 All right, so at this point, I will welcome my presenter, Laurie Dana Zodan, who is a midwife acupuncturist. And she's an independent midwife, freelance midwifery teacher. And she teaches at workshop for midwives on acupressure for pregnancy and bed. Of course, she does this nationally and across the globe. So Laurie Dana, at this point, I will make you the presenter. Sorry, just a minute. Okay. So Laurie Dana, you have the floor. Thank you very much. You're welcome to the IDM 2021. Laurie Dana, you are muted. Yeah, so you can start again. Okay, thank you for inviting me to this conference. I'm very happy to talk internationally to this, is acupressure for pain relieving labor, because I really believe that more people, more women are used acupressure internationally. This is very important for me. We make a big change into the health of the woman. First of all, I would like to acknowledge Deborah Betts and Sarah Bathe for their inspiration and permission to share some of their material. You can go to the website, Acupressure Isosome, from Deborah Betts. You get a lot of information about Leaflet. This is website very well done for women can get a lot of information about pain relieving labor and other way they can use acupressure. First of all, what is acupressure? Acupressure is a part of Chinese medicine technique, very old technique. It's been used in China for a very long time. Basically, instead of using the needle, which are the acupressure point, you apply pressure to the point. Okay, the same point you would use in certain needle. The acupressure point are situated in the channel of meridians. First of all, I need to discuss a little bit about the theory of Chinese medicine. It's a very big argument. However, just I'm going to talk about what is Qi and what is the, what are meridians. Qi can be translated as a energy of life force. It's the energetic form of output that makes us to lead basically. You cannot see this output, this energy, but it has a very strong effect. Actually, it can actually lift the lead of the point, okay? Qi flow to the channel, to the meridian, which are bilateral in our body, are like a network of river that travel our entire body and nourish and basically make us alive. In good health, Qi moves smoothly through the channel. However, if you have a blockage of Qi or deficiency or excess of Qi, you can have a pain in illness. In traditional Chinese medicine, mind and body is related. This is like a holistic approach. In labor, if a woman's go like she's fair, she's got some fear, anger or frustration, which is quite common in labor, especially if she's a first time mother, she was never in labor before, so she can have a fear. And this fear, this emotion can actually affect her body. She feel more the pain. And that's why you're using acupressure, as I said, with the pressure to block in, to make the Qi circulating better. So I'm blocking this occlusion. She restored with that. Basically make the air body to feel better, okay? How does acupressure work? Acupressure is a pain relief. It's not a block, it doesn't block the pain at all. It's not like an epidural, which takes pain away completely. It just stimulates the body sometimes, sometimes not always the epidural works. However, acupressure stimulates the body to work more effectively, which results in less pain, restore a balance, unblock harmony on the body, okay? Certain point affect our brain, which not to reduce sensitivity pain and stress. However, the most, it does seem to increase endorphin. Endorphins are like hormone that our body produce when we're in pain. So basically it will make us feel better just when you go to, for instance, you have physical activity or you're involved with somebody. Basically your endorphin will increase. Another way of our acupressure work is increase the ossitocin. Ossitocin is just important in the endorphin because it seems to sort of relax the woman, coping better to the pain. And as well, there is certain point which actually definitely increase this ossitocin. And as well, I really believe that the therapeutic effect of acupressure is that touch, stay with the woman, supporting her, touching with the pressure, and still stay with her, make that she's got somebody like create a safe healing space, which means that she, this will help to decrease the pain perception and increase, as I said before, the symptoms. What are the advantages? There are many advantages about using acupressure. First of all, it's not an invasive technique. Easy to use. You don't have to have a lot of knowledge of anatomy. Obviously you need to know the whole location, but then it's easy to use. What I tend to do, I tend to teach acupressure for 37 weeks. You can do what you teach action during antenatal classes. Half an hour section is enough, especially if you've got the couple. Or it can actually provide, as I said, during antenatal classes, or provide one-to-one session with a couple. More choice. What does acupressure does? Offer more choice to women. As I said, it's something that you can never know. Generally, you can have an epidural, or you can have an antenox, other things, but in some reality, women don't even know access to any child, any pain relief at all. So I think this is very useful. Offer choice to women. Another thing which is very important, promote birth in pattern involvement. A lot of the time from my experience, obviously women can choose to stay with the pattern she choose. I think that sometimes, pattern raising is in labor, she doesn't know what to do. So I think it's just a way of making in feel of her, the person, the woman choose to be with her, making feel, helping the woman, okay? I believe that it definitely increase midwifery autonomy. This is very important. I think is, I feel as a new wife, when I support women in labor and offer acupressure, I tend to use a lot in my clinical practice. I believe that I can offer more, this increase my autonomy. I don't have to rely on other people on anesthesies. I don't have to rely on doctor, or I can, I got something to offer to women. This is really increase my autonomy. As well, facilitate on birth. I tend to use a lot of acupressure on birth. And for my experience, it's very