Acupuncture has become an accepted and validated part of Western mainstream medicine and is increasingly used by clinicians, midwives, and acupuncturists for reproductive care, induction of labor, and analgesia. Most studies of the effects of obstetrical acupuncture are descriptive, many in foreign languages. Only a few have evaluated efficacy. Results suggest that acupuncture ripens the cervix, initiates labor, reduces labor pain, and shortens the first stage of labor. There is some evidence suggesting that certain acupuncture points have very specific effects on the fetus and uterus, which may be mediated through the hypopituitary-thalamic axis or by local neurovascular stimulation. The substantial maternal hormonal changes occurring just before and during labor offer a unique opportunity to clarify the mechanisms of action of acupuncture. Using a conceptual model based on possible mechanisms of action of the use of acupuncture in obstetrics, the authors propose specific research questions into the physiology of acupuncture administered before and at parturition.
Allaire, A.D., Moos, M., & Wells, S.R. (2000). Complementary and alternative medicine in pregnancy: A survey of North Carolina nurse-midwives. Obstetrics and Gynaecology, 95, 19-23.
2.
Barratt-Due, A., Hagen, I., & Dahl, V. (2005). Obstetric analgesia in Norwegian hospitals. Tidsskr Nor Laegeforen,125, 2504-2506.
3.
Bell, C. (1972). Autonomic nervous control of reproduction: Circulatory and other factors. Pharmacology Review, 24, 657-736.
4.
Budd, S., Yellam, S., & Maciocia, G. (2000). Acupuncture and herbal treatment in midwifery . In G. Maciocia & Z. West (Eds.), Acupuncture in pregnancy and childbirth (pp. 559-575). New York: Churchill Livingstone.
5.
Cardini, F., & Weixin, H. (1998). Moxibustion for correction of breech presentation. Journal of theAmerican Medical Association, 280(18), 1580-1584.
6.
Curtis, P. (2006). Evidence-based medicine and complementary and alternative therapies. Retrieved May 2006 from http://pim.med.unc.edu.
7.
Dorr, A. (1990). The possibility of inducing labor using acupuncture . American Journal of Acupuncture, 18(3), 213-218.
8.
Duke, K., & Don, M. (2005). Acupuncture use for pre-birth treatment. A literature review and audit based research. Complementary Therapies in Clinical Practice, 11, 121-126.
9.
Dunn, P.A., App, M., Rogers, D., & Halford, K. (1989). Transcutaneous electrical nerve stimulation at acupuncture points in the induction of labor. Obstetrics andGynecology, 73(2), 286-290.
10.
Ernst, E., & White, A. (Eds.). (1999). Acupuncture. A scientific appraisal. Oxford, UK: Butterworth-Heinemann.
11.
Ewies, A.A., & Olah, K.S.J. (2002). The sharp end of medical practice: The use of acupuncture in obstetrics and gynecology. British Journal of Obstetrics and Gynecology, 109, 1-4.
12.
Facchinetti, F., Nappi, G., Savoldi, F., & Genazzini, A.R. (1981). Primary headaches: Reduced circulating B-lipoprotein and B-endorphin levels with impaired reactivity to acupuncture. Cephalalgia, 1, 195-201.
13.
Filshie, J., & White, A. (Eds.). (1998). Medical acupuncture. A Western scientific approach. Edinburgh, UK: Churchill Livingtsone.
14.
Fovouzi, N., Frisbaek, Y., & Norwitz, E.R. (2004). Pituitary gland and pregnancy. Obstetrics and Gynecology Clinics of NorthAmerica, 31, 873-892.
15.
Han, J.S. (2003). Acupuncture: Neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences, 26, 17-22.
16.
Harper, T.C., Coeytaux, R.R., Chen, W., Campbell, K., Kaufman, J.S., Moise, K.J., et al. (2006). A randomized controlled trial of acupuncture for initiating labor. Journal of Maternal-Fetal and NeonatalMedicine, 19(8), 465-470.
17.
Hyodo, M., & Gega, O. (1977). Use of acupuncture anesthesia for normal delivery. American Journal of ChineseMedicine, 5, 63-69.
