By Jenny Johnston, L.Ac., Dipl.O.M., FABORM In order to answer this question, we first need…
Acupuncture Therapy for Prenatal, Perinatal and Postpartum Care
by Jenny Johnston, L.Ac., Dipl.O.M., FABORM
Pregnant women are one group of patients who are particularly highly motivated when it comes to maintaining optimal wellness and finding drug-free solutions to medical problems. In collaboration with the primary care provider (OB, midwife, RE, etc.), acupuncture is an ideal form of treatment as it offers women a safe and natural way to improve a woman’s quality of life and provide relief for a multitude of conditions that can arise during this vulnerable time. In China, texts with sections dedicated to obstetrics date as far back as the Ming dynasty (1368-1644), and since the early 20th century this invaluable traditional resource has been incorporated with Western medical knowledge in texts devoted specifically to obstetrics. Countries such as Denmark, France, Germany, Switzerland and New Zealand are successfully using acupuncture as a safe and effective part of obstetrical care.
Acupuncture can be used in a variety of ways to promote maternal and fetal health through the childbearing year:
- 1st trimester: Sets the foundation for a healthy pregnancy and ensures proper nutrition, alleviates nausea and vomiting, fatigue, headaches, constipation, and helps to prevent unnecessary miscarriage.
- 2nd trimester: Helps women adjust to the new demands placed on their bodies by alleviating common conditions such as heartburn, hemorrhoids, varicose veins, gestational diabetes, sleep problems, edema, elevated blood pressure, anemia, anxiety and depression, fatigue, colds/flus, sinusitis, and musculoskeletal pain.
- 3rd trimester: Prepares the body for an efficient and natural labor. Helps to address sciatica, hip, joint, pubic and back pain, carpal tunnel, breech and posterior presentations, small-for-date babies, pregnancy-induced hypertension, and edema.
- Labor and Delivery: Acupressure is taught to labor support people to help promote innate production of labor hormones and cervical maturation, relax the mind and body, promote proper baby positioning and descent into the pelvis, relieve whole body muscle tension and pain, improve energy and stamina, reduce nausea, and support emotional well-being.
- Postpartum: Assists with healing and recovery; helps to prevent urinary incontinence and retention; addresses breastfeeding issues such as insufficient lactation, blocked ducts, mastitis; alleviates discomfort such as back and pelvic pain, abdominal soreness, headaches, and recovery from cesarean section; helps with emotional balance, insomnia bowel irregularities, hemorrhoids, and prolapse.
Here are some highlights of the research that has been done to-date on safety and effectiveness:
Safety
Safety has been demonstrated through several studies, including these two systematic reviews:
In 2015, Clarkson et al. investigated “Adverse event reporting in studies of penetrating acupuncture during pregnancy.” The authors selected seventeen studies (ten investigated pain, three nausea and/or vomiting, one depression, one emotional complaints, one heartburn and another insomnia), and found that the information describing adverse events was often lacking detail. However, the majority of the adverse events were minor, and the incidence of adverse events was similar between the acupuncture and non-acupuncture groups (between 14-17% in the acupuncture groups and 15-19% in non-acupuncture groups). This evidence suggests that acupuncture produced neither more nor less adverse events compared with another intervention.[i]
“The safety of using acupuncture during pregnancy” was investigated by Authors Park et al. in 2014. They searched the electronic databases of Medline, Embase, Cochrane, Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and five Korean databases through February 2013 for articles reporting adverse events for pregnancy related acupuncture. The authors found that the most frequent adverse events related to pain at the needles site, with no incidence of severe adverse events considered likely to be caused by acupuncture. They concluded that acupuncture during pregnancy appears to be associated with few adverse events when correctly applied.[ii]
Pelvic and Back Pain
Pelvic and back pain are common and disabling problems during pregnancy, for which acupuncture has demonstrated substantial benefit. Elden et al. 2005 published to date the largest randomly controlled trial of acupuncture for pelvic pain in pregnancy. They involved 386 pregnant women with pelvic girdle pain and compared standard treatment (a pelvic belt, patient education and home exercises for the abdominal and gluteal muscles) with standard treatment plus acupuncture or standard treatment plus extra physical therapy stabilizing exercises (for the deep lumbopelvic muscles). The authors concluded acupuncture was superior to stabilizing exercises, with acupuncture the treatment of choice for patients with one-sided sacroiliac pain, one-sided sacroiliac pain combined with symphysis pubis pain and bilateral sacroiliac pain.[iii]
The latest Cochrane Review in 2015 examined 26 trials involving 4093 pregnant women with different therapies including acupuncture and physiotherapy for lower back pain and pelvic pain. They found acupuncture significantly reduced pelvic pain more than usual care alone, was significantly more effective than exercise in reducing pelvic pain, and was more effective than physiotherapy at relieving lumbo-pelvic pain and improving function.[iv]
Nausea and Vomiting
Nausea and vomiting can be a very real affliction for many pregnant women. Acupuncture treatment aims to strengthen the energetic function of the digestive system and correct any underlying imbalances, and includes dietary and lifestyle advice to help improve symptoms.