good because it seems to sometime, if you're the first time mother, women might be transferred to labor world because they want to be a relief. And you cannot offer any sort like you want to convert, obviously. So I think this is, women can stay at home. You can offer acupressure, and then avoid to be in the hospital for obtaining family. Another thing, which is very practical, I tend to use acupressure on water birth. Because we know that water birth, you know, you can have an acupressure on water birth, and then women can really mobilizing on having, they can move around, okay? And as a whole, using acupressure seem to reduce the medicalization on childbirth. I'm going to explain why, explain why. In fact, there's been some, it seems to employ women. You see, women feel there has been a research, more than a random compliment clinical practice, which is seen to women feel felt and power and acupressure give them the control and confidence when they see that they feel empowered in a way that they don't have to rely on other people, but they just rely on self. This is make them more satisfied, increase their self-esteem. And even me do I've noticed that if they look after women, they're using acupressure, they women feel more empowered is a sort of, they cope better with labor. And then another important thing about the reduced medicalization, I mentioned before, what are the evidence? There are some evidence that actually with Zalando-Malcon-Tron trial, they seem to acupressure reduce the need of epidural and cesarean section. Obviously, because it seems to reduce the need of epidural because the woman cope better with the pain, the labor seem less painful. And this is important for the reducing of the medicalization because you'll avoid cascading for the intervention. If a woman receive an epidural, obviously she doesn't produce her own osteocephal, which is a pain relief. So, even an epidural as well, increase the medicalization of childbirth because increase the rate of instrumental, they need a lot of force and ventures and that increase the possibility of laceration. So definitely, it just like birth can be more natural, less complication. What are the adverse events? There's been some research that there's reported no clinical issue about using acupressure, no premature labor or frequent distress. There might be some problem, minor adverse effect on bruising and pain only if you apply too much pressure to the point. However, we need to go by the woman feedback. The pressure you use, obviously you tend to use stronger pressure to do the labor. However, during pregnancy and after birth, just to utilize gentle pressure. Okay, so definitely if you go by the woman feedback, you shouldn't cause any problem. However, it's very important that you avoid certain point because they are very effective for labor induction. So, bladder 32, bladder 60, gold bladder 21, large intestine four, they must be avoided before 37 weeks because they are formed that can induce labor. They are strong point. So you don't want to induce labor too early. We start discussing all the point now. There are a few points. I start with a gold bladder 21, which is on the gold bladder meridian. As I said, the meridian always, the point are always bilateral, okay? So basically, I can see from the picture are there is the most standard point a lot pathway between C7, C7 and tip of shoulder joint and chromium process at the top of the trapezius muscle. Basically, you need, usually the point, the acupressure point, especially particularly gold bladder 21, is a tender point. So you need to go by the woman feedback. She will let you when she feel more tender, not painful, but just more like a more tender, in bilateral, okay? What is the technique? As I said, you need to apply, you need to apply firm down pressure. You can use your thumb, knuckles, or my bone. I usually start gently and increase the pressure to tolerance, okay? Start gentle and then increase. What I usually do, I pressure, I start with apply gentle pressure to begin on the concussion and then the pressure can be intensified during concussion. What is the cleaning? Every point I'm discussing, just going to give a little bit indication what is the clean, what do they do basically? Gold bladder 21 is very good for relaxing because it's relaxed depending on and helping the woman to relax generally. So that is important because after the time I think it can be quite tense if you are in pain, usually. Feedback from me twice and from my personal practice, I show that this point is particularly used during the second stage of labor. Artists allow the head to descend. It's got a very good descending properties. Obviously, if the head descend quickly, quicker she will feel the second stage will last a little shorter and she will feel less pain. And then the other point is bladder 22 which is located over the second seconds for amen. What the woman feel about is a dull, arched sensation. She feel like a sharp sensation in the woman. From my experience, this is a very good point, especially to use at the beginning of labor. It's very good for if you want to go backpack. And as I say, from the feedback I go for women, it's the most useful point in pain in labor. What is the technique? You apply firm pressure by placing necklace into the point. And you can apply maximum pressure as achieved when the woman is rocking back into your hand. You likely provide counter pressure. Another way women can use this point, they are alone, they're using a tennis ball against the wall to lean back into doing a contraction. As I mentioned before, this back, this point has got a very good, produce a very good place on the stage of the fight. Okay. I mentioned before, just because I'm going to discuss occupation and whatever. I use this in, I'm going to discuss a case, case clinical case I use, occupation and whatever. As I say, I found very useful. As you can see from the picture, it's like, I believe that the birth is like a social event. This is a family involved, okay? The men obviously might use like a pressure point on Goldbrother 21, the woman at the back. And Amy Dwight is actually checking in the way, so she's supporting, she's there with the