18.
Jeschke, U., Mylonas, I., Richter, D.U., Hocker, I., Briese, V., Makrigiannakis, A., et al. (2005). Regulation of progesterone production in human term trophoblasts in vitro by CRH, ACTH and cortisol. Archives of Gynecology and Obstetrics, 272, 7-12.
19.
Kim, J.S., Chang, S.N., Hwang, W.J., Lee, B.C., Shin, K.H., & Pak, S.C. (2003). Immuno-histochemical localization of cyclooxygenase in pregnant rat uterus by Sp-6 acupuncture. American Journal of ChineseMedicine, 31, 481-488.
20.
Kubista, E., & Kucera, H. (1973). Acupuncture preparation of primigravidae as a means of shortening labour. Wien Klin Wochenschr, 85, 628-629.
21.
Kubista, E., & Kucera, H. (1974). Acupuncture as a method of preparation in obstetrics. American Journal of ChineseMedicine, 2, 283-287.
22.
Kubista, E., Kucera, H., & Muller-Tyl, E. (1975). Initiating contractions of the gravid uterus through electro-acupuncture. American Journal of Chinese Medicine, 3, 343-346.
Lee, H., & Ernst, E. (2004). Acupuncture for labor pain management: A systematic review. American Journal of Obstetrics and Gynecology, 191(5), 1573-1579.
25.
Liao, Y., Saito, H., Fujita, M., & Kawakami, M. (1979). Effect of acupuncture on adrenocortical hormone production; 1. Variation in the ability for adrenocortical. Hormone production in relation to the duration of acupuncture stimulation. American Journal of ChineseMedicine, 7, 362-371.
26.
Lockwood, C.J. (2004). The initiation of parturition at term. Obstetrics and Gynecology Clinics of NorthAmerica, 31, 935-947.
27.
Lyrenas, S., Lutsch, H., Hetta, J., & Lindberg, B. (1987). Acupuncture before delivery: Effect on labor. Gynecologic and Obstetric Investigation, 24, 217-224.
28.
Ma, S.X., & Li, X.Y. (2002). Increased neuronal nitric oxide synthase expression in the Gracile nucleus of brainstem following electro-acupuncture given between cutaneous acupuncture points BL64 & BL65 in rats. Acupuncture & Electro-Therapeutics Research,27, 157-169.
29.
Maciocia, G. (2005). Obstetrics and gynecology in Chinese medicine . New York: Churchill Livingstone .
30.
Malizia, F., Andreucci, G., Paolucci, D., Crescenzi, F., Fabbri, A., & Fraioloi, F. (1979). Electroacupuncture and peripheral B-endorphin and ACTH levels. Lancet, 2(8141), 535-536.
31.
Mann, F. (2000). Reinventing acupuncture. A new concept of ancient medicine. Oxford, UK: Butterworth-Heinemann.
32.
McPherson, H., White, A., Cummings, M., Jobst, K.A., & Niemtzow, R.C. (2002). Standards for reporting interventions in controlled trials of acupuncture: The STRICTA recommendations . Journal of Alternative and Complementary Therapies, 8(1), 85-89.
33.
Medicine, S.C.o.T. (1981). Acupuncture. A comprehensive text. Seattle: Eastland.
34.
Melzack, R. (1999). From gate to neuromatrix. Pain , 6, S121-S126.
35.
Melzack, R., Stillwell, D.M., & Fox, E.J. (1977). Trigger points and acupuncture points for pain; correlations and implications. Pain, 3, 3-23.
36.
Mendelson, C.R., & Condon, J.C. (2005). New insights into the molecular endocrinology of parturitio. Journal of Steroid Biochemistry and MoecularlBiology, 93, 113-119.
37.
Neri, I., Fazzio, M., Menghini, S., Volpe, A., & Facchinetti, F. (2002). Non stress test changes during acupuncture plus moxibustion on BL 67 point in breech presentation . Journal of the Society for Gynecologic Investigation, 9, 159-162.
38.
Nesheim, B.I., Kinge, R., Berg, B., Alfredsson, B., Allgot, E., Hove, G., et al. (2003). Acupuncture during labor can reduce the use of meperidine: A controlled study. Clinical Journal ofPain, 19, 187-191.
