Acupuncture Moxibustion

The Effects of Hypnosis on the Labor Processes and Birth Outcomes of Pregnant Adolescents

Alice A. Martin, PhD; Paul G. Schauble, PhD; Surekha H. Rai, PhD; R. Whit Curry Jr, MD

 Gainesville, Florida

 Submitted, revised, February 13, 2001.

Hypnosis has been used in obstetrics for more than a century with little empiric evaluation of the effects of this type of intervention on labor and delivery. We evaluated how childbirth preparation incorporating hypnotic techniques affected the labor processes and birth outcomes of pregnant adolescents. The study included 42 teenaged patients receiving prenatal treatment at a county public health department before their 24th week of pregnancy. They were randomly assigned to either a treatment group receiving a childbirth preparation protocol under hypnosis or a control group receiving supportive counseling. When labor and delivery outcome measures were compared in the 2 groups, significant differences favoring the hypnosis intervention group were found in the number of complicated deliveries, surgical procedures, and length of hospital stay. Larger studies in different populations are needed.

key words  Hypnosis; obstetrics; labor; delivery; anesthesia. (J Fam Pract 2001; 50:441-443)

Hypnosis has been used to control pain during labor and delivery for more than a century, but the introduction of chemo-anesthesia and inhalation anesthesia during the late 19th century led to the decline of its use.1,2 Recently there has been a resurgence of this technique in obstetrics.3-7 Hypnotherapy has been found to be effective in providing pain relief,8,9 reducing the need for chemical anesthesia,8 and reducing anxiety, fear, and pain related to childbirth.1,2,7,10,11 Hypnosis has also been helpful in both managing various complications of pregnancy (such as premature labor5,12-14) and reducing the likelihood of premature labor and birth in high-risk patients.12 It has also has been effective in the treatment of hyperemesis gravidarum,15-16 acute hypertension associated with pregnancy17 and conversion of breech to vertex presentation.18

One promising application of hypnosis is in the area of labor and delivery.1,5,6,19 The use of hypnosis in preparing the patient for labor and delivery is based on the premise that such preparation reduces anxiety, improves pain tolerance (lowering the need for medication), reduces birth complications, and promotes a rapid recovery process.1,2,5 The key aspect of this treatment is involvement of the patient before labor begins, to promote her active participation and sense of control in the labor and delivery process. This is accomplished through educating the patient about this process and teaching her alternate ways to produce hypno-analgesia and anesthesia.1,2 Hypnotic preparation thus provides the expectant mother with a sense of control for managing her anxiety and physical discomfort.

Although there have been numerous reports suggesting the value of hypnosis in obstetrics, our study is one of the first to report a randomized controlled evaluation of childbirth preparation incorporating hypnotic techniques on labor processes and birth outcomes.

Methods

Our subjects were teenage patients (18 years or younger at the time of conception) who entered prenatal treatment with normal pregnancies at a Florida county public health department before the end of their 24th week. The clinic nursing director performed a chart review and identified 47 patients meeting the criteria. These patients were randomly assigned to either the treatment group or the control group. The treatment group received childbirth preparation in self-hypnosis that incorporated information on labor and delivery (the detailed protocol is described in a previous publication1). The control group received supportive counseling designed to control for interpersonal contact and social support and to provide an opportunity for discussion about pregnancy issues of concern to the patient. Patients in the treatment and control groups had the same number of visits.

We obtained institutional review board approval and informed consent from individual patients. The subjects were told that the study was an attempt to provide support for pregnant adolescents in addition to the routine prenatal care provided by the public health department and that they would be randomly assigned to 1 of the 2 groups, their intervention session would coincide with scheduled clinic appointments and would not interrupt their medical treatment in any way, and their participation was voluntary.

Both groups of patients received the standard prenatal treatment protocol from the medical staff, nurse practitioners, and hospital staff, all of whom were blind to group assignments. All patients were delivered at the local teaching hospital by obstetrics department staff who were blind to the study. The study interventions were begun with individual meetings with patients during regular clinic visits between 20 and 24 weeks’ gestation. Continuing clinic visits were scheduled for all patients on a biweekly basis, making the time span of the 4-session experimental conditions approximately 8 weeks. The study counselor (the primary author) provided hypnosis preparation training for the treatment group; a nurse midwife provided the supportive contact with the control group. Both interventions were completed before delivery; no prompting occurred during the labor and delivery process.

