improvement!
Adriana: We honed in on nausea, what are other early pregnancy symptoms that acupuncture can help with?
Patrick: Sometimes the fatigue that happens. I also treat habitual miscarriage, where people have a chronic issue of miscarrying. It could be early, it could be 12, 14, 16 weeks because that’s another thing that we don’t talk about enough. It’s way more common than we like to think, habitual miscarriage. It can be sometimes headaches— the little aches and pains. Those tend to be the most common early pregnancy-type symptoms.
Then moving forward, second trimester tends to be a lot smoother and so oftentimes, I’ll tell people like, “Come in every four-six weeks,” something like that, or, “Just come in if something’s bothering you. Come in and we’ll see what we can do.” That can be the list of pains that can happen, that can be insomnia, that can be hemorrhoids, it can be strong Braxton-Hicks. Braxton-Hicks very early or cramping throughout. Sometimes even prolonged spotting or bleeding where you’re not necessarily worried about miscarriage, but you don’t really want to be spotting bleeding the whole time.
Patrick: Yes, and then when we move to third trimester and end of pregnancy, then we’re doing obviously more pain, more pelvic pain, pubic symphysis disorder, round ligament pain, sacral stuff, and then even lightning crotch, that kind of thing.
Adriana: They’re wonderfully named “lightning crotch.” [Laughs.]
Patrick: I love that one. Then we’re moving into breech, treating non-vertex presentations. Then moving more into getting the body ready to transition from holding baby in to getting baby out.
Adriana: That’s a really interesting conversation, in that that can get us into the “forbidden point” of acupuncture because as we’re talking about all the benefits of acupuncture, is there any [contraindication]? Is there anything that should be avoided? I find that the research is spotty, and you’ve got people on all camps so it’s really hard to figure out for anybody, for me, for people who go to do acupuncture. Should I do it or should I not?
Patrick: Honestly, it’s true for a lot of acupuncturists too. I have a bunch of colleagues that when they’re treating pregnant people because they’re just not used to it, they’ll contact me and be like, “Is it okay to do this? What does this mean to you? What should I do in this case?” The idea of these contraindicated “forbidden points,” to me, is basically just a boards question.
When you’re taking your licensing test, you need to say like, “These are forbidden during pregnancy because they can induce labor,” but in practical sense, if it was easy to induce labor with acupuncture, there would be an acupuncturist in every single maternity ward in the entire country because it’s not the case. Even when I’m trying— in a hospital, trying to get somebody into labor, or trying to get somebody’s body there, or move them closer, it’s hard.
This medicine is a medicine of the individual and so every patient is different. A point that we say regulates contractions in somebody. If you’re not having contractions, what are we regulating? Nothing. Maybe we don’t want to do strong stimulation when somebody is 20 weeks pregnant on some of these points just because but it’s not like brushing past these points are going to cause anything bad to happen. I think a lot of this comes from context, of: Who wrote it? Why it was written. When was it written? What were the other factors involved in that? A lot of that we don’t know because a lot of these things are thousands of years old.
Adriana: What I’m hearing is that, circling back to it being really important to have a provider, an acupuncturist, who has the experience with pregnant people, and also is really good at understanding the individuality of the situation.
Adriana: It’s a toolkit. You might have a hammer and a screwdriver there. I could use the screwdriver, using it on the back if I need to hammer something, but truthfully, I need— this hammer would be better.
Patrick: Yes, absolutely. Just me as a person, I’m not really afraid of the pregnant body. I don’t think there’s anything extra to be afraid of. I think there’s so much fear associated with everything and that’s part of the reason why our healthcare involved in pregnancy and postpartum is what it is, it’s because we’re afraid. Why should we be afraid? If we understand the body, we understand the physiologic mechanisms, we understand what we’re doing, then we should be confident in our ability to do it and not cause problems.
Adriana: As you mentioned before, you’re very much a person of giving the person you’re treating knowledge and understanding of what you’re doing. It’s not like, “Oh, I’m just going to go ahead and needle all these points for you.” I’m guessing there’s a conversation that you have with them.
