Acupuncture

Acupuncture and acupressure at traditional Chinese medicine (TCM) sites used to treat low milk supply has been claimed to cause release of prolactin and oxytocin, although published studies have found mixed results regarding serum prolactin. A meta-analysis found that acupressure improved milk production and increased serum prolactin, but the quality and consistency of the studies was variable.[1] No serious adverse effects on milk production were seen among lactating women who received acupuncture or acupressure for postpartum sciatica.[1,2] Acupuncture has been well described in TCM for treating insufficient milk supply,[3,4] and has also been used in some Western countries.[5-7] Numerous studies found acupuncture at CV 17 (also referred to as Ren 17, Danzhong or Shanzong; located at the center of the sternum), SI 1 (Shaoze; on the little finger), ST 18 (Rugen; lower breast margins), Zusanli (ST 36), and Taichong (LR 3) to benefit women with a low postpartum milk supply.[8] These studies generally do not meet current evidence-based guidelines, partly because of the extreme difficulty in double-blinding and placebo-controlling acupuncture studies. However, 2 studies did find a better response to electroacupuncture applied at a traditional site for lactation stimulation (SI 1) than electroacupuncture applied at a site unrelated to milk production (LI 1). Electroacupuncture increased serum prolactin, infant weight and maternal perception of milk production more than domperidone alone.[9] None of the studies reported to date have made an attempt to optimize maternal nursing technique before acupuncture. Although less studied, acupressure at milk acupuncture sites has had similar effects.[10] Systematic reviews concluded that acupuncture and acupressure are effective in increasing serum prolactin and breastmilk volume, although study quality is critically low.[10-14] Acupressure combined with back massage increases serum prolactin and milk production more than either alone in one study.[15] The combination of acupuncture and Chinese herbal medicines appeared to be more effective in increasing lactation parameters than acupuncture alone.[14] Acupuncture therapy has been used to treat breastfeeding for milk stasis (engorgement). Randomized, nonblinded studies in an outpatient Swedish lactation clinic compared routine care (including oxytocin spray) to routine care plus acupuncture at 2 or 3 points for treating milk stasis.[16,17] A meta-analysis concluded that women who received acupuncture were less likely to develop an abscess, had less severe symptoms on day five, and had a lower rate of fever than women in the usual care group However, there is insufficient evidence from published trials to justify widespread implementation.[18] A survey of 50 Swedish maternity units in 2007 found that 60% of hospitals used acupuncture to treat milk stasis, 18% used acupuncture to treat mastitis, and 2.2% each used it for painful breastfeeding or to improve milk supply. The authors felt that this extensive use was not justified based on the limited evidence for most of these uses.[19] Acupuncture and acupressure have also been used successfully as a treatment for breast engorgement and pain.[11,20] Auricular therapy uses stimulation of acupoints on the ear corresponding to various anatomical sites and functions of the body for the diagnosis, treatment, and prevention of disease. All studies applied seeds to press on ear acupoints. Two systematic reviews on auricular therapy to increase milk supply have come to differing conclusions. One review found a positive effect on milk production, onset of lactation, serum prolactin, breast fullness, neonate states, and frequency of newborn urination and defecation.[21] A more recent review found varying efficacy between studies and poor methodology that did not allow for a definitive conclusion on efficacy as a galactogogue.[22] No adverse effects were reported in any studies. A newer additional small study found similar results.[23] A controlled study found that auricular acupressure may slightly increase the pain threshold some areas of the breast in nursing mothers.[24] A single-blind study found auriculotherapy to increase breastfeeding self-efficacy in the mothers of preterm infants and to increase infant weight gain at hospital discharge.[25]