PREGNANCY & LABOUR RESEARCH (© JCM Ltd)

GINGER STOPS NAUSEA AND VOMITING IN PREGNANCY
Ginger (Sheng Jiang) is an effective remedy for nausea and vomiting during pregnancy. A single blind clinical trial carried out in Iran randomly assigned 67 pregnant women to receive either 1000 mg ginger in capsules or placebo capsules for four days. Ginger users demonstrated a higher rate of nausea improvement than placebo users (85% versus 56%). The decrease in vomiting among ginger users was also significantly greater than among women who received the placebo (50% vs. 9%). (Effects of ginger capsules on pregnancy, nausea and vomiting. J Altern Complement Med. 2009 Mar;15(3):243-6).

AURICULAR ACUPUNCTURE FOR LOW BACK & PELVIC PAIN IN PREGNANCY
One week of continuous auricular acupuncture decreases the pain and disability experienced by women with pregnancy-related low back and posterior pelvic pain. In a randomised controlled trial, American clinicians randomly assigned pregnant women to continuous auricular acupuncture, sham auricular acupuncture or a waiting list control. All participants were monitored for two weeks. Participants in the acupuncture group reported a significant reduction in pain and improvement of functional status compared to those in the sham acupuncture and control groups. (Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study. Am J Obstet Gynecol. 2009 Jun 25. [Epub ahead of print]).

ACUPUNCTURE RELIEVES DYSPEPSIA IN PREGNANCY
Acupuncture may help alleviate dyspepsia during pregnancy, according to a Brazilian team. Forty-two pregnant women with dyspepsia were randomly allocated to receive acupuncture or conventional treatment alone. Significant improvements in symptoms were found in the acupuncture group, who also used less medication. (Acupuncture for dyspepsia in pregnancy: a prospective, randomised, controlled study. Acupunct Med. 2009 Jun;27(2):50-3).

ACUPUNCTURE IN LABOUR IMPROVES BABIES’ CONDITION AT BIRTH
Researchers in Denmark have compared acupuncture with transcutaneous electric nerve stimulation (TENS) and analgesic medication for pain relief during labour. 607 healthy women in labour at term were randomised to receive acupuncture, TENS or analgesics. Pain scores were comparable in all groups, but use of pharmacological and invasive methods was found to be significantly lower in the acupuncture group. Acupuncture was not found to influence the duration of labour or the use of oxytocin. Mean Apgar score (a method for assessing the health of newborn infants) at five minutes and umbilical cord pH value (which measures the level of oxygenation if the infant’s blood) were significantly higher among infants in the acupuncture group compared with infants in the other groups. (Acupuncture as pain relief during delivery: a randomized controlled trial. Birth. 2009 Mar;36(1):5-12).

ACUPUNCTURE SHORTENS LABOUR
A Canadian team has investigated the effectiveness of acupuncture for the initiation of labour in a prospective pilot RCT. Sixteen pregnant women at term were randomly assigned to receive acupuncture either at sites reported to cause onset of labour or at nearby sham sites. The results showed a difference in intervention to delivery interval of 62 hours in favour of the treatment group. Women in the true acupuncture group had shorter labours by a mean of two hours and 20 minutes. (Effectiveness of acupuncture for the initiation of labour at term: a pilot randomized controlled trial. J Obstet Gynaecol Can. 2008 Dec;30(12):1118-23).

ACUPUNCTURE FOR PELVIC GIRDLE PAIN (PGP) DURING PREGNANCY
Swedish researchers have compared acupuncture with non-penetrating sham acupuncture in women with pelvic girdle pain (PGP) during pregnancy. In a randomised double-blinded controlled trial 115 pregnant women with PGP were randomly allocated to standard treatment plus acupuncture or to standard treatment plus non-penetrating sham acupuncture for eight weeks. After treatment, median pain decreased in both groups (from 66 to 36 in the acupuncture group and from 69 to 41 in the non-penetrating sham group), but there was no significant difference between groups. Women in the acupuncture group were in regular work to a higher extent than women in the sham group and the acupuncture group had superior ability to perform daily activities measured by the disability rating index. The authors conclude that acupuncture has no superior effect on pain relief, compared with sham, but that it improved women's functional ability to perform daily activities. (Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG. 2008 Dec;115(13):1655-68).

