Pelvic Pain in Pregnancy
Elden et al. 2005 published a randomised single blind controlled trial involving
386 pregnant women in the British Medical Journal (BMJ).
The objective was to compare the efficacy of standard treatment for pelvic pain
(a pelvic belt, patient education and home exercises for the abdominal and gluteal
muscles) with standard treatment plus acupuncture or standard treatment plus physiotherapy
stabilising exercises (for the deep lumbopelvic muscles).
The study time frame consisted of one week which was used to establish a baseline,
followed by six weeks of treatment. The acupuncture treatment was given twice a
week and the stabilising exercise sessions one hour per week (with patients then
doing these exercises several times a day on a daily basis).
Follow up was carried out one week after treatment finished. Three physiotherapists
gave standard treatment, two medical acupuncturists delivered the acupuncture treatment
and two physiotherapists gave the stabilising exercises.
Pain was measured by a visual analogue scale and by an independent examiner before
and after treatment.
Acupuncture was superior to stabilising exercises in the management of pelvic girdle
pain in pregnancy, 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.
Smith et al. in 2002 published two articles from their research on nausea and
vomiting in pregnancy. The first looked at the effectiveness of acupuncture and
the second at the safety of acupuncture treatment in early pregnancy.
The objective was to compare i. traditional acupuncture treatment, ii. acupuncture
at Neiguan P-6 only, iii. sham acupuncture and iv. no acupuncture treatment for
nausea and vomiting.
593 women who were less than 14 weeks pregnant and were suffering nausea and vomiting
of pregnancy were randomised into 4 groups and received treatment weekly.
The acupuncture group, in which points were chosen according to a traditional acupuncture
diagnosis, received two 20 minute acupuncture treatments in the first week followed
by one weekly treatment for the next four weeks.
The sham acupuncture group were needled at points close to but not on acupuncture
points and both the sham and Neiguan P-6 acupuncture groups were treated with the
same frequency as the traditional acupuncture group.
All group received their treatment from the same acupuncturist.
The outcomes of treatment were measured in terms of nausea, dry retching, vomiting
and health status.
When compared to the women who received no treatment, the traditional acupuncture
group reported less nausea throughout the study and less dry retching from the second
week. The Neiguan P-6 acupuncture group reported less nausea from the second week
and less dry retching from the third week. The sham acupuncture group reported less
nausea and dry retching from the third week.
So while all three acupuncture groups reported improvement with nausea and dry retching,
it was the traditional acupuncture group that had the fastest response.
Patients receiving traditional acupuncture also reported improvement in five aspects
of general health status (vitality, social function, physical function, mental health
and emotional role function) compared to improvement in two aspects with both the
Neiguan P-6 and sham acupuncture groups. In the no treatment group there was improvement
in only one aspect.
Although there were no differences in vomiting found in any of the treatment groups
the authors speculated that more frequent treatments might have produced greater
In assessing the safety of acupuncture in early pregnancy data was collected on
perinatal outcome, congenital abnormalities, pregnancy complications and problems
of the newborn.
No differences were found between study groups in the incidence of these outcomes
suggesting that there are no serious adverse effects from the use of acupuncture
treatment in early pregnancy.
Acupuncture is a safe and effective treatment for women who experience nausea and
dry retching in early pregnancy.
Cardini et al. in 1998 had the following randomised controlled trial published
in the Journal of American Association (JAMA).
The objective was to evaluate the efficacy and safety of moxibustion on Zhiyin BL-67
to correct breech presentation.
130 women with a breech presentation and having their first baby (primigravidas)
at 33 weeks gestation received moxibustion to Zhiyin BL-67 while 130 women, also
with a breech presentation and who were also primigravidas, received no intervention.
The moxibustion was administered for seven days. Women were then assessed and a
further seven days of moxibustion treatment given if the baby’s position had not
Outcomes were measured in terms of foetal movements, as counted by the mother for
one hour each day for one week, and the number of cephalic presentations both at
35 weeks gestation and at delivery.
At 35 weeks gestation 75.4% in the intervention group had changed to cephalic (47.7%
in the control). In terms of foetal movement the moxibustion group experienced a
greater number of movements (a mean of 48.45 compared to the control group with
a mean of 35.35).
