Psychophysiologic responses to acupressure used as a pre-birth treatment at full term gestation

Induction of labor (IOL) entails the initiation of uterine contractions to bring on labor and birth. National vital statistics report a precipitous rise with a current IOL rate of 20.6%. The WHO recommends a less than 10% rate. Women that spontaneously labor versus those having an IOL have decreased morbidity. Post-date pregnancy also entails the potential for negative consequences. Spontaneous labor requires a balance of multiple complementary and parallel mediators. Some of these mediators are the same as those elicited by the stress response. Acupressure (APR) is hypothesized to elicit responses by modulating nervous system activity (particularly the autonomic nervous system) and is thought to influence the release of neurohormones and neurotransmitters with a "balancing" effect. An APR pre-birth treatment (PB-Tx) has the potential to enhance spontaneous labor and reduce the rate of IOL. A psycho-neuro-endocrinology framework was utilized in this one-group (n=25), repeated measures design to examine psychophysiologic responses to a one-time, 30 minute APR PB-Tx administered during the 39th week of gestation. Categorical variables were analyzed by descriptive statistics or Chi square and continuous variables by repeated measures ANOVA or paired t-tests. The APR PB-Tx decreased or had no effect on the maternal stress response as indicated by a pre- to post-PB-Tx decrease in maternal heart rate and diastolic blood pressure (other vital signs remained unchanged). Salivary alpha-amylase activity (an indirect marker of catecholamine level) and salivary cortisol levels did not change from immediately pre- to post-APR PB-Tx periods. APR PB-Tx decreased maternal anxiety as measured by State-Anxiety and visual analogue scale (VAS) scores. Maternal tension decreased as measured by VAS. No significant increase of uterine contractions lasting 31-60 seconds or &ge 61 seconds as measured by electronic monitor was noted during the 1.5 hour protocol. Fetal heart rate variables were reassuring and stable throughout the protocol. Response to a post PB-Tx maternal questionnaire revealed a perceived qualitative increase in contractions and fetal activity during the APR PB-Tx. Subjects also reported feeling relaxed and empowered by the treatment. Future studies will incorporate a control/comparison group to examine efficacy of an APR PB-Tx in reducing the rate of IOL.