ACUPUNCTURE EFFECTIVE FOR BREECH CORRECTION
A systematic review from Holland has concluded that acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on Zhiyin BL 67 are effective in correcting breech presentation, compared with expectant management. Of 65 citations retrieved from various databases, six RCTs and three cohort studies fulfilled the reviewers’ inclusion criteria. In the RCTs the pooled proportion of breech presentations was 34% following treatment versus 66% in the control group. The pooled proportion in the cohort studies was 15% versus 36%. Including all studies, the proportion of breech presentations was 28% following treatment versus 56% for the control group. (Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review. Complement Ther Med. 2008 Apr;16(2):92-100).

ACUPUNCTURE PROMISING FOR PELVIC PAIN
A systematic review of the effectiveness of acupuncture in treating pelvic and back pain in pregnancy has found promising results. Two small trials on mixed pelvic/back pain and one large high-quality trial on pelvic pain met the inclusion criteria. The authors concluded that the current evidence, although limited, supports the use of acupuncture in treating the conditions. (Acupuncture for pelvic and back pain in pregnancy: a systematic review. Am J Obstet Gynecol. 2008 Mar;198(3):254-9).

TREATING PELVIC AND BACK PAIN IN PREGNANCY
A systematic review using the Cochrane database has assessed the effects of interventions for preventing and treating back and pelvic pain in pregnancy. Authors searched the Cochrane database for randomised controlled trials of any treatment used to prevent or reduce the incidence or severity of back or pelvic pain in pregnancy. Eight studies (1305 participants from five countries) were included in the analysis. Strengthening exercises, sitting pelvic tilt exercises and water gymnastics reduced pain intensity and back pain-related sick leave better than usual prenatal care alone. Both acupuncture and stabilising exercises relieved pelvic pain more than usual prenatal care and acupuncture gave more relief from evening pain than exercises. One study found that acupuncture was more effective than physiotherapy in reducing the pain intensity scores of women with combined pelvic and back pain. Sixty percent of those who received acupuncture reported reduced pain, compared with 14% of those receiving usual care, with no complications associated with the use of acupuncture in pregnant women. Women who received usual prenatal care alone reported more use of analgesics, physical modalities and sacroiliac belts. The authors advise caution in interpretation of the results as all studies but one were judged to have considerable potential for bias. (Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001139).

ACUPUNCTURE/PRESSURE FOR MORNING SICKNESS
A meta-analysis has examined the effects of various methods for stimulating acupuncture points (acustimulation, AS) for the prevention of nausea and vomiting in pregnant women (NVP). The authors identified 14 eligible trials published over the last 16 years, involving a total of 1615 women and using either acupressure, acupuncture or electrical stimulation (ETS) as a method of AS. After the treatment, compared with controls, AS (all methods) reduced the proportion of nausea by more than 50% and vomiting by around 40%. Acupressure applied by finger pressure or wristband reduced NVP, as did ETS. However, acupuncture did not show an effect on reducing NVP. The authors advise caution in interpreting the results, as the number of acupuncture trials included was limited. (Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women. Explore (NY). 2006 Sep-Oct;2(5):412-21).

ACUPUNCTURE FOR LABOUR INDUCTION
Fifty-six primigravid women at 39 weeks or greater with a singleton gestation and Bishop score (a system for predicting whether induction of labour will be required) of less than seven were randomised to usual medical care or usual care plus three acupuncture treatments. Each treatment consisted of eight needles applied bilaterally to Hegu L.I.-4, Sanyinjiao SP-6, Shangliao BL-31 and Ciliao BL-32. Mean time from randomisation to delivery occurred 21 hours sooner in the acupuncture group, but this difference did not reach statistical significance. Compared with controls, women in the acupuncture group tended to be more likely to labour spontaneously and less likely to deliver by Caesarean section. (A randomized controlled trial of acupuncture for initiation of labor in nulliparous women. J Matern Fetal Neonatal Med. 2006 Aug;19(8):465-70).

ACUPUNCTURE & BREECH PRESENTATION
A study of the effectiveness and cost of moxibustion for breech presentation compared to standard care found that the percentage of breech presentations after moxibustion was 24.5% compared to 42% for standard care, and that if only 10% of women opted for moxibustion it would overall be more effective and less costly than standard care. (The effectiveness and cost-effectiveness of Breech Version Acumoxa compared to standard care to correct breech presentation. Focus Altern Complement Ther 2006; 11: 05).