Patrick: There is a conversation that’s— you let me know what you’re feeling. If you feel something weird even tomorrow let me know because, oh, maybe that was a little too strong, or maybe that wasn’t strong enough, or maybe we shouldn’t do this, or we should do this instead. I think understanding physiology is a huge part that I think a lot of acupuncturists miss, in my opinion. That comes from my massage background. That comes from, honestly, my doula background— is learning about the pregnant body, birth, postpartum. Physiologically, what is it doing? What’s happening throughout the body, structurally, hormonally, everything?
Then feeding that through the lens of Chinese medicine helps you understand more of what you’re capable of and what you’re not capable of within the medical system that you’re using. It’s just a toolbox, like you were saying. The body is the body. We won’t get too much into it but acupuncture is not a unique thing to China. People were putting needles in their body or doing medicinal tattooing, and all of these kinds of things all over the world. Even the Iceman Ötzi, the one from— where did they find him? They found him in the Alps and he was a 4,000-year-old frozen dude. He had all these tattoos all over his body.
They figured out that 75 or 80% of the tattoos aligned with acupuncture points. That guy didn’t go to China! The body is the body. You can only see it so many ways. To me, the channels are the nervous system, they are the blood vessels. They are the muscular channels. It’s all of this combined. You’re interacting with all of this tissue because you can’t not. That’s just how the body works. You can’t do something to just one system in the body. It doesn’t work that way. We’re very complex beings.
Adriana: You mentioned a thing about people being so cautious with pregnant bodies. When I look at the research, even ACOG had a statement. I can’t remember. It was 2008, I’ve got to look up the year. ACOG had a statement where it was saying, “We need more research. We’ve been so afraid of the pregnant body that then we don’t know what works and what doesn’t. While keeping being ethically responsible while not putting people in danger, we need to actually have some good research.” Since then, more and more research has been done relating to acupuncture and I’m sure to all modalities, but specifically to the perinatal period.
What I kept coming upon, was there, that fear of— for example, some might say definite conclusions about its effectiveness cannot be reached, and further research is justified, or there is a need for more research, or further randomized clinical trials are needed to investigate this further. There’s something there… but we can’t completely say just yet.
Patrick: I think one of the things that people miss is that that’s pretty true across all medicine. We tend to think of— they’ll call it CAM or “complementary alternative medicines,” things like that. We’ll go like, “Oh, well, there’s just not enough research.” There are things that happen every single day in every single medical office that are not evidence-based, that are just some things somebody came up with 100 years ago. They go like, “Well, that’s just how it’s always been done.” Stuff happens every day, that happens with medication, it happens with procedures, it happens with all of these things. I think part of the thing is, we’re holding this other stuff to a standard that doesn’t exist for everything else.
We go, “Oh, okay, well, we really don’t know why it works. We see that it does something but we don’t really know why it works.” There are infinite things in medicine where we have no idea why it works. That’s where off-label prescriptions even come from. They go like, “Okay, well, we’re going to do all this research on this very specific medication that’s supposed to do this very specific thing.” Oh, and then we notice it does this other thing but we don’t really know why.
Adriana: For this other population, like misoprostol?
Patrick: Yes, misoprostol. “We don’t really know why… but we can theorize… so we’ll just make it up.”
Adriana: Huge, important thing for people to understand that one of the most widely used medicines for cervical ripening in an induction is having an off-label use.
Patrick: It’s an ulcer medication.
Adriana: I think it’s important for people to view all this through their critical lenses and whatever standards they want from any of their care, it needs to be applied to all of their care.
Patrick: Absolutely. I wholeheartedly agree. I think part of the other thing that sometimes people miss is that when you’re doing a physical modality, acupuncture is very much a physical modality. You are physically inserting a needle; you are physically getting a tissue response. All of this stuff is very hard to do gold-standard, double-blind, randomized control trials on the physical modality.
You can’t do it on surgery, you can’t do it on PT, you can’t do it on chiro, you can’t do it on acupuncture. You can try and blind the patient. You can’t blind the provider… doesn’t work that way! You can’t get “gold standard.” You can’t hold a physical modality to the same… You can’t have it be a prescription medication. The research isn’t the same.
Adriana: When somebody is looking at an acupuncturist, what should they look for in their practitioner when they’re pregnant?
