Preeclampsia is the second leading cause of maternal death in Guatemala, where the maternal mortality rate (MMR) is second highest in Central America. Lay midwives (LMs), who attend most births in their country at home, are forbidden from providing biomedicine to treat disorders, such as preeclampsia. Acupressure, which has been shown to decrease blood pressure, is a promising treatment LMs could offer while transferring hypertensive patients to hospitals, particularly in the remote Peten Department where this study took place.
Materials and Methods:
Educational sessions regarding preeclampsia were held in 11 locations. A total of 179 LMs who participated in the educational sessions were taught six acupressure points to address preeclampsia and given laminated Reminder Cards with culturally appropriate drawings of the acupressure points to reinforce knowledge retention.
Results:
Participants experienced a significant increase in knowledge (possible 0–6) from pre-test (M = 0, SD = 0) to post-test (M = 4.29, SD = 1.722), paired t-test p < 0.001. No participants were aware of any acupressure sites on the pre-test (0%) compared with >71% who identified at least one site on the post-test.
Discussion:
Given no participants knew acupressure sites to address preeclampsia before the educational sessions, a change in knowledge is not surprising, yet significant. Providing these well-respected community leaders with tools, such as acupressure, to address preeclampsia could help reduce Guatemala’s MMR. Educating LMs about acupressure points to treat other pregnancy-related issues, such as encouraging and discouraging labor, turning breech babies, treating back and labor pain, and nausea and vomiting, would expand the care pregnant patients receive, particularly in remote areas.
GarciaK. San Raymundo: Focus group about comadronas’ response to obstetrical emergencies in urban guatemala. J Transcult Nurs, 2024; 35(5):381–387; doi: 10.1177/10436596241253864
5.
AustadK, JuarezM, ShryerH, et al.Obstetric care navigation: Results of a quality improvement project to provide accompaniment to women for facility-based maternity care in rural Guatemala. BMJ Qual Saf, 2020; 29(2):169–178; doi: 10.1136/bmjqs-2019-009524
JuarezM, JuarezY, CoyoteE, et al.Working with lay midwives to improve the detection of neonatal complications in rural Guatemala. BMJ Open Qual, 2020; 9(1):e000775; doi: 10.1136/bmjoq-2019-000775
GarciaKS, KilanowskiJF. Senales de Peligo: Guatemalan Lay Midwives’ Perceptions of Responding to Obstetrical Complications. J Transcult Nurs, 2020; 31(6):547–553; doi: 10.1177/1043659619889114
11.
GarciaKS, RodriguezA, GonzalezZ, et al.Pretest-post-test evaluation with lay midwives in remote Guatemala after educational activities about COVID-19. Rural Remote Health, 2024 Jul;24(3):8387; doi: 10.22605/RRH8387
12.
Taylor-SwansonLJ, BellL, TuW, et al.Teaching Guatemalan lay midwives acupressure: Outcomes and lessons learned. Med Acupunct, 2024; 36(5):264–271; doi: 10.1089/acu.2023.0139
13.
FlachskampfFA, GallaschJ, GefellerO, et al.Randomized trial of acupuncture to lower blood pressure. Circulation, 2007; 115(24):3121–3129; doi: 10.1161/CIRCULATIONAHA.106.661140
14.
LinGH, ChangWC, ChenKJ, et al.Effectiveness of acupressure on the taichong acupoint in lowering blood pressure in patients with hypertension: A randomized clinical trial. Evid Based Complement Alternat Med, 2016; 2016:1549658; doi: 10.1155/2016/1549658
15.
RestawanG, SjattarEL, IrwanAM. Effectiveness of acupressure therapy in lowering blood pressure in patients with hypertension: A systematic review. Clinical Epidemiology and Global Health, 2023; 21:101292; doi: 10.1016/j.cegh.2023.101292
KocherZ, Castro-PearsonS, ColicchiaL, et al.Examination of Acupuncture and Acupressure as an Integrative Treatment for Preeclampsia With Severe Features [ID: 1354672. ]. Obstet Gyneol, 2023; 141(5S):77S–77S; doi: 10.1097/01.AOG.0000930912.64390.c4
18.
KocherZ, HobbsV. Integrating acupuncture for preeclampsia with severe features and HELLP syndrome in a high-risk antepartum care setting. Med Acupunct, 2019; 31(6):407–415; doi: 10.1089/acu.2019.1399
19.
ZengY, LiuB, LuoT, et al.Effects of acupuncture on preeclampsia in Chinese women: A pilot prospective cohort study. Acupunct Med, 2016; 34(2):144–148; doi: 10.1136/acupmed-2015-010893
CuthillM. Exploratory research: Citizen participation, local government and sustainable development in Australia. Sustainable Development, 2002; 10(2):79–89.
GarciaK. An observational study of teaching methods with low-literacy comadronas in urban Guatemala. Canadian Journal of Midwifery Research and Practice, 2022; 21(3):53–63.
CitkovitzC. Acupressure and Acupuncture During Birth. Singing Dragon: Philadelphia, PA, 2019.
26.
MouQ, JiB, ZhaoG, et al.Effect of electro-acupuncture at ST 36 on maternal food restriction-induced lung phenotype in rat offspring. Pediatr Pulmonol, 2021; 56(8):2537–2545; doi: 10.1002/ppul.25466
27.
GodleyE, SmithMA. Efficacy of acupressure for chronic low back pain: A systematic review. Complement Ther Clin Pract, 2020 May;39:101146; doi: 10.1016/j.ctcp.2020.101146
28.
BazarganipourF, LamyianM, HeshmatR, et al.A randomized clinical trial of the efficacy of applying a simple acupressure protocol to the Taichong point in relieving dysmenorrhea. Int J Gynaecol Obstet, 2010; 111(2):105–109; doi: 10.1016/j.ijgo.2010.04.030
29.
SmithCA, CollinsCT, LevettKM, et al.Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev, 2020; 2(2):CD009232; doi: 10.1002/14651858.CD009232.pub2
30.
O’BrienB, RelyeaMJ, TaerumT. Efficacy of P6 acupressure in the treatment of nausea and vomiting during pregnancy. Am J Obstet Gynecol, 1996; 174(2):708–715; doi: 10.1016/s0002-9378(96)70454-4
31.
WangX, YangG, LiK, et al.Efficacy and safety of acupressure in nausea and vomiting during pregnancy: A systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet, 2024; 309(4):1237–1248; doi: 10.1007/s00404-023-07313-0
32.
ZhangNM, DalyD, TerblancheM, et al.Doctors’ and Nurses’ Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey. Pain Manag Nurs, 2022; 23(6):800–810; doi: 10.1016/j.pmn.2022.08.008
33.
AllaireAD, MoosMK, WellsSR. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol, 2000; 95(1):19–23; doi: 10.1016/s0029-7844(99)00481-0