ACUPUNCTURE & LABOUR PAIN
A meta-analysis of three trials (496 women) into the use of acupuncture to relieve pain in labour suggests that women receiving acupuncture required less analgesia, including the need for epidural analgesic and a reduced need for augmentation with oxytocin. (Complementary and alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews 2006 Issue 4).

ACUPUNCTURE & PELVIC PAIN
Acupuncture has previously been shown to be more effective than either standard or specialised exercises in relieving pelvic pain in pregnancy (BMJ 2005;330:761). Now a new study has compared subcutaneous needling without further stimulation and deep needling with deqi for the same problem. Both groups experienced significant improvements in levels of pain intensity at rest and in daily activities as well as in rated emotional reaction and loss of energy, but there was no difference between the two different methods of acupuncture. (Decrease of pregnant women’s pelvic pain after acupuncture: a randomized controlled single-blind study. Acta Obstet Gynecol Scand. 2006;85:12-9).

PREBIRTH ACUPUNCTURE
A study of prebirth acupuncture given in the practices of 14 New Zealand midwives over a four-month period found a 35% reduction in induction rates (43% for primigravidae), 31% reduction in epidurals, 32% reduction in emergency caesarean sections and 9% increase in normal vaginal birth compared to the general population. The most commonly used points were Sanyinjiao SP-6, Zusanli ST-36, Yanglingquan GB-34, Kunlun BL‑60 and Hegu L.I.-4. (Acupuncture for prebirth treatment: an observational study of its use in midwifery practice. Medical Acupuncture. 2006; 17:3).

ACUPUNCTURE REDUCES EPIDURALS
A Norwegian study has shown that women who receive acupuncture during labour have a significantly reduced rate of epidural anaesthesia. (Nesheim BI, Kinge R. Performance of acupuncture as labor analgesia in the clinical setting. Acta Obstet Gynecol Scand. 2006;85(4):441-3).

SHIATSU HELPS POST-TERM LABOUR
Pregnant post-term women who were taught shiatsu techniques by a midwife were significantly more likely to go into labour spontaneously compared to women who did not learn the technique. (Complement Ther Med 2005; 13: 11-15).

ACUPUNCTURE EFFECTIVE FOR PELVIC PAIN IN PREGNANCY
One in three women suffer potentially severe and disabling pelvic girdle pain during pregnancy. Now a Swedish study has demonstrated that acupuncture is more effective than either standard or specialised exercises in relieving the pain. 386 pregnant women were assigned to a six-week treatment programme involving either standard home exercise, standard exercise plus acupuncture or specialised exercises designed to improve mobility and strength. Pain levels were assessed morning and evening. The women receiving the acupuncture showed the greatest relief in pain, which, achieved without the use of medication, is of particular benefit to pregnant women. Acupuncture treatment focused on the following points: Baihui DU-20, Hegu L.I.-4, Guanyuanshu BL-26, Ciliao BL-32 Zhongliao BL-33, Zhibian BL-54 Henggu KID-11,Kunlun BL-60, Huantiao GB-30, Chongmen SP-12 and Zusanli ST-36. Deqi was obtained and the needles were retained for 30 minutes, with manipulation every 10 minutes. Treatment was given twice weekly for the six-week study period. The authors of the study say: “We conclude that acupuncture as well as stabilising exercises constitute effective complements to standard treatment for pregnant women with pelvic girdle pain. Acupuncture was superior to stabilising exercises in this study. The findings are of particular importance because no previous study has shown such marked treatment effects among pregnant women with well defined pelvic girdle pain”. (BMJ 2005;330:761 (2 April), doi:10.1136/bmj.38397.507014.E0).

ACUPUNCTURE FOR PREGNANCY DEPRESSION
Pharmaceutical medication is largely unsuitable for depression during pregnancy and therefore any non-pharmaceutical alternative is potentially of great value. In a study carried out at Stanford University, 61 women with major depressive disorder were randomly assigned to receive one of three treatments: i. Individually tailored true acupuncture designed to treat their depression, ii. True acupuncture but with points not chosen to treat the depression, and iii. Massage treatment (included to provide a control for attention, physical contact, relaxation and respite from daily stress). Acute phase treatment was given for twelve sessions over eight weeks, with continued treatment throughout pregnancy for those who responded. As far as possible the acupuncture treatment was double-blinded, with the treatment to be given by a treating acupuncturist determined by a different (assessing) acupuncturist. The assessment, treatment design, needle insertion, and needle stimulation were all standardised. Response rates at the end of the acute phase were 68.8% in the depression specific acupuncture, 47.4% in the non depression-specific acupuncture, and 31.6% in the massage group. The study also showed that successful treatment of depression during pregnancy offers protection from postpartum depression. (Journal of Affective Disorders, Volume 83, Issue 1, 15 November 2004, Pages 89-95).