Patrick: Definitely somebody who’s talking about pregnancy on their website or they have experience with pregnancy! Also, I tend to be a big fan… When I have patients that are moving or they’re like, “Hey, my family member wants to find somebody, can you…?” I’ll do a little Google Search of the area and look at people’s websites and stuff. The stuff that really makes me personally go like, “Oh, yes, you should see that person,” is other things than just the acupuncture. If they do just acupuncture, I think it’s totally fine if that’s the way they want to practice. I just feel like it’s doing a disservice to the medicine as a whole because it’s not just acupuncture.
The medicine is really five main parts and it’s acupuncture, it’s Chinese herbal medicine, it’s bodywork, we would call it tuina. It’s our version of PT/chiro/massage-like structural physical bodywork. There’s dietary therapies and there’s self-care exercise. We do Qigong, we do other things like that which is like “Chinese yoga”— it’s what I call it, because it’s the easiest way to picture it. If they’re just doing acupuncture and they don’t do herbs and they don’t do bodywork, and they don’t talk about diet, and they don’t really talk about movement, I feel like you can get a lot of results, but I think in the long run, it’s not as good. It shows me that the provider understands that this medicine is more than just one thing.
Adriana: Has more tools in their toolbox.
Patrick: Has more tools in their toolbox. To be honest, acupuncture’s not the right answer for everybody. I have patients come in and we go like, “I don’t think acupuncture’s going to work… but let’s do herbs, and let’s do some bodywork. Let’s take a look at what you’re eating and how you’re eating it,” versus that.
Adriana: Also because you’re doing a very time-specific treatment. The needles are there for some time and then the treatment works for an extended period of time, but then your body goes back to its normal tendencies if you didn’t take away whatever else was causing the situation. If you’re eating sugar all day long, there’s only so much acupuncture can do for gestational diabetes.
Patrick: In those cases, it’s that education, trying to work with people to see what they can change, what they want to change, what they don’t want to change, and working with that in there to make a larger life benefit rather than just symptom treat.
Adriana: Looking at an acupuncturist that is familiar, that has a lot of experience with pregnant population or perinatal work, and then making sure they’re not doing just acupuncture.
Patrick: Yes. That’s just a me/personal thing.
Adriana: That’s helpful.
Patrick: Especially like if they do moxibustion, a plus.
Adriana: Let’s talk about moxibustion. What is that? That’s a great segue into turning breech presentations.
Patrick: Moxibustion is a technique within Chinese medicine, and it’s actually a part of acupuncture theory. Classically, acupuncture and moxibustion are related. They’re like brother/sister. It’s a warming technique. It uses an herb called “Chinese mugwort” or Artemisia vulgaris is the Latin. It’s a plant that probably grows in the parking lot down the street. It’s just a weed that grows. What happens is they prepare it, they grind it up and so it’s just the plant fiber left and you burn it over specific areas. It can be just general areas, it can be acupuncture points, it can be all sorts of things.
For the most part, you’re just burning this herb over a point for the purpose of warming the area, warming the point. For breech, we’re doing it on the outside of the fifth toe, the little toe. The protocols vary a little bit, but the standard protocol tends to be 10 to 15 minutes each foot once a day. Depending on when somebody’s coming in for breach or taking a larger look at pelvic structure, intention and not just going like, “Oh, breech, here you go, this is the breech protocol.”
Really taking a look at, like, why the baby’s breech. That can get into Spinning Babies trainings that I’ve done, and more physiological understanding, and structural. Really taking into account why the baby’s breech and looking at it from not just a strictly Chinese medicine perspective. The research is pretty good on it actually. It shows that especially before 36 weeks, it’s right around 60% of people turn with a combination of acupuncture and moxibustion, versus the 45%, which is typical. It bumps it up some for sure. Every day for ten days is a course of moxa, is what we say.
Adriana: If a person has their baby in a non-optimal position, whether it be breech or posterior, then the idea is, especially for breech, the sooner the better—
Patrick: The sooner the better.
Adriana: —to start getting treatment?