The 2 groups of patients were compared on medication use (Pitocin, anesthetic, and postpartum medication), complications and surgical intervention during delivery, and length of hospital stay for mothers and neonatal intensive care unit (NICU) admission for the infants. Complications fell into 36 categories of events (eg, multiple pregnancies, preeclampsia, vacuum-assisted delivery) that were entered in subjects’ records by obstetric staff who were unaware of the study. Statistical analysis was based on a simple count of the presence or absence of complications in the medical record by researchers (the researchers were not blinded to the patient’s study assignment).

Results

Of the 47 patients, 3 moved out of the geographic area before delivery, and 2 patients (1 in each group) did not complete the research protocol and were not included in the research. Results were thus obtained for 22 patients in the hypnosis group and 20 in the control group, resulting in a total of 42 subjects. A two-tailed Fisher exact analysis at the .05 level was used to test for significance.

Only one patient in the hypnosis group had a hospital stay of more than 2 days compared with 8 patients in the control group (P=.008). None of the 22 patients in the hypnosis group experienced surgical intervention compared with 12 of the 20 patients in the control group (P=.000). Twelve patients in the hypnosis group experienced complications compared with 17 in the control group (P=.047). Although consistently fewer patients in the hypnosis group used anesthesia (10 vs 14), Pitocin (2 vs 6), or postpartum medication (7 vs 11), and fewer had infants admitted to the NICU (1 vs 5), statistical analysis was nonsignificant.

Discussion

We focused on the educational preparation of the patient while in hypnosis to create the expectation of a normal labor and delivery, develop a conditioned response of comfort and confidence, and facilitate an increased sense of control in achieving a healthy delivery.

The subjects in the treatment group received a 4-session sequence of standard hypnotic interventions incorporating childbirth preparation information (ie, the hypnoreflexogenous method1,2,20) in which they were instructed in the methods and benefits of focused relaxation and imagery to increase the likelihood of a safe and relatively pain-free delivery. The sessions provided an opportunity to experience and practice hypnotic induction and deep relaxation. The suggestions directed toward the expectant mothers during the hypnotic state focused on the conceptualization of pregnancy and childbirth as a healthy natural process. Suggestions were also given to help the patient respond to possible complications, in the event they might occur.1 These suggestions were designed to increase the patient’s sense of trust in her physician and her confidence in her own ability to manage anxiety and discomfort. Hypnotic inductions also included ego-strengthening techniques and suggestions for a relatively discomfort-free delivery and suggestions for the application of the hypnotic techniques to other stressful periods in their lives. In each session the patients were given the opportunity to ask any questions of concern regarding the method or the pregnancy.

The main limitations of our study are the relatively small number of subjects and the fact that these patients were adolescent women, which affects the generalizability of results.

Future Research

Future research should involve a larger subject pool including adults, have a control group receiving traditional prenatal care with no added intervention, and provide an analysis of cost-saving benefits.

Conclusions

Our study provides support for the use of hypnosis to aid in preparation of obstetric patients for labor and delivery. The reduction of complications, surgery, and hospital stay show direct medical benefit to mother and child and suggest the potential for a corresponding cost-saving benefit.

· Acknowledgments ·

We would like to acknowledge the pioneering workon the use of hypnosis in obstetrics by the late William Werner, MD, and express appreciation for his assistance in designing the intervention protocol. We would also like to thank Maury Nation, PhD, for his assistance with statistical analysis and Poorti Karve Riley, MD, for her comments on a previous version of this manuscript.

