Pregnancy is a physiological state, but even when a woman has an uncomplicated pregnancy she may suffer with back and pelvic pain, nausea, indigestion or emotional problems such as anxiety and depression.
When the fetus is in the breech position, labour can be complicated. Labour consists of a series of rhythmic, involuntary, progressive contractions of the uterus that cause effacement (thinning and shortening) and dilation of the uterine cervix. In a first pregnancy, labour usually lasts 12 to 18 hours on average; subsequent labors are often shorter, averaging 6 to 8 hours. During labour, most women need some form of analgesia, and some may require local anaesthesia during stitching if they tear during the birth. Normal labour usually begins within 2 weeks (before or after) the estimated delivery date.
National Collaborating Centre for Women's and Children's Health, 2008. Antenatal care. Routine care for the healthy pregnancy woman. [online]Available: http://www.nice.org.uk/nicemedia/live/11947/40145/40145.pdf
How acupuncture can help
An overview of systematic reviews and randomised controlled trials across the whole area of pregnancy found evidence that acupuncture may assist with the management of some complaints, though more studies are needed (Smith 2009).
Systematic reviews of randomised and quasi-randomised controlled trials suggest that acupuncture may help to relieve pain during labour (Cho 2010; Smith 2006). The later review found that acupuncture was superior to conventional analgesia but not, or marginally, better than minimal (sham) acupuncture. Given that 'sham' acupuncture interventions are not inert placebos the effect of 'real' acupuncture may be under-estimated in such trials, and non-superiority should not necessarily be taken at face value (Lundeberg 2009). Since that review was compiled there have been further trials supporting the efficacy of electroacupuncture (Ma WZ 2010), moxibustion (Ma SX 2010) and acupressure (Hjelmstedt 2010) though the size (and clinical significance) of the effect is still to be confirmed.
Several systematic reviews have found that moxibustion has a positive effect in correcting breech presentation (Vas 2009; Li 2009; Van den Berg 2008), though the results from two recent trials go against the general trend (Millereau 2009;Guittier 2009). A modeling study based on the systematic review data calculated that moxibustion treatment would be cost-effective (van den Berg 2010).
For back and pelvic pain there is a systematic review (Ee 2008) and one subsequent RCT (Wang 2009) indicating that acupuncture may provide effective pain relief. In another recent study (Eldon 2008) acupuncture was significantly superior to sham for functional ability but not pain relief (see above for comments on sham acupuncture comparisons).
A systematic review of acupuncture for labour induction suggested that it could be beneficial, although the randomised trials had mixed results (Lim 2009). Five subsequent RCTs (Liu 2008; Smith 2008; Asher 2009; Modlock 2010) are also mixed, so the case for acupuncture in induction remains unproven.
There is evidence in favour of acupuncture for depression (Manber 2010), emotional problems in general (da Silva 2007) and dyspepsia (da Silva 2009).
Acupuncture is relatively safe with no records of serious adverse events in the pregnancy-related systematic reviews (Cho 2010; Lim 2009; Vas 2009; Ee 2008).
See Table overleaf for further details of the cited studies.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010)
In pregnant women, acupuncture may help to relieve pain (e.g. back pain, labour pain), improve mood and reduce anxiety, alleviate dyspepsia, and turn a fetus who is breech by:
·increasing relaxation and reducing tension (Samuels 2008). Acupuncture can alter the brain's mood chemistry, reducing serotonin levels (Zhou 2008), and increasing endorphins (Han, 2004) and neuropeptide Y levels (Lee 2009), which can help to combat negative affective states.
·stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Zhao 2008;Cheng 2009);
·reducing inflammation, by promoting release of vascular and immunomodulatory factors(Zijlstra 2003; Kavoussi 2007);
- increasing cortico-adrenal secretion, placental estrogens, and changes in prostaglandin levels, which leads to raised basal tone of the uterus and enhanced movement of the fetus, thus making version more likely (Van den Berg 2008).