Smith, et al. published two articles from their research on nausea and vomiting in early pregnancy, in which the first looked at the effectiveness and the second at the safety of acupuncture treatment in early pregnancy. They found no serious adverse effects, traditional acupuncture had the fastest effect on reducing nausea and dry retching (compared to sham and no treatment), and patients receiving traditional acupuncture also reported improvement in general health parameters of vitality, social function, mental health and emotional role function.[v],[vi]
Breech Presentation
Malposition is associated with increased risks to mother and baby, and while cesarean section for this condition reduces perinatal or neonatal death and severe neonatal morbidity, it also causes increased maternal morbidity.[vii] Moxibustion therapy, an acupuncture technique, ideally addressed between 34-36 weeks gestation has been shown to reduce the number of breech presentations at term, thus reduce the number of cesarean sections, and is cost-effective compared to expectant management including external cephalic version.[viii], [ix], [x]
Labor Preparation
“Prebirth” acupuncture therapy involves a series of at least 4 weekly treatments from week 36 or 37 to onset of labor to help prepare a woman’s body for labor and delivery. Treatment addresses individualized factors such as a woman’s constitution, presenting signs and symptoms, and pregnancy history. Points are used to promote cervical ripening, ideal positioning of baby for labor, balancing of emotional factors, and optimizing physical energy and stamina. A case control study in 1998 recommends prebirth acupuncture for its ability to shorten the duration of the first stage of labor, [xi] and an observational study in 2004 showed an overall 35% reduction in the number of inductions (43% for primiparas), 31% reduction in epidurals, 32% reduction in emergency cesarean deliveries, and a 9% increase in normal vaginal births.[xii]
A Cochrane Review in 2013 evaluated 14 studies involving 2220 women and found some evidence of changes in cervical maturation and the length of labor for women receiving acupuncture.[xiii]
Acupuncture to Induce Labor
The research to date does not support effectiveness of using acupuncture to stimulate contractions for induction purposes when given without the prebirth individualized approach. According to the same Cochrane Review from 2013 mentioned above, acupuncture aimed to induce uterine contractions in women who were overdue may increase the readiness of the cervix for labor, but did not reduce the number of women receiving an epidural, the rate of instrumental delivery or cesarean sections. The authors concluded that further research is required to determine if acupuncture or acupressure for induction increases the number of vaginal deliveries.
Acupuncture and Acupressure for Pain Relief in Childbirth
Acupressure is often taught as a part of labor preparation acupuncture treatments beginning around 37 weeks gestation to pregnant women and their partners and/or labor support, with the aim to facilitate natural and efficient labor and delivery.
In terms of labor and delivery, acupuncture and acupressure have been shown by a recent Cochrane review involving 1986 women to help relieve labor pain, reduce pharmacological analgesia, and improve maternal satisfaction. However, due to the small number of trials and poor quality of reporting within some of these trials, further high-quality research is required.[xiv]
[i] Clarkson CE, O’mahony D, Jones DE. Adverse event reporting in studies of penetrating acupuncture during pregnancy: a systematic review. Acta Obstet Gynecol Scand. 2015;94(5):453-464. doi:10.1111/aogs.12587
[ii] Park J, Sohn Y, White AR, Lee H. The safety of acupuncture during pregnancy: a systematic review. Acupunct Med. 2014;32(3):257-266. doi:10.1136/acupmed-2013-010480
[iii] Elden H, Ladfors L, Olsen MF, Ostgaard H-C, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ. 2005;330(7494):761. doi:10.1136/bmj.38397.507014.
[iv] Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015;(9):CD001139. doi:10.1002/14651858.CD001139.pub4
[v] Smith C, Crowther C, Beilby J. Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med. 2002;10(2):78-83.
[vi] Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early pregnancy: a randomized controlled trial. Birth. 2002;29(1):1-9.
[vii] Hofmeyr et al. Planned caesarean section for term breech delivery | Cochrane. doi:10.1002/14651858.CD000166.pub2
[viii] Cardini F, Weixin H. Moxibustion for correction of breech presentation: a randomized controlled trial. JAMA. 1998;280(18):1580-1584.
[ix] van den Berg I, Kaandorp GC, Bosch JL, Duvekot JJ, Arends LR, Hunink MGM. Cost-effectiveness of breech version by acupuncture-type interventions on BL 67, including moxibustion, for women with a breech foetus at 33 weeks gestation: a modelling approach. Complement Ther Med.
[x] Vas J, Aranda-Regules JM, Modesto M, et al. Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial. Acupunct Med. 2013;31(1):31-38. doi:10.1136/acupmed-2012-010261
[xi] Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P. Influence of acupuncture on duration of labor. Gynecol Obstet Invest. 1998;46(1):22-25. doi:10.1159/000009990
[xii] Betts D, Lenox S. Acupuncture For Prebirth Treatment: An Observational Study Of Its Use In Midwifery Practice. Medical Acupuncture. 2006;17:16-19.
[xiii] Smith et al. Acupuncture or acupressure for induction of labour | Cochrane. doi:10.1002/14651858.CD002962.pub4
[xiv] Smith et al. Acupuncture or acupressure for relieving pain in labour | Cochrane. doi:10.1002/14651858.CD009232
