📍 Forbidden Points During Pregnancy

Traditionally, there are several acupuncture points that are contraindicated during pregnancy.

Of course, points on the lower abdomen and sacral area should not be used. But distal points that are traditionally contraindicated include: LI-4, SP-6, BL-60, GB-21

(There are a couple other possible contraindications as well. For example, the Maciocia OB/GYN book lists BL-67 as being contraindicated, but most textbooks such as Deadman and CAM do not. Some classics list ST-12 as being contraindicated during pregnancy, but many modern textbooks do not.)

But has anybody actually done any studies to see if this is actually true?

Well, it turns out they have!

Studies on the Safety of Obstetric Acupuncture

I came across a study a while ago titled: The safety of obstetric acupuncture: forbidden points revisited​

This was a review of 15 clinical trials that looked at using forbidden points during acupuncture treatments and what outcomes it had on pregnancy and delivery.

And good news! Acupuncture seems to be pretty safe during pregnancy, even when "forbidden" are used.

Any adverse events (miscarriage, pre-term birth, still birth) fall within expected limits. That is, they occur at the same rate as people who don't get acupuncture (or who get acupuncture treatments that don't include forbidden points).

The study concludes: "Given the numerous evidence-based indications for obstetric acupuncture and lack of evidence of harm, risk:benefit assessments will often fall in favour of treatment."

What were they treating and what points were they using?

When you look at the table of studies, most of them were using the point BL67 to treat a breech presentation, and these did not result in adverse events.

But, as we said above, many sources do not consider BL67 to be a forbidden point, so this isn't surprising to me.

(And I think that usually at the time when you are treating a breech presentation, you're at a stage of pregnancy where you're unlikely to cause any adverse events anyway.)

However, there were several studies using points such as LI-4, SP-6, and sacral points to treat low back and pelvic girdle pain. Even in these situations, rates of adverse events were not greater than those in the untreated group.

Inducing Miscarriage

The main concern with avoiding points like LI-4 is that we don't want to inadvertently cause a miscarriage. Some of these points are so moving, we may end up moving the baby right out.

But does this actually happen?

Well...

From the study...

Tsuei et al used electroacupuncture (EA) at SP6/LI4 in an attempt to terminate seven healthy but unwanted mid-trimester pregnancies with 0% success, despite cervical softening/effacement and strong uterine contractions.

And then...

Ying et al applied EA at SP6/LI4 before surgical termination of 20 first trimester pregnancies and similarly failed to demonstrate any abortifacient potential of acupuncture (with no adverse effects on β-human chorionic gonadotropin values) despite a slight (2.8 mm) increase in cervical dilatation relative to controls. Consequently, there is no objective evidence that acupuncture can induce the miscarriage of a healthy pregnancy.

So points like LI-4 and SP-6 do seem to have some effect on cervical softening and uterine contractions, but not enough to actually cause a miscarriage.

Promoting Labor

So we seem to be pretty safe against accidentally causing a miscarriage.

But does acupuncture work to promote labor?

Regarding term induction of labour, a Cochrane review of 14 RCTs (n=2220 women) clearly showed no effect of acupuncture on timing of delivery, despite measurable effects on cervical ripening.

So basically, it seems like acupuncture can help with things like cervical dilation and uterine contractions, but it doesn't actually make the baby come out any quicker (in the patients studied).

Effects on Gestation and Fetal Development?

Finally, the article references a study done on rats.

Researchers performed e-stim on LI-4, SP-6, BL-27, and BL-28 on rats.

(I'd like to see how you e-stim LI-4 on a rat...)

They were trying to see if stimulating these points had any effect on implantation, embryonic development, or fetal development. And it seems that it didn't.

Rates of miscarriage and everything else was similar to the control group.

Conclusions

So what does this mean?

I don't know. I don't want to tell you what to do.

Personally, I would still avoid these points when treating pregnant patients, for various reasons. However, not everyone agrees:

Despite his traditional approach, Römer clearly states in his textbook of obstetric acupuncture that he considers there to be no such thing as contraindicated points in pregnancy. Accordingly all the forbidden points are frequently needled without anxiety at the University Hospital Mannheim, irrespective of gestation. And maybe when it comes to things like pelvic girdle pain or low back pain during pregnancy, useful points like LI-4 should be considered.

And with regard to inducing labor, it does seem like acupuncture has some effect on easing delivery. However, I think it would be interesting to do a study that focused specifically on patients who were experiencing prolonged labor or who where well past their due date (I don't think this studied mentioned that specifically).

So I don't know. What do you think?