ACUPUNCTURE FOR PELVIC AND BACK PAIN IN PREGNANCY
In this Swedish study, 72 pregnant women (24-37 weeks) suffering pelvic or low back pain were randomly assigned to an acupuncture group or a control group. Traditional acupuncture points and ahshi points were needled (with deqi elicited) in individualised treatments, once or twice a week until 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. (Acta Obstet Gynecol Scand 2004; 83(3): 246-50).

ACUPUNCTURE FOR BREECH PRESENTATION
An Italian study into breech presentation compared 112 randomly selected women who were given acupuncture and moxibustion at Zhiyin BL-67, with 114 women who were simply observed. All were at 33-35 weeks of gestation. The proportion of caesarean sections required in the acupuncture treatment group was significantly lower than in the control group (52.3% versus 66.7%). (Journal of Maternal-Fetal and Neonatal Medicine, 15; 4: 247-252).

ACUPUNCTURE FOR BACK PAIN IN PREGNANCY
A Brazilian study which compared the levels of low back and pelvic pain in women treated by acupuncture compared to non-treated controls, found that the acupuncture group showed a greater reduction in overall pain, maximum pain and  pain at the time of interview, reduced use of analgesics, and greater capacity to perform general activities, to walk and to work. (Acupuncture in Medicine, 2004 vol 22(2), 60-67).

ACUPUNCTURE & BREECH PRESENTATION
A study carried out in Croatia compared the outcome of 34 pregnant women with breech presentation treated by manual needling of Zhiyin BL-67 (with deqi), and 33 similar women not treated by acupuncture as a control. Acupuncture was given from 34 weeks, each session lasting 30 minutes, 2 sessions a week. The rate of successful conversion to vertex presentation (verified by ultrasonography) was 76.4% in the acupuncture group, and 45.4% in the control group. A mean of 6 acupuncture treatments was needed, and acupuncture was discontinued on successful outcome, or after 38 weeks if unsuccessful. (Fetal Diagnosis and Therapy Vol. 18, No. 6, 2003).

ACUPUNCTURE EFFECTIVE FOR BREECH CORRECTION
A systematic review from Holland has concluded that acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on Zhiyin BL 67 are effective in correcting breech presentation, compared with expectant management. Of 65 citations retrieved from various databases, six RCTs and three cohort studies fulfilled the reviewers’ inclusion criteria. In the RCTs the pooled proportion of breech presentations was 34% following treatment versus 66% in the control group. The pooled proportion in the cohort studies was 15% versus 36%. Including all studies, the proportion of breech presentations was 28% following treatment versus 56% for the control group. (Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review. Complement Ther Med. 2008 Apr;16(2):92-100).

ACUPUNCTURE FOR LABOUR PAIN
A randomised, unblinded, controlled study carried out at the Department of Obstetrics and Gynecology, Ulleval University Hospital, Oslo, Norway, has indicated that acupuncture is effective in controlling labour pain. Of the 106 women in labour who received acupuncture, only 11% required Meperidine analgesia, compared to 37% and 29% in two control groups. The use of other analgesics was also lower in the acupuncture group. Patient satisfaction was high: 89 of 103 patients asked said they would want acupuncture during another labour. (Clin J Pain. 2003 May-Jun;19(3):187-91).

ACUPUNCTURE AND LABOUR PAIN
Obstetricians from Norway have said that acupuncture is the analgesic method of choice for reducing labour pain, whether supplemented by pharmacological pain-killers or not. 210 mothers in spontaneous labour were randomly assigned to receive either real acupuncture or false acupuncture. The results were tested by assessing their request for pharmacological pain-relief, and on their perception of pain felt on a Visual Analogue Score. The researchers concluded that acupuncture not only reduced the amount of labour pain, it also reduced delivery time. It was particularly useful for those mothers preferring non-pharmacological pain-relief without side-effects. (Acta Obstet Gynecol Scand 2002 Oct; 81(10):943-8).