woman, okay? So the case study I'm going to discuss is one of my case studies and say, was a water birth at home, okay? I started using supreme gravure. I started using bladder 22, which was very good for making pain reliever. She was very coping very well with the pain. However, at one point, I noticed that the head was not descending, although she was fully directed, the head was not descending and she was not pushing and the head to push. So I decided to use Goldbrother 21, which is definitely really helpful because the head was descending more, but more than if nothing else, she felt the urge to push more and shared a nice normal delivery on the second stage lasting only one hour. So as I say, Goldbrother 21 is a good point to use on the second stage of labor because when the head is not descending, reduce the pain short in the second stage of labor. I'm going to discuss another point, large intestine four. Large intestine four is a good point that woman can use for herself basically, is on the dorsal hand between the first and second metatarsal. This is a very good point for any, if you go any pain, basically, if you go head back, any pain. Okay, if you don't expect any pain, okay. What is the technique? You apply firm pressure on your tongue, you can see from the feature, the woman can do this for herself. It is a very energetic point as it is tonified and cheap. I tend to use this point when the woman is very tired on the transition. Okay, this will just give her more energy and she will feel better, okay. Another good point is the kidney one. Is the location of kidney one, is the depression found in the top third of the sole of the foot. You need to apply strong pressure in war and upward towards the big toes. Kidney one is a very good point to help with during transition. Anytime, basically the woman, she's scared in labor and for my experience, when women are having labor war, they tend to be tense. So I use this point and the contractions start. Even if they are fair, if they are like a previous traumatic birth, kidney one is a very good point. It's really relaxing, calming the mind. And the same as well to release oxytocin, which is the oxytocin just as I mentioned before, is calming, it's a form of relaxing and making me feel better. Another way of using this kidney one is to apply cis-sickness band with the bottom. Apply pressure to the kidney one or you can use pumpkin or sesame seed or with the plaster. Apply both to the kidney one bilateral so the women can move around in labor. They can be squatting and helping them to relax. Another good point is comms. As well, this is very practical. Women can bring comms to labor war or even using an atom. The location is placed in a comb along palm of hand where fingers join the palm. And women can grip comms when doing contruction as required. So they are in control of the situation. What the comms seem to do is that we are pointing the point on the point where you can increase the endorphin and there is as well some acupuncture point which seem to help them to relax. Okay? That's why it seems to work. And from experience, this is a very good way of helping women with the pain. If you're thinking about using the point, I just wanted to give a general view because you might be asking, which point to use as I say, I discussed few points. It just depends on women choice in a way. You have to go by the women feedback. So you start using the point and you notice that which point women prefer. For my experience, I say before women really like bladder 32 because they seem that when you stop using it, they want to treat you the game. So it's definitely very good for pain. You can use it all the time. A kidney one is another good point where women feel more relaxed because as I say before, sometimes labor doesn't start. I had one case like this. The next year, the water bubble, labor definitely didn't start. I use a lot kidney one because she was just dealing with fear. So sometimes just one point is good. So as I said, you need to evaluate, try different point. Going back to the why do I think acupressure improve equity in that for all which is the theme of this year's international conference. I believe that it seems that women by using acupressure, they can use like, they can feel empowered. They don't have to rely on other people on other results. On the other side, it's very cheap. It's very easy to use. It really should be made really accessible. So by using acupressure for pain reliever, they can have a better choice. And I believe that they should start doing it. They should be encouraged to use it. And as I say before, often more choose to women. So basically, I really think that acupressure for pain reliever labor can make women feel better. Empower, they are in charge of their health. As I say, they don't have to rely on other people or doctors. And this definitely is very self-esteem. And like as I say before, body and mind is related to Chinese medicine. If you feel better, as if you've done something for yourself mentally, you physically, you feel better, your health will improve, you've got a good memory about your birth. This is a challenge obviously. What we can do to help women to achieve a good health for acupressure as well. It is difficult for not speaking English to be able to practice acupressure technique. So I know that it's more used in a country where people, English is the main languages, okay? Like they use a lot in Australia, in New Zealand acupressure for pain relief. And so what it can be the solution? Meanwhile, should provide translation serving for this. They should be, women should be, because it's important they know the form, the pattern for in their own languages. And other ways, I believe that the service, because as I mentioned before, the service is cheap and help to reduce cesarean session and the use of epidural and the medicalization. I believe that all the trust, all the hospital, all the service, maternity service should offer this acupressure service. If they want to increase equity for all. I'm really happy, thank you for listening. I just want to, okay, there's some links with the video, some video, if you can go on the Rizzo Zoma YouTube, you can see all the video