    REFERENCES

  1. Schauble PG, Werner WEF, Rai SH, Martin A. Childbirth preparation through hypnosis: the hypnoreflexogenous protocol. Am J Clin Hypnosis 1998;40:273–83.
  2. Werner WEF, Schauble PG, Knudson MS. An argument for the revival of hypnosis in obstetrics. Am J Clin Hypnosis 1982;24:149–71.
  3. Dillenburger K, Keenan M. Obstetric hypnosis: an experience. Contemp Hypnosis 1996;13:202–04.
  4. Baram DA. Hypnosis in reproductive health care: a review and case report. Birth 1995;22:37–42.
  5. Goldman L. The use of hypnosis in obstetrics. Psychiatric Med 1992;10:59–67.
  6. Harmon TM, Hynan MT, Tyre TE. Improved obstetric outcomes using hypnotic analgesia and skill mastery combined with childbirth education. J Consult Clin Psychol 1990;58:525–30.
  7. Kroger WS. Hypnoanesthesia in obstertrics. In: Davis CH, ed. Gynecology and obstetrics. Hagerstown, Md: Harper & Row; 1960.
  8. Mairs DAE. Hypnosis and pain in childbirth. Contemp Hypnosis 1995;12:111–18.
  9. Hilgard ER, Hilgard JR. Hypnosis in the relief of pain. Revised ed. New York, NY: Brunner/Mazel; 1994.
  10. Martin J. Hypnosis gains legitimacy, respect, in diverse clinical specialties. J Am Med Assoc 1983;249:319–21.
  11. Oster MI. Psychological preparation for labor and delivery using hypnosis. Am J Clin Hypnosis 1994;37:12–21.
  12. Cheek DB. The early use of psychotherapy in prevention of pre-term labor: the application of hypnosis and ideomotor techniques with women carrying twin pregnancies. Pre Peri Natal Psychol J 1995;10:5–19.
  13. Omer H. A hypnotic relaxation technique for the treatment of premature labor. Am J Clin Hypnosis 1987;29:206–14.
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  15. Iancu I, Kotler M, Spivak B, Radwan M, Weizaman A. Psychiatric aspects of hyperemesis gravidarum. Psychother Psychosom 1994;61:143–49.
  16. Torem MS. Hypnotherapeutic techniques in the treatment of hyperemesis gravidarum. Am J Clin Hypnosis 1994;37:1–11.
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The Journal of Family Practice ©2001

Hyperemesis Gravidarum

Most women experience some form of morning sickness during their pregnancy, especially between the 5th and 12th weeks. However, about 1 percent of pregnant women experience severe nausea and vomiting, a condition called hyperemesis gravidarum. While normal morning sickness is thought to be caused by rising hormone levels, the precise cause of hyperemesis gravidarum is unknown.

Hyperemesis gravidarum, or HG, is characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Women who suffer from this condition may experience dehydration, headaches, confusion, rapid heart rate, and fainting; and may be unable to work, complete usual daily tasks, or maintain a normal social routine. Left untreated, severe cases of HG can cause significant health problems for you and your baby. Acid-based disturbances caused by malnutrition and dehydration can lead to kidney and liver injury, persistent vomiting can lead to esophageal tears, and nutritional deficiencies can lead to neurological changes. Risks to the baby include premature birth, low birth weight, and a slight increase in malformation of the central nervous system and skin.

HG is usually diagnosed by ruling out any other cause of severe nausea and vomiting such as pancreatitis, hepatitis, peptic ulcer disease, and hyperthyroidism. Your doctor will take a full medical history, perform a thorough clinical evaluation, and identify your symptoms.

How to tell the difference between HG and normal morning sickness:

Morning Sickness Hyperemesis Gravidarum
Nausea sometimes accompanied by vomiting Nausea accompanied by severe vomiting
Nausea that subsides at 12 weeks or soon thereafter Nausea that continues past the first trimester (13 weeks)
Vomiting that does not cause severe dehydration Vomiting that causes severe dehydration
You are able to keep some food down You cannot keep any food down

If you are diagnosed with HG, you will most likely be hospitalized immediately to restore fluids and replace electrolytes intravenously. You may also receive vitamin supplements, especially vitamins B6, C, and thiamine. You should not consume food orally until the vomiting stops and dehydration has been corrected; if vomiting persists, you may be given antiemetic (anti-nausea and vomiting) drug therapy.

Studies performed to determine the cause of HG have been inconclusive. It is thought that estrogen, progesterone, adrenal, and pituitary hormones all play a part. Psychological and social factors also seem to have a connection. For example, women who are having an unwanted pregnancy; or young, unwed mothers who feel harassed by their parents for their "mistake" seem to have a higher incidence of HG. The disease is also more common among women with a higher body weight, no previous completed pregnancies, those who are carrying twins, first-time pregnancies, and those with a history of HG in previous pregnancies. It is becoming clear that HG is a complex physiological disease probably caused by multiple factors.

Acupressure and hypnosis has been shown to help some women suffering from HG. The pressure point to reduce nausea is located at the middle of the inner wrist and applying pressure to this point may help some HG sufferers. Seabands that use this pressure point can be purchased at many drug stores.