ACUPUNCTURE & MORNING SICKNESS
A study of 593 women at the Women’s and Children’s Hospital, Adelaide, Australia, who were less than 14 weeks pregnant and suffered from symptoms of nausea or vomiting, compared traditional acupuncture, simple acupuncture at Neiguan P-6 only, sham acupuncture and no acupuncture. The acupuncture patients received two 20-minute sessions of acupuncture in the first week followed by one weekly treatment for four weeks. Traditional acupuncture consisted of the insertion of a maximum of 6 needles at a mixture of abdominal points and points selected according to pattern differentiation. Abdominal points were Burong ST-19, Chengman ST-20, Liangmen ST-21, Youmen KID-21, Futonggu KID 20, Juque REN-14, Shangwan REN-13, Zhongwan REN-12, Jianli REN-11 and Xiawan REN-10. Points selected according to differentiation were Liver qi stagnation: Taichong LIV-3, Neiguan P-6, Yanglingquan GB 34, Shangwan REN-13, Youmen KID-21, Liangqiu ST-34, Zusanli ST-36; Stomach or Spleen deficiency: Zusanli ST 36, Neiguan P-6, Zhongwan REN 12; Stomach heat: Neiting ST-44, Jianli REN-11, Liangqiu ST 34, Liangmen ST-21, Neiguan P-6, Quze P-3; Phlegm: Fenglong ST-40, Yinlingquan SP-9, Burong ST-19, Pishu BL-20, Youmen KID-21; Heart qi deficency: Tongli HE-5, Neiguan P-6, Zusanli ST-36, Juque REN-14; Heart fire: Neiguan P-6, Juque REN-14, Xinshu BL-15. Deqi was obtained and needles were left for 20 minutes. The sham acupuncture group were needled at points close to, but not on, acupuncture points. All three acupuncture groups reported less nausea and dry retching, with traditional acupuncture having the fastest effect. Patients receiving traditional acupuncture reported improvement in five aspects of general health status (vitality, social function, physical function, mental health and emotional role function) compared with improvement in 2 aspects in the other acupuncture groups, and 1 aspect in the no acupuncture group. Although no kind of acupuncture was able to reduce vomiting, the authors speculate that more frequent treatments might have produced greater benefit. (Birth 29:1 March 2002).

ACUPUNCTURE EFFECTIVE FOR LABOUR PAIN
A study carried out at Orebro University Hospital in Sweden has found that women who received acupuncture during labour were less likely to ask for an epidural to relieve pain (12% compared to 22%) and felt more relaxed than women who did not receive acupuncture. 46 women were randomised to receive acupuncture during labour, and reported at least once an hour how much pain they were experiencing and how relaxed they felt. Results were compared to 44 women who did not receive acupuncture. The women in both groups had constant access to other methods of pain relief, including epidurals, nerve blocks and warm rice bags. The acupuncture was administered by midwives who had gone through a 4-day course on the use of acupuncture during labour and was individualised according to the type of pain experienced. The women who received acupuncture were half as likely to request an epidural during labour, were less likely to ask for other types of pain relief, such as nerve stimulation therapy or a warm rice bag, and reported feeling more relaxed than their untreated peers, although the treatment had no significant effect on how much pain the women said they were feeling. The acupuncture appeared to have no effect on the length of labour. (British Journal of Obstetrics and Gynaecology 2002;109:637-644).

ACUPUNCTURE DURING LABOUR
A study was conducted to see if acupuncture can influence cervical ripening, induce labour and reduce the need for induction. 45 women were randomly assigned to an acupuncture or a control group on their due date. In the acupuncture group, women were needled at Hegu L.I.-4 and Sanyinjiao SP-6 bilaterally every other day, until they either gave birth or, if the due date was exceeded by 10 days, were induced. In the acupuncture group the time from the first positive fibonectin test to delivery was 2.3 days (compared to 4.2 days in the control group), the time from due date to delivery was 5 days on average (7.9 in the control), and only 20% of women in the acupuncture group needed to be induced (35% in the control). There was no difference in duration of labour between the two groups. (Wien Klin Wochenschr 2001;113:942-6).