Patrick: There’s more space. Frankly, there’s more space for a baby to turn earlier. We’re adding on to that. There’s a good chance your baby turns without doing anything. I think we have to admit that we’re not saying, like, “Oh, moxibustion is this amazing thing that’s going to definitely turn your breech baby and nothing else will.” There’s a good chance your baby will turn on its own if you did absolutely nothing. This just improves the odds. Before 36 weeks is preferred, I treat people as late as they find out or they want to come in. Then, I’ve heard stories of babies turning on the OR table for a scheduled cesarean.
Adriana: Smart baby.
Patrick: When I hear that, it makes me go like, “Oh, they were holding”— they were mentally holding that baby. As soon as the anesthesia kicked in and they couldn’t physically use their mind to hold that baby, even subconsciously—
Adriana: It would’ve never been intentionally!
Patrick: —then baby just “whoop,” because now the space is there.
Adriana: The tissue is relaxed! I see that sometimes in really long labors where the uterus is getting crampy and tired and things are getting a little sloggy and somebody gets an epidural.
Patrick: Oh yes. Then it just changes.
Adriana: It can be a really good tool for that.
Patrick: I see that with epidurals too, where oftentimes it’s that person that craves control and for some reason, their brain just will not shut off. It’s not their fault, it’s just what it is. That physical mind, body break, that epidural goes like, “You can’t control this anymore.” The body could just allow the physiologic function to happen without the frontal lobe interfering.
Adriana: We know that we need to get to Laborland, we need to get to a deeper brainwave, we need to shut off that thinking brain. If that thinking brain is so strong that it won’t shut off, then it’s really difficult to create some labor, which then brings us back to another benefit of acupuncture. Which is that when you’re on the table and going to those deep brainwaves, you’re actually helping your body practice—
Patrick: Absolutely. To me, that’s a lot of the function of acupuncture, to ripen the cervix and get the body in a better place, get that sympathetic—parasympathetic back—
Adriana: To some balance?
Patrick: —to what we want it to be, to that balance. Mental tension, physical tension comes down. Hormonal function, digestive function, immune function comes back up. And we regulate. It’s that going back to we know we’re dropping cortisol levels, and cortisol is an antagonist to a bunch of hormones, but oxytocin. You are feeling the physical effects of stress less. The hormonal system allows the body to do the physiologic function it’s supposed to. It’s not the person’s body doing anything wrong either. It’s built to do this, it’s evolutionary in your system to have a mechanism of, “I’m giving birth in the woods, twig snaps behind me. I need to stop this labor, I need to move to safety, I need to start again.”
The problem is that now it’s not a twig snapping, it’s the machine beeping and it’s the lights and it’s the people bothering you. All of those things are stress responses. They are all triggering this sympathetic response. Cortisol level comes up, shuts things down, because your body doesn’t feel safe enough to enter into the vulnerable state that is labor. Labor is evolutionarily the most vulnerable you will ever be in your entire life. You need to feel as safe as you possibly can. Acupuncture can help re-regulate some of that too.
Adriana: I really appreciate how it can do that, while at the same time checking the mental box of I did something for this.
Patrick: Absolutely. When was it? Maybe a year ago or something, but I got called in, she was a patient of mine ahead of time, went in, getting a lot of back pain, a lot of sacral pain. I walked in that room and within three minutes I was like, “Oh, this baby is just OP.” The contraction pattern, the pain, the sensation, everything was just screaming OP to me. I was like, “Okay, we’ll do some of this stuff that I do for turning OP and some body work and trying to get the baby to turn.” She was in a better spot. I left, because she had a doula.
My place in the birth as an acupuncturist is when there’s something going on that needs to be corrected, I come in hour, two hours, sometimes three or four, but usually, it’s an hour or two, try and address the problem, fix it, get it to a better spot and then turn it back over to your birth team. I left and I was like, “If you need anything else, just let me know.” I got a call again, probably another four hours, five hours, or something. They were like, “Oh, she really just wants you to come back in.” I came back in and she was laying on her side sleeping between contractions and waking up to just go like, “Oh,” and then go back to sleep.
I looked at the doula and I just mouthed, “Why am I here?” She was like, “She just was like, ‘I need Patrick to come in.'” That was when I went like, “Oh!” There’s literally nothing pathologic going on right now. It was that mental block. She needed me to come in so that she could feel like she could do it or that she could move to the next step. I literally just did some hip rocking and some doula stuff and I just let her doula take a nap for an hour and then she woke up and I left. It was that mental block, it had nothing to do with acupuncture, it had nothing to do with— it was just that.
