Forbidden acupuncture points and implications for inducing labor

1. Background

The use of acupuncture during pregnancy appears to be safe and well tolerated by women in all trimesters. However, there is some debate regarding the use of certain acupuncture points that were historically considered to be forbidden during pregnancy.¹ Randomized controlled trials evaluating acupuncture during pregnancy and labor where forbidden points have been used indicate there is no evidence of induction or miscarriage.2, 3 Therefore, it is unclear if acupuncture can induce labor for pregnant women experiencing delayed labor or post-term pregnancy.

2. Key questions for knowledge translation

• •
  Thinking about the implications of the current research:

  • ∘
    As an educator, would this information change your teaching materials?
  • ∘
    As a practitioner, would this information change your approach when treating a patient who is pregnant and wants to be induced due to overterm pregnancy?
  • ∘
    As a practitioner, would this information change your approach when treating a patient who is pregnant but not at the induction stage?

3. Key issues to consider

• 1.
  Historical

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    Translation—forbidden may have meant use caution.
  • •
    There may have been more detailed explanations that have been lost.
  • •
    Points may be a record of adverse events.
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    Old needles were bigger and may cause different adverse events.
  • •
    Acupuncture practice in Australia is modified for the Australian context, e.g., de qi sensations are gentler.
  • •
    Traditional teachings may have specified point orders for specific effects.
• 2.
  Safety

  • •
    Emphasis must be on patient safety.
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    In low-risk pregnancies, forbidden points may be safe to use when clinically indicated, but alternatives exist.
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    Outcomes may be dependent on strength, order, or technique of stimulation.
• 3.
  Research

  • •
    While evidence of effectiveness for induction is not shown, outcome measures were inconsistent and some individual trials showed a clear effect.
  • •
    Acupuncture may stimulate contractions and cervical ripening.³
  • •
    The clinical use of forbidden points is not well researched.⁴
  • •
    There is no evidence acupuncture increases the incidence of preterm birth or complications.
• 4.
  Legal

  • •
    If we are taught forbidden points and then use them, there would be liability issues if adverse events occurred.

4. Knowledge translation

• •No evidence of harm does not equate to evidence of no harm.
• •For educators and practitioners, the priority is a healthy mother and baby.
• •All issues highlighted above must be considered when teaching students and treating patients.
• •Educators’ judgement will be at the meeting point of historical knowledge, safety, research, and legal considerations (Fig. 1).
• •Practitioners’ judgment will be at the meeting point of individual patient factors, acupuncture points, and their combinations and order, as well as strength of stimulation (Fig. 2).

Fig. 1.

Educators.

Fig. 2.

Practitioners.

Conflicts of interest

All authors have no conflicts of interest to declare.