ACUPUNCTURE & MORNING SICKNESS
A study of 593 women at the Women’s and Children’s Hospital, Adelaide, Australia, who were less than 14 weeks pregnant and suffered from symptoms of nausea or vomiting, compared traditional acupuncture, simple acupuncture at Neiguan P-6 only, sham acupuncture and no acupuncture. The acupuncture patients received two 20-minute sessions of acupuncture in the first week followed by one weekly treatment for four weeks. Traditional acupuncture consisted of the insertion of a maximum of 6 needles at a mixture of abdominal points and points selected according to pattern differentiation. Abdominal points were Burong ST-19, Chengman ST-20, Liangmen ST-21, Youmen KID-21, Futonggu KID 20, Juque REN-14, Shangwan REN-13, Zhongwan REN-12, Jianli REN-11 and Xiawan REN-10. Points selected according to differentiation were Liver qi stagnation: Taichong LIV-3, Neiguan P-6, Yanglingquan GB 34, Shangwan REN-13, Youmen KID-21, Liangqiu ST-34, Zusanli ST-36; Stomach or Spleen deficiency: Zusanli ST 36, Neiguan P-6, Zhongwan REN 12; Stomach heat: Neiting ST-44, Jianli REN-11, Liangqiu ST 34, Liangmen ST-21, Neiguan P-6, Quze P-3; Phlegm: Fenglong ST-40, Yinlingquan SP-9, Burong ST-19, Pishu BL-20, Youmen KID-21; Heart qi deficency: Tongli HE-5, Neiguan P-6, Zusanli ST-36, Juque REN-14; Heart fire: Neiguan P-6, Juque REN-14, Xinshu BL-15. Deqi was obtained and needles were left for 20 minutes. The sham acupuncture group were needled at points close to, but not on, acupuncture points. All three acupuncture groups reported less nausea and dry retching, with traditional acupuncture having the fastest effect. Patients receiving traditional acupuncture reported improvement in five aspects of general health status (vitality, social function, physical function, mental health and emotional role function) compared with improvement in 2 aspects in the other acupuncture groups, and 1 aspect in the no acupuncture group. Although no kind of acupuncture was able to reduce vomiting, the authors speculate that more frequent treatments might have produced greater benefit. (Birth 29:1 March 2002).

ACUPUNCTURE & LABOUR
A German study has compared the morphologic features and
duration of labour in 878 women with at least 36 weeks of uncomplicated
pregnancy after receiving a) active acupuncture (329 primiparas), b) nonspecific
acupuncture (224 women), or c) no acupuncture treatment (325 primiparas).
Women who received specific acupuncture experienced significantly shorter
labour times (470 +/-190 minutes) compared to those who received
nonspecific acupuncture (536 +/-200 minutes) and no acupuncture (594 +/-
241 minutes). Cervical maturation was also more pronounced in the
treatment group. The authors conclude that uterine contractions may be
"better co-ordinated" in women who receive specific acupuncture, and they
suggest that "prenatal acupuncture should be considered for women with
uncomplicated pregnancies as they approach term."(Romer A, Weigel M, Zeiger W, Melchert F.  Prenatal acupuncture: Effects on cervical maturation and duration of labor. Geburtshilfe Und Frauenheilkunde.  2000;60(10):513-518).

ACUPUNCTURE FOR LOW-BACK AND PELVIC PAIN IN PREGNANCY
Acupuncture may be more effective than physiotherapy for pregnancy-related
low-back and pelvic pain, according to a recent prospective study. Sixty
pregnant women with low-back and pelvic pain were randomised to receive 10
treatments of either acupuncture (30-minute sessions, given within 1
month) or physiotherapy (50-minute sessions of counselling and physical
therapies, given within 6 to 8 weeks). Significant improvements were noted
in pain and in the ability to perform daily activities in the acupuncture
group. The physiotherapy group had less pain relief but symptoms did not
become worse (as they often do in pregnancy). While the physiotherapy
group had a high dropout rate, which weakened the analysis, the
researchers conclude that acupuncture is "promising enough to warrant
further studies." (Acta Obstet Gynecol Scand. 2000;79:331-335).

ACUPUNCTURE IN CHILDBIRTH
A study carried out at The Department of Obstetrics & Gynaecology at the University of Vienna has shown that prenatal acupuncture can reduce the duration of the first stage of labour (196 minutes versus 321 minutes in a control group), but not the second stage of labour, can significantly reduce use of oxytocin in both the first and second stages, and significantly raise serum levels of prostaglandin E2 at the end of the first stage (Abstracted in Deutsche Zeitschrift für Akupunktur, Jg. 43, 1, 2000, p40).