Adriana: It’s so complex.
Patrick: It’s so complex. The body is infinitely complicated and we’ll never truly understand it fully.
Adriana: Talk to me about induction because I feel like… Is that the thing you get called in for most?
Patrick: Yes. When I get called inpatient, it’s mostly to assist with an induction. It’s one of those things where we’re not supposed to say, “Acupuncture induces labor,” which it really doesn’t. That’s not the goal, especially for me. I’m not a fan of trying to take a sledgehammer to break open a door, when we could just try and unlock it and turn the handle because then at that point, what am I trying to do? I’m trying to be Pitocin or something.
I don’t want to be Pitocin. Pitocin has its functions and it can be great, but that’s not me. I’m not Pitocin. I’m not trying to force the body to do something that it doesn’t want to do. That’s not within my capability. It’s about taking down the roadblocks, so to speak. Whether that’s mental or physical or position or hormonal or whatever, to get the body to progress organically to what it’s supposed to do.
When I’m in the hospital, it’s a little different story because as soon as you enter the hospital, now you’re on a timeline, which means I would like you to meet that timeline and so that means now I’m on a timeline. Now, I need to try and get a physical noticeable change as quickly as possible, which tends to mean that intensity and strength of the treatment goes way up. People that have had acupuncture before, I’m saying, “This is probably going to be a lot more than what you’re used to,” and people that have never had acupuncture, I go, “This is not what a normal treatment is like.”
Adriana: What makes that difference?
Patrick: It’s just the intensity, it’s just the sensation that we’re attempting to get is a lot more. Those heavy sensations, those weird sensations, the sensations moving up or down a limb or just heavy, achy, baby moving weird, all of these numb, sometimes even numb sensations. We’re really working to get those sensations, because it’s an indication that we’re affecting the nervous system right now. We’re getting a [stimulus] right now because that’s what we need to do.
If you’re in the hospital and you’ve had one dose of miso and it’s 40 weeks induction or something like that or even 39, we’re not necessarily even doing a treatment like that at that point because, again, your body’s working through this still. It tends to be more of a premature rupture membrane induction where they don’t want you to go four days or it’s active labor. We’re trying to change the position of a baby, trying to treat certain pains, difficulty pushing, failure to progress, getting stuck at a centimeter, maybe not transitioning fully.
Adriana: The scenario that I am more familiar with is pregnancy is starting to get into that 41 week or something is up and they’re looking at an induction, talking about an induction for next week or they’re having prodromal labor that is just not organizing labor and it’s going on for days and days and saying, “Hey, acupuncture, you haven’t been doing it… but acupuncture could really be a really good tool here. Why don’t you try it?” What I tell my clients because I know that the treatment at that point is a little different than usual treatment, I tell them, “This is like Viking acupuncture. There’s going to be a little bit more intensive!”
Patrick: I think the funny thing is it’s not even Viking acupuncture, it’s just Chinese acupuncture. Honestly, real Chinese acupuncture is very much— and Chinese medicine, in general— is very much a “This is going to suck today and feel good tomorrow” thing. In America, in the United States, we cut down on sensation a lot.
When I was in China, the amount of stimulation and the amount of intensity of treatment that I saw for just regular everyday people was at least two to three times what we do. It’s just accepted. I think it’s part of that— I don’t want to call us “babies” or anything, but we’re not good with a lot of sensation. It freaks us out, which is totally fine.
Adriana: We do everything we can to avoid pain.
Patrick: Oh, totally. We do everything we can to avoid sensation and pain and being uncomfortable and it’s just part of it. The funny thing is it’s actually more of a traditional Chinese treatment to just be like, “You’re not going to like this but it’s going to work.”
Adriana: I think this matches what you were saying before, of “You’re not Pitocin,” of that you’re helping the body do things. I feel that I don’t see acupuncture get labor going, but I do see it get the body more ready, even be more of a cervical ripener, get the body more ready to accept labor or the induction, and make for an easier experience once it gets going.