 

Acupuncture for labour (labor)

Acupuncture during labor can reduce the use of meperidine: a controlled clinical study.
Nesheim BI, Kinge R, Berg B, Alfredsson B, Allgot E, Hove G, Johnsen W, Jorsett I, Skei S, Solberg S., Department of Obstetrics and Gynecology, Ulleval University Hospital, Oslo, Norway.
OBJECTIVE: To evaluate the effectiveness of acupuncture as an analgesic during labor. DESIGN: A randomized, unblinded, controlled study. SETTING: A labor ward in a University Hospital. PATIENTS: Parturients at term. INTERVENTIONS: One group received acupuncture (N = 106); another did not (N = 92). A second control group (N = 92), drawn from the labor ward protocol, consisted of patients who met the eligibility criteria for the study and were matched to the "no acupuncture" group by parity, but who had not been offered the opportunity to take part. Outcome measure "effectiveness of acupuncture" was measured by the requirement for use of meperidine. RESULTS: Meperidine was given to 11% of the acupuncture group, 37% of the no acupuncture group (P < 0.0001), and 29% of the control group. 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 labor. CONCLUSIONS: Acupuncture during labor reduced the requirement for other painkillers and has high patient satisfaction in this randomized, unblinded, controlled study.


Acupuncture in the management of pain in labor.
Skilnand E, Fossen D, Heiberg E., Department of Obstetrics and Gynecology, County Hospital of Oestfold, Fredrikstad, Norway.
BACKGROUND: To assess if acupuncture could be a reasonable option for pain relief in labor and to look at possible effects of acupuncture on the progress of labor. METHODS: In a controlled, single blind study, 210 healthy parturients in spontaneous, active labor at term were randomly assigned to receive either real acupuncture or false acupuncture. Visual analog scale assessments were used to evaluate subjective effect on pain. The objective parameter of outcome was the need for analgesic medication in each group. RESULTS: There were significantly lower mean pain scores and significantly less need for pharmacological analgesia in the study group compared with the control group. The women given real acupuncture spent less time in active labor and needed less augmentation than the control group. CONCLUSION: The results indicate that acupuncture reduces the experience of pain in labor. A secondary outcome of acupuncture was a shorter delivery time, which mainly, if not exclusively, can be explained by the reduced need for epidural analgesia. Acupuncture may be useful for parturients who wish a nonpharmacological analgesia without side-effects. For others it could be the analgesic method of choice, with pharmacological analgesics as supplements.


Acupuncture treatment during labour--a randomised controlled trial.
Ramnero A, Hanson U, Kihlgren M., Department of Obstetrics and Gynaecology, Orebro University Hospital, Sweden.
OBJECTIVE: To investigate acupuncture treatment during labour with regard to pain intensity, degree of relaxation and outcome of the delivery. DESIGN: Randomised controlled trial. SETTING: Delivery ward at a tertiary care centre hospital in Sweden. POPULATION: Ninety parturients who delivered during the period April 12, 1999 and June 4, 2000. METHODS: Forty-six parturients were randomised to receive acupuncture treatment during labour as a compliment, or an alternative, to conventional analgesia. MAIN OUTCOME MEASURES: Assessments of pain intensity and degree of relaxation during labour, together with evaluation of delivery outcome. RESULTS: Acupuncture treatment during labour significantly reduced the need of epidural analgesia (12% vs 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30 to 0.92). Parturients who received acupuncture assessed a significantly better degree of relaxation compared with the control group (mean difference -0.93, 95% CI -1.66 to -0.20). No negative effects of acupuncture given during labour were found in relation to delivery outcome. CONCLUSIONS: The results suggest that acupuncture could be a good alternative or complement to those parturients who seek an alternative to pharmacological analgesia in childbirth. Further trials with a larger number of patients are required to clarify if the main effect of acupuncture during labour is analgesic or relaxing.


Influence of acupuncture on duration of labor.
Zeisler H, Tempfer C, Mayerhofer K, Barrada M, Husslein P., Department of Obstetrics and Gynecology, University of Vienna, AKH, Austria.
The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p less than 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (chi2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, chi2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, chi2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.


Acupuncture for Cervical Maturation

by Tremeau ML; Fontanie-Ravier P; Teurnier F; Demouzon J. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction, 1992, 21(4):375-80.
Abstract:
Protocol was carried out on 98 patients who were divided into three groups selected as (one control group, two 'placebo' group, and three treated with acupuncture).