at the point location, okay? And then you can just want you to, I just wanted to know if you want some more information regarding training, acupressure and moxibustion from pregnancy, where you can call them, this is my email. The moment I just be doing some sort of online, not much, I really prefer to sort of face to face from future, okay, this is my email, anything you want more information, the substance, just contact me. Any, thank you for listening, it was very, I'm open to any questions. Thank you so much, Lory, then I thank you so much for that beautiful presentation. So interesting, part filled with information, I like most of us are hearing this probably for the first time, and this is really useful information. Thank you once again, thank you so much. So this is time for question and answer, and we already got some in the chat box. We already got some, so I would read them out for you. So the first question is saying, what kind of training do you suggest that would help midwives and best workers become competent in the use of acupressure? So this person is asking what specific training would you suggest to help midwives and professionals? And let me quickly add on to that question that aside to the kind of training, how long do you think it would take anyone to learn an interested person who wants to learn this, a midwife? How long would it take to learn acupressure? Okay, I can talk from my own experience, I say I've been doing a lot of workshop in Italy and internationally. I believe that one day, okay, eight hours is enough, but you need to be practical, you show the point, and as I say, I've been teaching in different hospitals as well. The nice thing is that if you teach all the stuff in one hospital or it's very sort of, it's not like obviously, if you're using acupuncture, you need a more training like I did for your training, so use it with acupressure, I believe in eight hours. Although I really believe that eight hours is a minimum, I don't think that you should just learn and propose the acupressure, the point to people that just reading from the book and things. So as I said, eight hours, good workshop, yeah. So, awesome, that's very brilliant. Eight hours, like so I spent eight hours and I gained all of the skills, beautiful. Another person is quite asking that, is it used for induction? Yeah, is it used for induction or something? Yeah, yeah, I think it has been a lot if you go on the RisoZone, Deborah Beth's website. It's very good for induction. There has been a few points, I usually teach when I do the workshop, the workshop I do, I tend to teach acupressure for induction and labour preparation as well. So definitely, because it seems to increase, make the flow, space there is a point, just one point, just mention one point, split six, which is seen to sort of make the circulation, the cervical ripening, pre-improve the cervical ripening. There's been a lot of research regarding this. So definitely, yes, it's very good. Oh, thank you, thank you so much. Another person is asking that, it's interesting to hear about the poems, that's Grace Dawson saying that. It's not something she's come across before, but does it kind of come matters? So... No, no, it's very interesting. No, I think it just need to be sort of like, she can have two combs in a way, so in a way, not too big basically, okay? It's just the location on the point, the stimulant and dolphin. This is very interesting because it's been used, the combs for many, it was quite popular in Russia apparently. I've seen once, even before, I was sort of doing any acupressure training, acupuncture, I saw a woman arriving there with the combs, so yeah, it's something that is worth considering, yeah. Oh, okay, okay, so I think that has been answered. Another question here says, can it be used for any other kind of pain relief, asides, labor, pregnancy and all that? Yes, I think one two-point, I just want to mention two-point. I think large intestine four, which I mentioned before, it's before that. And then another point is spleen six. I know it's not on my power point, but spleen six, however, I don't use women before 37 weeks because it's an induction point. However, spleen six is a very good point, it's on the leg, bilateral, on the spleen meridian, is very good point for if you go like pain period pain, like menstrual pain, period pain, yeah. Okay, okay, okay. As I said, I don't use before 37 weeks, please. Oh, all right, yeah. So I think a lot of words, including myself, has found this very interesting and useful information, thank you. But there's a comment here about acupuncture. She says, she believes that women will work in synergy with other modalities, about medicine, massage, and also considering the best environment. But I have a question to, yeah, so who come to that, that is it used all over the world? I'm just interested, what does the evidence say about it's used on a global scale? Also, are there cultural undertones to be used? What has been defined in terms of cultural acceptance Yes, I think it just depends. The acceptance is very, as I say, is not because in Italy it's very well used a lot because as I say, the more you teach, the more midwife are involved and I got a very good feedback, they're using it. And in just, I think in New Zealand, it used a lot because in New Zealand, 60% of, because of Deborah Beth, of 60% of midwife use acupuncture. So they tend to use acupressure as well. And it's very, they got very good results. In Australia it's very popular. I think it should be more popular. This is my sort of impression in England as well. It's starting to get, it's starting to train now. It all comes to training and education because it's been good, well, they use a lot. They got very good results, getting good research and midwife are very happy. So question, answer to question, just it should be more used widely, should be more used. There is a potential for using it more widely. Awesome, awesome. Thank you so much again, Laurie Daga. So talking about skills, competencies, techniques that midwife can use to stand as professionals that we are. Yeah, this is something we need to learn about and understand. Thank you so much again for this presentation.