That in prigravidas at 33 weeks gestation with breech presentation, moxibustion
treatment for one to two weeks at Zhiyin BL-67 increased foetal activity during
the treatment period and cephalic presentation at 35 weeks and at delivery.
Research on the use of acupuncture to prepare women for labour first appeared in
1974 with a study by Kubista and Kucera. Their research concluded that acupuncture
once a week from 37 weeks gestation using the acupuncture points Zusanli ST-36,
Yanglingquan GB-34, Jiaoxin KID-8 and Shenmai BL-62 was successful in reducing the
mean labour time of the women treated.
They calculated the labour time in two ways. The first was the mean time between
a cervical dilation of 3-4 cm and delivery. In the acupuncture group this was 4
hours and 57 minutes compared to five hours and 54 minutes in the control group.
The second was the mean subjective time of labour, taken from the onset of regular
(10-15 minute) contractions until delivery.
The acupuncture group had a labour time of 6 hours and 36 minutes compared to eight
hours and 2 minutes in the controls.
In 1998 Zeisler et al. used the acupuncture points Baihui DU-20, Shenmen HE-7
and Neiguan P-6, treating from 36 weeks gestation.
This study concluded that acupuncture treatment had a positive effect on the duration
of labour by shortening the first stage of labour, defined as the time between 3cm
cervical dilation and complete dilation.
The acupuncture group had a median duration of 196 minutes compared to the control
group time of 321 minutes.
In 2004 I was involved in an observational study looking at the effect of prebirth
acupuncture together with Sue Lennox, a midwife.
169 women who received prebirth acupuncture were compared to local population rates
for gestation at onset of labour, incidence of medical induction, length of labour,
use of analgesia and type of delivery
In the acupuncture group there was an overall 35% reduction in the number of inductions
(for women having their first baby this was a 43% reduction), 31% reduction in the
When comparing midwifery only care there was a 32% reduction in emergency caesarean
delivery and a 9% increase in normal vaginal births.
Our conclusion was that prebirth acupuncture appeared to provide some promising
therapeutic benefits in assisting women to have normal vaginal births and that a
further randomized controlled study is warranted.
A randomised controlled trial into the effects of acupuncture on cervical ripening
was published by Rabl in 2001.
The objective was to evaluate whether acupuncture at term can influence cervical
ripening and thus reduce the need for postdates induction.
On their due dates 45 women were randomised into either an acupuncture group (25)
or a control group (20). The acupuncture group received acupuncture every two days
at the acupuncture points Hegu L.I.-4 and Sanyinjiao SP-6.
The women in both groups were examined every other day for cervical length (measured
by vaginal trasonography, cervical mucus and cervical stasis according to Bishop’s
If women had not delivered after 10 days labour was induced by administering vaginal
The time from the woman’s due date to delivery was an average of 5 days in the acupuncture
group compared to 7.9 days in the control group, and labour was medically induced
in 20% of women in the acupuncture group compared to 35% in the control group.
There were no differences between overall duration of labour or of the first and
second stages of labour.
Acupuncture at the points Hegu L.I.-4 and Sanyinjiao SP-6 supports cervical ripening
and can shorten the time interval between the woman’s expected date of delivery
and the actual time of delivery.
 Elden H, Ladfors l, Fagevik Olsen M, Ostaard H, Hagberg H. Effects of acupuncture
and stabilising exercises as adjunct to standard treatment in pregnant women with
pelvic girdle pain: randomised singleblind controlled trail. BMJ 2005;330:761.
 Smith C, Crowther C, Beilby J. Acupuncture to treat nausea and vomiting in early
pregnancy: a randomized trial. Birth.2002, Mar:29 (1):1-9.
 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 Jun; 10(2):78-83.
 Cardini F, Weixin H. Moxibustion for correction of breech presentation. JAMA
 Kubista E, Kucera H. Geburtshilfe Perinatol 1974; 178 224-9.
 Zeisler H, Tempfer C, Mayerhofe Kr, Barrada M, Husslein P. Influence of acupuncture
on duration of labour Gynecol Obstet Invest 1998; 46:22-5.
 Betts D, Lennox S. Acupuncture for prebirth treatment: An observational study
of its use in midwifery practice. Medical acupuncture 2006 May; 17(3):17-20
 Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P. Acupuncture for cervical
ripening and induction of labour at term – a randomised controlled trail. Wien Klin
Wochenschr 2001; 113 (23-24): 942-6.