"The ultimate goal of acupuncture in pregnancy is to offer each patient a more positive pregnancy and birthing experience."
What do studies say about the safety of acupuncture during pregnancy?
Acupuncture is generally considered safe at any point during pregnancy provided it is performed by a sufficiently trained, qualified practitioner. Two separate systematic reviews (which consolidated the evidence from several individual studies) found that adverse effects are usually mild and short-lived, and in many cases were comparable to that of non-acupuncture therapies (1, 2). Another large study was conducted, looking at the medical records of over 20,000 pregnant patients in Korea. It found that women having acupuncture had no increased risk of preterm labor or stillbirth (3). They concluded that acupuncture during pregnancy is a safe therapy for relieving discomfort without adversely affecting the health of the mother or baby (3).
Another study looked specifically at 593 women having acupuncture during the first trimester- often seen as the most delicate point in pregnancy. These women were having acupuncture to treat nausea and/or vomiting, and concluded that there was no increased risk of adverse events affecting mother or baby (4).
A variety of statements by professional organizations such as ACOG (American College of Obstetricians and Gynecologists) (5), RCOG (Royal College of Obstetricians and Gynaecologists) (6) and the Royal College of Midwives (7), show recognition of acupuncture as a means of complementary care during pregnancy.
What about “forbidden points of pregnancy”?
Traditionally, certain points are thought to be contraindicated during pregnancy because of their purported ability to affect the cervix, induce labour or influence uterine contractions. Researchers have studied this topic by examining studies that included needling these particular points in pregnant people. Several researchers have concluded that using these points did not lead to any undesirable effects. Other researchers pointed out that those studies were not always well designed: Even though the data tells us that these points didn’t lead to an increase in premature births, the studies didn’t keep track of whether or not pre-term contractions occurred.
In conclusion, out of an abundance of caution, it’s recommended that these particular points are not needled during pregnancy, especially since non-contraindicated points can provide the same benefits. Until we have more information and better studies, the points that are in question shouldn’t be used unless the goal is labour preparation or help with an already progressing labour.
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
Park, J., Sohn, Y., White, A. R., & Lee, H. (2014). The safety of acupuncture during pregnancy: a systematic review. Acupunct Med, 32(3), 257-266. doi:10.1136/acupmed-2013-010480
Moon HY, Kim MR, Hwang DS, et al. Safety of acupuncture during pregnancy: a retrospective cohort study in Korea. BJOG. 2020;127(1):79–86. doi:10.1111/1471-0528.15925
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. doi:10.1054/ctim.2002.0523
ACOG Practice Bulletin No. 209: Obstetric Analgesia and Anesthesia. Obstet Gynecol. 2019;133(3):e208–e225. doi:10.1097/AOG.0000000000003132
Shehmar, Manjeet & MacLean, Marjory & Nelson-Piercy, Catherine & Gadsby, Roger & O'Hara, Margaret. (2016). The Management of Nausea and Vomiting of Pregnancy and Hyperemesis Gravidarum (Green-top Guideline No.69).
The Royal College of Midwives. RCM Midwifery Blue Top Guidance No.2 Induction of Labour (Sept 2019)
Conditions treated by Acupuncture during Pregnancy or Postpartum:
Lower back pain or pelvic pain
Nausea/vomiting and Hyperemesis Gravidarum*
Anxiety & Depression
Breech or Malposition
Threatened Miscarriage
Pre-eclampsia*
PPROM*
Anemia
Sinusitis
Hypertension*
Heartburn
Insomnia
Incontinence
Cervical ripening
Cervical ripening can begin at week 36 or 37 and continue weekly until delivery. This is also a very important time for the birthing person to set aside some self-care time leading up to the birth of their child. Often patients come in for cervical ripening with 2 to 4 of the above listed ailments (i.e. anxiety, anemia, heartburn and insomnia), and by finding relief and getting more restful sleep - they report feeling less exhausted and more prepared for labour. When given the chance to be nurtured during pregnancy, the birthing person can be set up for a smoother recovery. The ultimate goal of acupuncture in pregnancy is to offer each patient a more positive pregnancy and birthing experience.
Threatened miscarriage/bleeding in pregnancy
This is not a topic generally advertised by acupuncturists with a focus in prenatal care, due to its sensitive nature and the abundance of fear that most pregnant patients already deal with throughout their pregnancy. However, I do believe education is necessary to care providers so that an alternate option to the "wait and see" approach can be given to those patients wishing for a little more support. Acupuncture is not a powerful enough intervention to cause the body to hold on to a pregnancy that is ultimately not viable, but it can ensure that a patient is in the best possible state to avoid a threatened miscarriage. It can also offer emotional support to those patients going through an inevitable or missed miscarriage, and the chance to move through the experience with minimal intervention.
Labour "induction", preparation or encouragement
Acupuncture can be used to encourage labour when a patient is overdue or scheduled to be medically induced within a few days. To encourage/initiate contractions before the appropriate time only subjects a birthing person to more discomfort if their body is not ready. Working on cervical ripening and pelvic floor relaxation, plus addressing any discomforts of the third trimester instead, would ultimately encourage a more efficient labour when the time comes.
*While I am very passionate about providing a positive birth experience, this includes the awareness that there are some conditions that require urgent medical care. I will ensure that the patient contacts their healthcare provider to address their condition. Acupuncture can provide complementary support while being monitored by their healthcare provider. In certain cases, acupuncture can help stabilize a patient's condition if more time is ideal (for patient and/or baby) before intervention.
If you have any questions, please email me at alyssajhuang@gmail.com