This protocol showed that it was possible to improve cervical maturation if acupuncture sessions were carried out at the beginning of the 9th month. The Bishop scores in the three groups after 10 days interval showed that there was a significant progression of 2.61 points in the group treated with acupuncture as against only 0.89 and 1.08 in the placebo and control groups.


Acupuncture for cervical ripening and induction of labor at term--a randomized controlled trial.
Rabl M, Ahner R, Bitschnau M, Zeisler H, Husslein P., Department of Obstetrics and Gynecology, University of Vienna, Austria.
OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Moxibustion for Turning Breech Babies

Moxibustion for correction of breech presentation: a randomized controlled trial.
Cardini F, Weixin H JAMA 1998 Nov 11;280(18):1580-4
CONTEXT : Traditional Chinese medicine uses moxibustion (burning herbs to stimulate acupuncture points) of acupoint BL 67 (Zhiyin, located beside the outer corner of the fifth toenail), to promote version of fetuses in breech presentation. Its effect may be through increasing fetal activity. However, no randomized controlled trial has evaluated the efficacy of this therapy.
OBJECTIVE : To evaluate the efficacy and safety of moxibustion on acupoint BL 67 to increase fetal activity and correct breech presentation.
DESIGN : Randomized, controlled, open clinical trial.
SETTING : Outpatient departments of the Women's Hospital of Jiangxi Province, Nanchang, and Jiujiang Women's and Children's Hospital in the People's Republic of China.
PATIENTS : Primigravidas in the 33rd week of gestation with normal pregnancy and an ultrasound diagnosis of breech presentation.
INTERVENTIONS : The 130 subjects randomized to the intervention group received stimulation of acupoint BL 67 by moxa (Artemisia vulgaris) rolls for 7 days, with treatment for an additional 7 days if the fetus persisted in the breech presentation. The 130 subjects randomized to the control group received routine care but no interventions for breech presentation. Subjects with persistent breech presentation after 2 weeks of treatment could undergo external cephalic version anytime between 35 weeks' gestation and delivery.
MAIN OUTCOME MEASURES : Fetal movements counted by the mother during 1 hour each day for 1 week; number of cephalic presentations during the 35th week and at delivery.
RESULTS : The intervention group experienced a mean of 48.45 fetal movements vs 35.35 in the control group (Plessthan.001; 95% confidence interval [CI] for difference, 10.56-15.60). During the 35th week of gestation, 98 (75.4%) of 130 fetuses in the intervention group were cephalic vs 62 (47.7%) of 130 fetuses in the control group (Plessthan.001; relative risk [RR], 1.58; 95% CI, 1.29-1.94). Despite the fact that 24 subjects in the control group and 1 subject in the intervention group underwent external cephalic version, 98 (75.4%) of the 130 fetuses in the intervention group were cephalic at birth vs 81 (62.3%) of the 130 fetuses in the control group ( P = .02; RR, 1.21; 95% CI, 1.02-1.43).

CONCLUSION : Among primigravidas with breech presentation during the 33rd week of gestation, moxibustion for 1 to 2 weeks increased fetal activity during the treatment period and cephalic presentation after the treatment period and at delivery.


Acupuncture conversion of fetal breech presentation.
Habek D, Cerkez Habek J, Jagust M.Clinical Department of Obstetrics and Gynecology, Clinical Hospital Osijek, Osijek, Croatia.
AIM: The aim of this study was to assess the value of acupuncture (AP) in the conversion of fetal breech presentation into vertex presentation.
PATIENTS AND METHODS: A randomized prospective controlled clinical study included 67 pregnant women with fetal breech presentation: 34 women with singleton pregnancies treated with manual AP (urinary bladder 67, Zhiyin) and a control group which included 33 women with singleton pregnancies without AP treatment. The AP treatment lasted 30 min a day, and was conducted during and after 34 weeks of pregnancy with simultaneous cardiotocography. RESULTS: The success rate of the AP correction of fetal breech presentation is 76.4% (26 women), and spontaneous conversion without AP in vertex presentation is observed in 15 women (45.4%; p0.001).
CONCLUSIONS: We believe that AP correction of fetal malpresentation is a relatively simple, efficacious and inexpensive method associated with a lower percentage of operatively completed deliveries, which definitely reflects in improved parameters of vital and perinatal statistics.