ACUPUNCTURE AND CHILDBIRTH
In a study carried out in Sweden, the analgesic effect of acupuncture during childbirth was assessed by comparing the need for other pain treatments such as epidural analgesia, nitrous oxide/oxygen etc. in 90 women given acupuncture (acupuncture group) compared with 90 women not given acupuncture (control group). 52 women (58%) in the acupuncture group and 13 (14%) in the control group managed their deliveries without further pain treatment. The groups were similar with respect to age, pariety, duration of delivery, use of oxytocine and incidence of Caesarean section. Acupuncture treatment was found to have no major side effects, and 85 women (94%) given acupuncture reported that they would reconsider acupuncture in future deliveries. The authors concluded that acupuncture reduces the need for other methods of analgesia in childbirth (Acupunct Electrother Res, 23(1):19-26 1998).

MOXIBUSTION AT ZHIYIN BL-67
An Italian obstetrician has carried out a study into the application of moxibustion at Zhiyin BL-67 for the treatment of breech presentation in pregnancy. Francesco Cardini and Huang Weixin divided 130 women (in the 33rd week of their first pregnancy) in two Chinese hospitals into two groups. Those treated with moxibustion (for 7 consecutive daily treatments with seven more if needed) experienced greater foetal movement and had significantly more normal (cephalic) births than women left untreated  (The Journal of the American Medical Association 1998;280).

ACUPUNCTURE FACILITATES NATURAL BIRTH
Acupuncture significantly reduces duration of labour and reduces the need for augmentation of labour with contraction-stimulating drugs. A study randomised 100 women with spontaneous rupture of membranes at term to either acupuncture or no acupuncture. Treatment was individualised on the basis of traditional Chinese medical diagnosis and used three points per patient from a pool of nine possible choices. Treatment principles applied were to increase energy, soften the cervix and open the Conception vessel. Although time from membrane rupture to delivery did not differ significantly between the groups, length of active labour was significantly reduced in the acupuncture group by a mean difference of 1.7 hours. In addition, significantly fewer patients in the acupuncture group required oxytocin (used to stimulate contractions) for longer than two hours. Medical induction of labour was eventually necessary in 15 acupuncture patients and 20 controls. When induction was carried out, women assigned to acupuncture completed the active phase of labour in half the time compared to controls, a statistically significant difference. (Acupuncture administered after spontaneous rupture of membranes at term significantly reduces the length of birth and use of oxytocin. A randomized controlled trial. Acta Obstet Gynecol Scand. 2006;85(11):1348-53).
   
ELECTRO-ACUPUNCTURE EFFECTIVE FOR LABOUR PAIN
In a study investigating the efficacy of electro-acupuncture (EA) for relief of labour pain, 36 pregnant women were randomly divided into an EA group and a control group. Two rounds of EA were carried out, one at the beginning of the active phase of labour and one at 7-8cm of cervical dilatation. Hegu L.I.-4 and Sanyinjiao SP-6 were stimulated bilaterally for 20 minutes at a frequency of 2–100 Hz and current of 14–30 mA (a tolerable level) with a dense/disperse waveform. The EA group was found to exhibit lower pain intensity and better relaxation during labour than the control group. In addition, there was found to be a significant increase in the concentration of the pain-relieving substances beta-endorphin and 5-hydroxytryptamine in the peripheral blood of the acupuncture group at the end of the first stage of labour. (Electro-acupuncture in relieving labor pain. Evid Based Complement Alternat Med. 2007 Mar;4(1):125-30).

ACUMOXA FOR BREECH BABIES
A study has evaluated the effects of acupuncture and moxibustion on the behaviour of breech foetuses. Women were treated by stimulating Zhiyin BL-67 twice a week for 20 minutes. Fourteen cases were treated using both acupuncture and moxibustion, 15 cases by moxibustion and ten cases by acupuncture. In 56% of cases, foetal position converted from breech to cephalic (80% success rate for moxibustion, 28% for acupuncture, 57% for acupuncture plus moxibustion). Conversion, on average, was achieved after three sessions. During the process of stimulation, it was found that foetal movements were reduced by both acupuncture plus moxibustion and moxibustion alone, and that foetal heart rate was reduced only by acupuncture plus moxibustion in combination. (Effects of three different stimulations (acupuncture, moxibustion, acupuncture plus moxibustion) of BL.67 acupoint at small toe on fetal behavior of breech presentation. Am J Chin Med. 2007;35(1):27-33).