39.
Oh, S.Y., Kim, C.J., Park, I., Romero, R., Sohn, Y.K., Moon, K.C., et al. (2005). Progesterone receptor isoform (A/B) ratio of human fetal membrane increasing during term parturition. American Journal of Obstetrics and Gynecology, 193, 1156-1160.
40.
Omura, Y. (1975). Pathophysiology of acupuncture: Treatment effects of acupuncture on cardiovascular and nervous systems. Acupuncture & Electro-Therapeutics Research, 1, 51-141.
41.
Pak, S.C., Na, S.C., Kim, J.S., Chae, W.S., Kamiya, S., Wakatsuki, D., et al. (2000). The effect of acupuncture on uterine contraction induced by oxytocin. American Journal of ChineseMedicine , 28, 35-40.
42.
Peng, L., Feng-Yen, S., & An-Zhong, Z. (1983). The effect of acupuncture on blood pressure: The inter-relation of sympathetic activity and endogenous opioids. Acupuncture & Electro-Therapeutics Research, 8, 45-46.
43.
Rabl, M., Ahner, R., Bitschau, M., Zeisler, H., & Husslein, P. (2001). Acupuncture for cervical ripening and induction of labor at term—A randomized controlled trial. Wien Klin Wochenschr, 113(23), 942-946.
44.
Ramnero, A., Hanson, U., & Kihlgren, M. (2002). Acupuncture treatment during labor— A randomized controlled trial. British Journal of Obstetrics and Gynecology , 109(6), 637-644.
45.
Reid, D. (1995). The complete book of Chinese health and healing . Boston: Shambhala.
46.
Renaud, R., Raffi, F., Biechler, M., Rosenthal, C., Vandevenne, A., Darras, J.C., et al. (1976). Induction du travail opar electro-acupuncture [Induction of labor by electroacupuncture]. La Nouvelle Presse Medicale, 5, 151.
47.
Roemer, A., Weigel, M., Zeiger, W., & Melchert, F. (1998). Veranderungen von Cervixreife und Geburtsdauer nach geburtsvorbereiter Akupunkturtherapie [Changes in cervical ripening and labor duration after acupuncture for birth preparation]. In A. Roemer (Ed.), Akupunkturtherapie in der Geburtshilfe und Frauenhelikunde. Stuttgart, Germany: Hippocrates.
48.
Roemer, A.T. (2005). Medical acupuncture in pregnancy. New York: Thieme.
49.
Rogers, R.M. (1998). Basic pelvic neuroanatomy. In J. F. Steege, D. Metzger , & B. Levy (Eds.), Chronic pelvic pain: An integrated approach (pp. 31-58). New York: W. B. Saunders.
50.
Sato, A., & Scmidt, R.F. (1979). Somtasympathetic reflexes: Afferent fibres, central pathways, discharge characteristics. Physiological Reviews , 53, 916-943.
51.
Scharf, A., Staboulidou, I., Gunter, H.H., Wustermann, M., & Sohn, C. (2003). Influence of antenatal acupuncture on cardiotocographic parameters and maternal circulation— A prospective study. Z Geburtshilfe Neonatal, 207(5), 166-172.
52.
Schnyer, R.N., & Allen, J.J.B. (2002). Bridging the gap in complementary and alternative medicine research: Manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture. Journal of Alternative and ComplementaryMedicine, 8, 623-634.
53.
Skelton, I.F., & Flowerdew, M.W. (1988). Acupuncture and labour—A summary of results. Midwives Chronicle and NursingNotes, pp. 134-137.
54.
Skilnand, E., Fossen, D., & Heiberg, E. (2002). Acupuncture in the management of pain in labor . Acta Obstetrica Gynecologica Scandinavica, 81, 943-948.
55.
Smith, C.A., & Crowther, C.A. (2003). Acupuncture for the induction of labor. Cochrane Database of Systematic Reviews2004. Issue 1. Art No; CD002962. DOI:10.1003/4651858CD002962.pub2.
56.