Acupuncture plus moxibustion to resolve breech presentation: a randomized controlled study.
Neri I, Airola G, Contu G, Allais G, Facchinetti F, Benedetto C., Department of Obstetrics and Gynecology, University of Modena-Reggio Emilia, Modena, Italy.
OBJECTIVE: In many Western countries breech presentation is an indication for elective Cesarean section. In order to correct fetal presentation, the stimulation of the acupuncture point BL67 by moxibustion, acupuncture or both has been proposed. Since no studies had previously been carried out on Western populations, pregnant Italian women at 33-35 weeks gestational age carrying a fetus in breech presentation were enrolled in a randomized, controlled trial involving an active BL67 point stimulation and an observation group. METHODS: A total of 240 women at 33-35 weeks of gestation carrying a fetus in breech presentation were randomized to receive active treatment (acupuncture plus moxibustion) or to be assigned to the observation group. Bilateral acupuncture plus moxibustion was applied at the BL67 acupuncture point (Zhiyin). The primary outcome of the study was fetal presentation at delivery. RESULTS: Fourteen cases dropped out. The final analysis was thus made on 226 cases, 114 randomized to observation and 112 to acupuncture plus moxibustion. At delivery, the proportion of cephalic version was lower in the observation group (36.7%) than in the active-treatment group (53.6 %) (p = 0.01). Hence, the proportion of Cesarean sections indicated for breech presentation was significantly lower in the treatment group than in the observation group (52.3% vs. 66.7%, p = 0.03). CONCLUSIONS: Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.


Non-stress test changes during acupuncture plus moxibustion on BL67 point in breech presentation.
Neri I, Fazzio M, Menghini S, Volpe A, Facchinetti F., Clinica Ostetrica, Universita di Roma-Tor Vergata, Rome, Italy.
OBJECTIVES: We assessed fetal heart variability and activity using a computerized non-stress test (NST) during acupuncture plus moxibustion on the BL67 point. For comparison, the same changes were assessed during placebo acupuncture (minimal acupuncture) in the same subjects. METHODS: Twelve pregnant women in the 33rd week of gestation, carrying singletons in the breech presentation were enrolled in the study. In a single-blind design, each woman received a first session of minimal acupuncture followed 1-2 days later by true acupuncture. During the sessions, women were monitored using computerized non-stress testing starting 20 minutes before the stimuli and continuing for 20 minutes after treatment. RESULTS: During true acupuncture a significant reduction in fetal baseline heart rate, and more accelerations and movement were observed. During minimal acupuncture, there were no significant changes in these variables. No signs of fetal distress or changes in short- or long-term variability were noted, and there were no uterine contractions. CONCLUSION: In our study population, acute application of acupuncture plus moxibustion did not cause fetal distress as assessed by either fetal heart rate decelerations or changes in either short- or long-term variability. Considering that the modifications in fetal movement and heart rate occurred in true but not during minimal acupuncture, we could consider that such changes are related to the effect of the acupuncture stimulation. The mechanisms leading to the cephalic version remain to be clearly established.


Acupuncture for Morning Sickness

Manual acupuncture reduces hyperemesis gravidarum
a placebo-controlled, randomized, single-blind, crossover study.
Carlsson CP, Axemo P, Bodin A, Carstensen H, Ehrenroth B, Madegard-Lind I, Navander C.
Physical Medicine Unit, Department of Rehabilitation, University Hospital, Lund, Sweden.
Hyperemesis gravidarum, severe vomiting, develops in about 1-2% of all pregnancies. Acupuncture on the point PC6 above the wrist on the palmar side has been found to prevent some types of nausea and vomiting. The purpose of the present study was to see if acupuncture, in addition to standard treatment, could hasten the improvement of hyperemesis gravidarum. Thirty-three women with hyperemesis were evaluated in a randomized, single-blind, crossover comparison of two methods of acupuncture, active (deep) PC6 acupuncture or placebo (superficial) acupuncture. The women estimated their degree of nausea on a visual analogue scale (VAS).
The daily number of emesis episodes were documented. Crossover analyses showed that there was a significantly faster reduction of nausea VAS and more women who stopped vomiting after active acupuncture than after placebo acupuncture. This study suggests that active PC6 acupuncture, in combination with standard treatment, could make women with hyperemesis gravidarum better faster than placebo acupuncture.