Patrick: Even the data we have as of now is— because I wrote a paper on this as part of my doctoral program on acupuncture for preventing c-sections. Honestly, there’s really no conclusive evidence. There’s no good data that shows that it reduces c-section rate. What it did show, from that research, is that it raises Bishop scores and it raises cervical dilation. Even over a 24-hour period, it’s usually an extra one on the Bishop score or an extra centimeter or more effacement or more softening, or things like that.
Adriana: Can we explain what the Bishop score is?
Patrick: Basically it’s just a score that providers use to determine how effective they think the induction is. Is it the right call to induce now, or is it better to just wait?
Adriana: They start with a Bishop score to understand, “Do I start with a cervical ripener or can I go directly to Pitocin?” because Pitocin is just going to create contractions, but the cervix is really long and tight and closed.
Patrick: Then what are those doing?
Adriana: Not much. You’ve got to have a— and that’s where it’s not a favorable cervix and the higher— the induction will probably fail, or lead to a cesarean.
Patrick: We see better Bishop scores and cervical dilation over a 24-hour period in the research.
Adriana: That is my anecdotal experience is that, and that’s what I tell my clients. It can be really helpful too, then, even if you go in for an induction, you might just need the cervical ripener and that’s it. You might not go to Pitocin, you might not… It’ll be one day instead of four.
Patrick: Even if you’re not like, “Oh, wow, I spontaneously went into labor two hours after I got my treatment.” I’ve had that happen, but I think most of the time we are just trying to get the body into a better place for whatever ends up happening and if you avoid the induction, wonderful, and if you don’t, hopefully, you’re in a better place where there’ll be less desire for intervention along the way.
Adriana: How is your experience with prodromal labor? I find it really helps.
Patrick: Pretty good. Prodromal labor, it’s really just the body’s right at this apex and it just won’t go over for some reason. That can be mental, that can be position, that can be all the other things we’ve been talking about this whole time. Figuring out, again: Why haven’t you gone into labor yet? Why is this happening?
Addressing that can get the body to move into a place. Either stop contractions and say, “You’re not ready, you shouldn’t be having contractions,” and so stop contractions— because I’ll do that antepartum sometimes too, for— so antepartum is usually, it’s high-risk people or people that their water broke super early. They’re basically on hospital bedrest until they hit 36, 37, 38 weeks and then they’re going to induce them to get baby out. They’re just trying to keep baby in as long as possible for whatever reason.
A lot of those people have premature contractions. What I’m doing in those cases or in prodromal sometimes is trying to stop or slow down contractions rather than speed up. Ironically, some of the points we’re using to stop contractions are the points we say, “Oh those are contraindicated points. You shouldn’t do those.” We do those because it regulates contractions. It’s not about making them stronger, it’s regulate. What’s the body supposed to be doing right now? Let’s just have it do what it’s supposed to be doing.
Adriana: Fantastic. Fantastic. I also know that sometimes you will leave people— and I’ve seen other practitioners do this too— is have a treatment, say for induction, and then leave them with some acu-tacks, with little sticky mini itty bitty needles or seeds—
Patrick: Yes, I use—
Adriana: —instead of prolonging the treatment.
Patrick: Yes, I use seeds and that’s just… Because I work in the hospital, you don’t want unaccounted-for metal in the body when you’re in a hospital so I use seeds. There are these little seeds called the vaccaria seed, that I think it’s just the perfect size and shape. [Laughs.] I think it’s just the perfect size and shape. It’s a seed or a metal ball, some people will use. They’ll put it on ears or other points on the body too just to give a little bit of pressure stimulation. Then the people that use the tacks, they’re literally just this super tiny—
Adriana: An 1/8 of an inch!
Patrick: Yes, super tiny needle that just goes barely into the skin. It’s just this consistent stimulation. I have no problem with those. I think they’re great. I just try and stay away from metal, because of just the hospital stuff.
Adriana: Clients that have used them, they really like it because they can press on it. Then segues us to a conversation on acupressure. Can you speak to that?
Patrick: Yes. Acupressure is basically just this concept of you’re using your finger pressure or a tool or something like that to press on the area that we would typically needle to try and get some of that stimulation to activate the point so to speak. It can be really good stuff to do at home. I do some of that in labor when we’re in a place of– especially active labor, where I don’t want you to be sitting on a table in one place not moving. I want you to be moving.
