Acupuncture During Pregnancy

• Acupuncture treatment reduces pelvic and back pain in pregnancy. In this Swedish study, 72 pregnant women suffering from pelvic or low back pain were randomly assigned to an acupuncture group or a control group. Traditional acupuncture points were needled in individualised treatments, once or twice a week until the disappearance of symptoms or delivery in the acupuncture group. Treatment was given for at least three weeks, twice weekly for the first two weeks, then once a week. The control group received no treatment. During the study period the pain decreased in 60% of patients in the acupuncture group compared to 14% of the controls, dropping to 43% and 9% respectively at the end of the study.20


• Moxibustion aids in the correction of breech presentation. Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. 130 subjects were randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Japanese term for Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks’ gestation and delivery. Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.21


• In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupoint BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33–35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group.A total of 240 women at 33–35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. The study concluded that acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.22


• The objective of this study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain. Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. Evidence supports the proposition that acupuncture is useful in treating pregnancy-related pelvic and back pain.23


• This study compared ongoing pregnancy and live birth rates in spontaneous users and non-users of complementary and alternative medicines (CAMs) during a 12-month period of assisted reproduction technique (ART) treatment. 728 women about to have ART for the first time completed self-report assessments prior to treatment. The ongoing pregnancy and live birth rate was 31.3% lower in CAM users (42.2%) compared with non-users (61.4%). The researchers concluded ONLY that concurrent CAM use should be monitored during ART. A main limitation to this study was that the researchers could not ascertain which type of CAM was most associated with lower pregnancy rates. Acupuncture was not specifically studied. Total Wellness Centre insists that all patients undergoing concurrent Western fertility and traditional Chinese medical treatments inform both their medical doctor and TCM practitioner of all treatments they are undergoing.24


• Acupuncture aids in the treatment of depression during pregnancy. A total of 150 pregnant women who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for major depressive disorder were randomized to receive either acupuncture specific for depression or one of two active controls: control acupuncture or massage. Treatments lasted 8 weeks (12 sessions). Fifty-two women were randomized to acupuncture specific for depression, 49 to control acupuncture, and 49 to massage. Women who received acupuncture specific for depression experienced a greater rate of decrease in symptom severity compared with the combined controls or control acupuncture alone. They also had significantly greater response rate (63.0%) than the combined controls (44.3%) and control acupuncture alone (37.5%). Symptom reduction and response rates did not differ significantly between controls (control acupuncture, 37.5%; massage, 50.0%). CONCLUSION: The short acupuncture protocol demonstrated symptom reduction and a response rate comparable to those observed in standard depression treatments (pharmaceuticals) of similar length and could be a viable treatment option for depression during pregnancy, or for depression in the general population. The potential risk to the fetus associated with pharmaceuticals can be avoided using natural therapies such as acupuncture.25


• Many women experience low-back (LBP) or pelvic pain during pregnancy. Pain usually increases as pregnancy advances, interfering with work, daily activities, and sleep. The purpose of this study was to determine what therapies, including acupuncture, exercise, “usual care” and physiotherapy were most effective at reducing lower back pain, pelvic pain, and lumbo-pelvic pain during pregnancy. Moderate-quality evidence showed that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced evening pelvic or lumbo-pelvic pain. Acupuncture was significantly more effective than exercise for reducing evening pelvic pain. A 16- to 20-week training program was no more successful than usual care in preventing pelvic or LBP. Low-quality evidence suggested that exercise reduced pain and disability from LBP. Reported adverse effects were minor and transient. 51


• Researchers in this study wanted to study whether the addition of moxibustion at 33-35 weeks gestation corrects non-vertex presentation (NVP). Researchers were disappointed with past studies lack of control. 406 women in Spain were placed in one of three groups; The first group received moxibustion at BL67, the second group received sham moxibustion at an inert point, and the third group received no intervention. All other intervention such as postural management were controlled. The researchers concluded that moxibustion at BL67 was effective at correcting NVP after 33 weeks of gestation.70


• This study attempted to determine if using moxibustion was effective to correct non-vertex (breech) presentation. Researchers employed a randomised controlled trial of 406 low-risk women with a fetus in ultrasound breech presentation with a gestational age of 33-35 weeks. Participants were assigned to 1) true moxibustion at point BL67 plus usual care; (2) moxibustion at SP1, a non-specific acupuncture point (sham moxibustion) plus usual care; or (3) usual care alone. The primary outcome was cephalic presentation at birth. Researchers concluded moxibustion at acupuncture point BL67 is effective and safe to correct non-vertex presentation when used between 33 and 35 weeks of gestation. They believe that moxibustion represents a treatment option that should be considered to achieve version of the non-vertex fetus.71


• Researchers studied the efficacy comparison of Chinese medicine’s labour inducement methods to conventional methods and to the combination of both. This study included 80 women aged 22-40, who required labor inducement. The study group consisted of 50 women who received Chinese medicine’s inducement treatment (Shiatsu and/or Acupuncture) prior to and/or during hospitalization. The control group consisted of 30 women who received customary hospital labor inducement methods. Significant correlation was found between Chinese medicine inducement methods (Shiatsu/Acupuncture) and reduction of additional interventions throughout the birth process, when these were given during hospitalization (x2=47.29, d.f.=21, p=0.001). Correlation close to significant was found when inducement was given prior to hospitalization, especially when labor was induced by Shiatsu (x2=16.8, d.f.=9, p=0.052). An outstanding difference was found in shortening the birth process time (MS=0.45, F(6,72)=2.505, p=0.029) when combining Chinese medicine and conventional inducement methods (medicinal/mechanical). Study results show that Chinese medicine inducement methods, whether or not combined with conventional methods, are an important and effective tool in their ability to reduce the extent of intervention throughout the birth process and also in reducing delivery completion interventions.73

Jonah Arnold