Success of Acupuncture and Acupressure of the Pc 6 Acupoint in the Treatment of Hyperemesis Gravidarum
D. Habek, A. Barbir, J. . Habek, D. Jan uliak, M. Bobi -Vukovi , Research in Complementary and Classical Natural Medicine 2004;11:20-23 Objective: The aim of this study was to evaluate the antiemetic effect of acupuncture (AP) and acupressure (APr) of the Pc 6 acupoint in pregnant women with hyperemesis gravidarum (HG). Methods: A prospective, placebo-controlled trial included 36 pregnant women with HG. Two methods of acupuncture were used: bilateral manual AP of the Pc 6 (Neiguan) acupoint (group 1, n = 10) and bilateral APr of the Pc 6 acupoint (group 2, n = 11); furthermore, superficial intracutaneous placebo AP (group 3, n = 8) and placebo APr (group 4, n = 7) was carried out. Results: Anxiodepressive symptoms occurred in 9 pregnant women with HG from group 1, 8 women from group 2, 7 women from group 3, and 5 women from group 4 (p less than 0.001). The average gestation age at the occurrence of HG symptoms and the beginning of treatment was 7 weeks in group 1 and 8 weeks in groups 2, 3, and 4. Four women from group 1 and 7 women from groups 2, 3, an 4 needed intravenous compensation of liquid and electrolytes. The antiemetic metoclopramide was given intravenously to 1 woman from group 1, 2 women from group 2, 6 women from group 3, and 4 women from group 4. Promethazine was given to 1 woman from group 2, 1 woman from group 3, and to 3 women from group 4. The efficiency of the HG treatment with AP of the point Pc 6 was 90%, with APr of the Pc 6 63.6%, with placebo AP 12.5%, and with placebo APr 0%. Conclusion: Acupuncture (p less than 0.0001) and acupressure (p less than 0.1) are effective, nonpharmacologic methods for the treatment of HG.


Acupuncture for Pain During Pregnancy

Acupuncture for low back pain in pregnancy--a prospective, quasi-randomised, controlled study.
Acupunct Med. 2004 Jun;22(2):60-7., Guerreiro da Silva JB, Nakamura MU, Cordeiro JA, Kulay L Jr.
This study was undertaken to investigate the effects of acupuncture in low back and pelvic pain during pregnancy under real life conditions, as compared with patients undergoing conventional treatment alone. A total of 61 conventionally treated pregnant women were allocated randomly into two groups to be treated or not by acupuncture. Twenty-seven patients formed the study group and 34 the control group. They reported the severity of pain using a Numerical Rating Scale from 0 to 10, and their capacity to perform general activities, to work, and to walk. We also assessed the use of analgesic drugs. Women were followed up for eight weeks and interviewed five times, at two-week intervals. All women completed the study. In the study group the average pain during the study period showed a larger reduction (4.8 points) than the control group (-0.3 points) (P < 0.0001). Average pain scores decreased by at least 50% over time in 21 (78%) patients in the acupuncture group and in five (15%) patients in the control group (P < 0.0001). Maximum pain and pain at the moment of interview were also less in the acupuncture group compared with the control group. The capacity to perform general activities, to work and to walk was improved significantly more in the study group than in the control group (P < 0.05). The use of paracetamol was lower in the acupuncture group (P < 0.01). These results indicate that acupuncture seems to alleviate low back and pelvic pain during pregnancy, as well as to increase the capacity for some physical activities and to diminish the need for drugs, which is a great advantage during this period.


Pelvic Pain Relief for Pregnant Women
British Medical Journal, published online March 17, 2005
A new study shows acupuncture and strengthening exercises may help relieve pelvic girdle pain experienced by pregnant women.

The pelvic girdle is a complex of bones that connects the trunk and legs. Pain in the pelvic girdle is very common among pregnant women. The study authors explain this pain inhibits the ability to stand, walk and sit, but there is no cure.

Standard treatment consists of a pelvic belt and a home exercise regimen. However, the effectiveness of these options is questionable. So, researchers in Sweden set out to investigate whether acupuncture or strengthening exercises could help manage the pain.

They divided 386 women into three groups. One received standard treatment, another received standard treatment plus acupuncture, and the third underwent standard treatment plus stabilizing exercise that improved mobility and strength. These women recorded their pain levels every morning and evening and were examined at the end of the treatment period.