I want you to be doing these things. I want you to be feeling what you’re feeling. Then we’re doing more strong stimulation— really “digging a fingernail in” thing, but again, that’s during labor. You want that strong stimulation. At home, it can be rubbing in circles and pressing. You can do it. There’s all the kind of typical contraindicated points and labor points that people will use to try and get labor started. Wonderful. Do that if you want to. Yes, it can be a really great tool during labor for pain, position.
Adriana: Where can people learn about acupressure?
Patrick: Honestly, there’s a lot of online resources and even YouTube where you can just type in acupressure for pregnancy or acupressure for labor. You’re going to get 1,000 videos of somebody talking about where they are and showing you and doing demonstrations and all that kind of stuff. YouTube is a great resource.
Adriana: It’s a great… the internet is such a great resource. In terms of symptoms that can also be helped with acupuncture during pregnancy, or during labor, what are some things that we left out?
Patrick: I think what we left out was hemorrhoids, which especially postpartum, and herbally and moxa and all these techniques will help with that. Then even in the same realm, varicose veins (which a hemorrhoid is basically just a varicose vein). We’re helping with that circulatory system, getting toned back in the circulatory system, and then gestational diabetes, it’s a blood sugar issue. Regulating that blood sugar, regulating those hormonal systems can be really helpful.
Then preeclampsia and high blood pressure. There’s even herbal things that we can do for those as well as acupuncture to try and get the stress down, get the tension on the vessels because sometimes the tension on the vessels can even be a relaxant, a prostaglandin thing where we’re supposed to have this relaxing, going through our bodies, these prostaglandins, that help to stretch things. Things aren’t stretching, then blood pressure goes up because you’re having all this extra blood. Getting that prostaglandin relax and release too along with that. Let’s see…
Adriana: How about for anxiety and just mental health, depression both pregnancy and post preg-related?
Patrick: Especially pregnancy postpartum, because you’re going through wide hormonal swings. They have a lot of impact on what our perception is and what our stressors are and how we handle things. Keeping that stress response in the body under control, widening that threshold of what gets you because that’s what people will say too. When I’m treating anxiety, depression, mood disorders, it’s not that it’s gone necessarily because the stressors won’t go away.
For the most part, we live in a constant state of stress and it’s just the world we’ve created. It’s not our fault. We can’t avoid it, it just happens. We can’t really have a stress-free life— it doesn’t exist! What we can do is we can have our bodies cope with the stress better. It’s people saying, “This thing happened to me, and typically, I would have exploded.” I was like, “Oh okay, that’s fine.” You know what I mean? They just felt like they could take a second, think about it, respond appropriately, rather than just “instinctual stress response” responding to things.
Adriana: A little more capacity and tolerance.
Patrick: Correct. Yes.
Adriana: Well, Patrick, we’ve had a fantastic conversation.
Patrick: Yes, as always.
Adriana: We didn’t go too far in all the tangents. [Laughs.]
Patrick: I know. I was a little afraid!
Adriana: Thank you so very much for doing this today.
Patrick: You’re very welcome.
That was board-certified acupuncturist, massage therapist, and birth doula, Dr. Patrick Boswell, who specializes in menstrual, reproductive, pregnancy, birth, postpartum, and pelvic health. You can learn more at anewlifeacupuncture.com.
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Come back for more ways to inform your intuition.
Lozada, Adriana, host. “Understanding Acupuncture From a Physiological Lens (and Why You Shouldn’t Fear the Needles!)” Birthful, Birthful. February 22, 2023. Birthful.com.
About Patrick Boswell
Dr. Patrick Boswell is a board-certified acupuncturist, a massage therapist and a birth doula. He owns his own practice, specializing in menstrual/reproductive concerns, pregnancy, labor/delivery, postpartum, and pelvic health. He has inpatient treating privileges with the University of Rochester OB/GYN department. This allows him to use acupuncture for antepartum, labor/delivery, and postpartum patients in two local hospitals. Dr. Boswell uses his wide range of modalities, training, and experiences to find the root of the issue and treat it based on a multifaceted approach to medicine and the body.
You can connect with Patrick via his website!
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