Staebler, F.E. (1985). Clinical acupuncture in childbirth. British Journal of Acupuncture, 8, 3-12.
57.
Stener-Victorin, E., Waldenstrom, U., Andersson, S.A., & Wikland, M. (1996). Reduction of blood flow impedance in the uterine arteries of infertile women with electroacupuncture. Human Reproduction,11, 1314-1317.
58.
Stepanov, V.S., & Filimonov, V. (1976). Use of acupuncture for stimulation on the contractile activity of the uterus. Vopr Okrr Materin Det, 24, 90.
59.
Stux, G., & Hammerschag, R. (2001). Clinical acupuncture. Scientific basis. New York: Springer.
60.
Tempfer, C., Zeisler, H., Heinzl, H., Hefler, L.A., Husslein, P., & Kainz, C. (1998). Influence of acupuncture on maternal serum levels of interleukin-8, prostaglandin F2alpha and beta-endorphin: A matched pair study. Obstetrics andGynecology, 92, 245-248.
61.
Travell, J.G., & Simons, D.G. (1992). Myofascial pain and dysfunction. The trigger point manual. Vol 1. Baltimore: Williams and Wilkins.
62.
Tremeau, M.L., Fontanie-Ravier, P., Teurnier, F., & Demouzon, J. (1992). Protocole de maturation cervicale par acupuncture . Journal de Gynecologie, Obstetrique et Biologie de la Reproduction , 21, 375-380.
63.
Tsuei, J.J., Yiu-Fun, L., & Sharma, S.D. (1977). The influence of acupuncture stimulation during pregnancy. The induction and inhibition of labor. Obstetrics andGynecology, 50(4), 479-488.
64.
Ulett, G., Han, S., & Han, J. (1998). Electro-acupuncture: Mechanisms and clinical application. BiologicalPsychiatry, 44, 129-138.
65.
Uvnas-Moberg, K. (2002). Oxytocin: Possible mediator of anti-stress effects induced by acupuncture. Acupuncture in Medicine, 20, 109-120.
66.
Wadhwa, P.D., Garite, T.J., Porto, M., Glynn, L., Chicz-DeMet, A., Duussel-Schetter, C., et al. (2004). Placental corticotrophin releasing hormone (CRH) spontaneous birth and fetal growth restriction: A prospective investigation . American Journal of Obstetrics and Gynecology, 191, 1063-1069.
67.
Yanai, N., Shalev, E., Yagudin, E., & Zuckerman, H. (1987). The use of electroacupuncture during labor. American Journal of Acupuncture, 15, 311-312.
68.
Yang, H., Chang, J.Y., Woodward, D.J., Baccala, L.A., Han, J.S., & Lue, F. (2005). Coding of peripheral electrical stimulation frequency in thalamocortical pathways. ExperimentalNeurology, 196, 138-152.
69.
Ying, Y.-K., Lin J.-T., & Robins, J. (1985). Acupuncture for the induction of cervical dilatation in preparation for first-trimester abortion and its influence on HCG. Journal of ReproductiveMedicine, 30, 530-543.
70.
Yip, S.K., Pang, J.C.K., & Sung, M.L. (1976). Induction of labor by acupuncture electro-stimulation. American Journal of ChineseMedicine, 4, 257-265.
71.
Zeisler, H., Eppel, W., Husslein, G., Bernaschek, G., & Deutinger, J. (2001). Influence of acupuncture on Doppler ultrasound in pregnant women. Ultrasound in Obstetrics andGynecology , 17, 229-232.
72.
Zeisler, H., Rabl, M., Joura, E.A., & Husslein, P. (2000). Prenatal acupuncture and serum prostaglandin E2 levels during the first stage of labor. Geburts Frauenheilk , 60, 638-640.
73.
Zeisler, H., Tempfer, C., Mayerhofer, K., Barrada, M., & Husslein, P. (1998). Influence of acupuncture on duration of labor . Gynecologic and Obstetric Investigation, 46, 22-25.
74.
Ziaei, S., & Hajipour, L.H. (2006). Effect of acupuncture on labor. International Journal of Gynecology and Obstetrics , 92, 71-72.