Both the acupuncture group and the stabilizing-exercise group had less pain than the standard treatment group in the morning and evening. The acupuncture group showed the greatest reduction of pelvic girdle pain.

The study authors conclude acupuncture or these specific exercises prove beneficial in addition to standard treatment for pelvic girdle pain.


Other Pregnancy Research

Influence of acupuncture on Doppler ultrasound in pregnant women.
Zeisler H, Eppel W, Husslein P, Bernaschek G, Deutinger J., Department of Obstetrics and Gynecology, University of Vienna, General Hospital Vienna, Austria.
OBJECTIVE: To evaluate the influence of acupuncture on the blood flow in the umbilical artery (UA), fetal aorta and uterine artery and on the fetal heart rate using two different acupuncture points (SP-6 (Sanyinjiao) and LI-4 (Hegu)). METHODS: In group A (n = 50), measurements (Doppler ultrasound and fetal heart rate) were performed at term after an uneventful pregnancy (#1) followed by acupuncture treatment using the acupuncture-point SP-6 bilaterally. The treatment time lasted 15 min after which the next measurement (#2) was carried out. The needles were then inserted into the LI-4 acupuncture point for a further 15 min. A third measurement at the end of acupuncture treatment (#3) completed the session. In group B (n = 25), measurements were made before (#1) and after (#4) acupuncture at LI-4 acupuncture points only. RESULTS: In group A, the mean systolic/diastolic (S/D) ratios of UA #1, UA #2 and UA #3 were 2.45, 2.38 and 2.22, respectively (P = 0.0012). The difference in mean S/D ratios between UA #1 and UA #3 as well as that between UA #2 and UA#3 were statistically significant (P = 0.0002 and P = 0.008, respectively). There was no difference between the mean S/D ratios of the uterine artery and between the mean resistance indices of the fetal aorta. In group B, the only significant difference between measurements following acupuncture treatment was in fetal heart rate (139 vs. 143 bpm, P = 0.02). CONCLUSION: Our study indicates a positive influence of acupuncture treatment on umbilical artery waveforms when using a combination of SP-6 (Sanyinjiao) and LI-4 (Hegu) acupuncture points. Acupuncture performed at these sites either individually or in combination does not seem to affect blood flow in the fetal aorta or uterine artery.


Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K., Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany.
OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.


Pre-Term Labour: The effect of acupuncture on uterine contraction induced by oxytocin.
Pak SC, Na CS, Kim JS, Chae WS, Kamiya S, Wakatsuki D, Morinaka Y, Wilson L Jr., Department of Acupuncture and Anatomy, Dongshin University, Naju, South Korea.
Preterm labor (PTL) is one of the main causes of fetal mortality and morbidity in obstetrical medicine. Current methods of treatment are not very effective and often have significant side effects. For this reason new methods of preventing PTL are currently being sought. In Western medicine the newest development is oxytocin antagonists. In Oriental medicine acupuncture and moxibustion are being utilized for the purpose of stopping PTL. The goals of this study were to determine if acupuncture in pregnant rats can suppress oxytocin induced uterine contractions and to compare these results with those inhibited by an oxytocin antagonist. Uterine contractions were induced by continuous infusion of exogenous oxytocin. The first fetus in one uterine horn near the ovarian end was removed and distilled water-filled catheter was inserted into that vacated amniotic sac to measure uterine contractions as intrauterine pressure changes. Two acupuncture points of Ho-Ku (LI-4) and San-Yin-Chiao (Sp-6) were selected for acupuncture and Kuan-Yuan (Co-4) was used for moxibustion. The oxytocin-induced uterine contractions were significantly suppressed by acupuncture on the LI-4 (p < 0.05), but not by Sp-6. Stimulation of Co-4 by moxibustion had no significant (p > 0.05) tocolytic effect. The administration of oxytocin antagonist eliminated all the uterine contractions induced by oxytocin. The application of acupuncture to re-stimulate the activity that was suppressed by the oxytocin antagonist did not produce any positive results. However, prostaglandins did cause the uterus to contract. In conclusion, acupuncture on LI-4 was found to suppress uterine contractions induced by oxytocin in the pregnant rat. If acupuncture is similarly effective in counteracting the effects of oxytocin in women, then this may an alternative medical treatment for women in preterm labor.

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