Safe Acupuncture and Dry Needling During Pregnancy: A Survey of New Zealand Physiotherapists’ Practice

Abstract

Acupuncture guidelines advise caution when treating pregnant patients because of historical ‘forbidden’ acupuncture points, believed to stimulate miscarriage or early labour. Recent research demonstrates acupuncture as useful and safe for pregnancy-related low back and pelvic girdle pain (LB/PGP), in trimesters two-three. However, fear of miscarriage and subsequent blame by association may restrict acupuncture provision for pregnant patients. Physiotherapists in New Zealand (NZ) mainly practice Western-medical acupuncture; some are traditional Chinese medicine focused. Recent increases in dry needling (DN/trigger-point needling) courses has potentiated the rapid growth in DN practice in NZ. It is unknown if physiotherapists practicing DN have similar cautions during pregnancy. It was hypothesised that physiotherapists practicing acupuncture would treat pregnant patients more conservatively than those practicing DN only. Hence it was postulated that pregnant women may be being denied safe and useful treatment. NZ registered physiotherapists practicing acupuncture needling and/or DN were invited to participate in an electronic survey. Results: Of 124 respondents only 60(48%) would treat pregnant patients with ‘needling’, with a further 66% of those still expressing concerns. Practitioners practicing DN only were more likely to needle areas related to ‘forbidden points’ in all trimesters. Comparatively, NZ physiotherapists were less likely to needle ‘forbidden’ points than their British peers. These findings supported the hypothesis that awareness of ‘forbidden’ acupuncture points caused acupuncture trained therapists to practice defensively. This awareness is not demonstrated in DN practice. Conclusion: Conflicting literature and a fear of blame influences NZ physiotherapy acupuncturists decisions to offer acupuncture and/or DN during pregnancy. This restricts potential musculoskeletal treatment options for pregnant women. Further training is recommended, to provide safe needling-related physiotherapy options for pregnant women suffering musculoskeletal pain. Additional research into the use of needling therapies, in the first trimester of pregnancy, and DN for the pregnant patient is warranted. Ethics approval: 17/100 AUTEC.