Background: Perinatal acupuncture has a long and venerable history in Chinese Medicine but is relatively understudied by Western medical research.
Objectives: The purposes of this study are to assess evidence from systematic reviews and randomized controlled trials about the use of acupuncture therapies during pregnancy and childbirth and examine the epistemological implications of Positivist research methodologies being used to assess the complex Whole Systems medicine of acupuncture. Critical Theory, Feminism, and Postmodern Postcolonial Feminist traditions will support the examination of evidence-based medicine research methods.
Data sources: The overview systematically searched PubMed, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The period in this search was July 1, 2008, to May 26, 2017. Study Eligibility Criteria, participants, Interventions: Criteria for inclusion encompassed English language articles of systematic reviews on acupuncture, acupressure, electrical stimulation on acupuncture needles, or moxibustion during pregnancy and childbirth, including reviews of many interventions for a particular prenatal condition as long as it included at least 1 trial using the intervention of acupuncture, acupressure, electrical stimulation on acupuncture needles, or moxibustion. Also included were RCTs published after the most recent systematic review. Excluded were systematic reviews of acupuncture treatments for a nonpregnant condition, crossover studies, and quasi-randomized RCTs.
Risk of Bias: Bias was assessed using Overview Quality Assessment Questionnaire (OQAQ) to evaluate the validity and quality of systematic reviews and the Cochrane Handbook of Systematic Review checklist for evaluating bias in randomized controlled trials.
Study appraisal and synthesis methods: The results are summarized in narrative and table formats. Due to the heterogeneity of the systematic reviews and included studies, this systematic review does not include a meta-analysis.
Results: Thirty systematic reviews and 4 randomized controlled trials were identified for the treatment of nausea, anxiety, and depression, lower back, and pelvic pain, breech presentation, induction of labor, and pain management in labor. One article on safety was found, although it was not a specific search term.
Synthesis of results: Favorable evidence supports prenatal acupuncture therapies (manually stimulated acupuncture, electro-acupuncture, acupressure, and moxibustion). Acupuncture, the data suggests, is most effective at treating perinatal nausea and vomiting, intraoperative nausea related to cesarean section anesthesia, depression, lower back, and pelvic pain, and pain intensity during childbirth. Acupressure shows promise in relieving nausea and decreasing pain intensity during childbirth. Electrical acupuncture resulted in less epidural analgesia. Moxabustion combined with postural techniques was more effective than postural techniques for reducing breech positions, and moxa did have the secondary outcome benefits such as decreasing augmentation with oxytocin before and during labor, as well as cesarean sections. However, a new study of moxa versus laser placebo finds no significant difference. Evidence is also limited for induction of labor but acupuncture significantly reduces pain intensity. Promising evidence shows acupuncture reduces the following: the length of active labor by more than an hour on average, the use of instruments (e.g., forceps) in vaginal deliveries, and the amount of pharmacological analgesia required. It also increases maternal satisfaction and relaxation. Safety studies show that acupuncture has minor adverse side effects and conclude that research on acupuncture should continue as a safer alternative to many treatments for pregnancy with known adverse effects.
Limitations: Evidence is limited by the Positivist research methodologies of the randomized controlled trial and systematic review. Conclusions and implications of key findings: Favorable evidence supports perinatal acupuncture therapies (i.e., manually stimulated acupuncture, electroacupuncture, acupressure, and moxibustion) for nausea, back, and pelvic pain, breech presentation, pain relief during childbirth, depression, and intraoperative nausea during cesarean section. Quality, methodologies, and bias ranged but most were relatively high quality. Generalizability may be limited by small effect sizes. Randomized controlled trials are poorly suited to understanding the complexity of the healing encounter in the acupuncture clinic, and Whole Systems Research may hold more promise for developing a fuller knowledge base about perinatal acupuncture.
Acupuncture, child birth, pregnancy, critical theory, postmodern postcolonial feminism
Pamela Gregg Flax, DAOM, FABORM, DOM