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Acupuncture Treatment as Breastfeeding Support: Preliminary Data

Article  in  Journal of alternative and complementary medicine (New York, N.Y.) · February 2011
DOI: 10.1089/acm.2009.0714 · Source: PubMed

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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 17, Number 2, 2011, pp. 133–137
ª Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2009.0714

Acupuncture Treatment as Breastfeeding Support:

Preliminary Data

Isabella Neri, MD, PhD,1 Gianni Allais, MD,2 Valentina Vaccaro, MD,1 Simona Minniti,1 Gisella Airola, MD,2
Paola Schiapparelli, MD,2 Chiara Benedetto, MD, PhD,2 and Fabio Facchinetti, MD1

Abstract

Objectives: This article investigates the efficacy of acupuncture for the maintenance of breastfeeding during the
first 3 months of a newborn’s life.
Subjects and interventions: After written informed consent was obtained, 90 women were randomly divided into
two groups: acupuncture treatment or observation. Acupuncture sessions were performed twice weekly for 3 weeks
(total six sessions). The control group made weekly visits to the clinic and the midwife observed their breastfeeding,
giving routine care. In both groups, a semistructured clinical assessment of breastfeeding quality was carried out by
the midwife at enrollment and after 3 weeks. Moreover, in both groups a telephone interview was conducted by the
midwife at the third month of the infants’ lives, regarding the continuation of breastfeeding.
Results: No significant difference in the exclusive breastfeeding rate before treatment was observed between
acupuncture and observation groups (51.2% versus 48.8%). However, at 3 weeks postenrollment, exclusive
breastfeeding was significantly lower in the observation group than in the acupuncture group (60% versus 100%;
p < 0.03). At the third month of the newborns’ lives, breastfeeding was reported in 35% of the acupuncture
group, compared to 15% of the observation group ( p < 0.03).
Conclusions: Such preliminary data suggest that 3 weeks of acupuncture treatment were more effective than
observation alone in maintaining breastfeeding until the third month of the newborns’ lives.

Introduction accurate study, performed in Northern Italy, reported a 70%

A s human milk not only provides species- and age-
specific nutrients, but also immunological factors, anti-
bacterial properties, factors that promote both cellular growth
and differentiation, as well as a correct balance of nutrients, it
represents the ideal food for neonates.1
Currently, the undoubted benefits of breastfeeding have
led the Italian Public Health Service, as elsewhere, to pro-
mote breastfeeding.1,2 In particular, a recent Cochrane Re-
view established that exclusive breastfeeding (defined as no
solids, or liquid other than human milk, vitamins, or medi-
cations) for 6 months has several advantages compared to 3
or 4 months of exclusive breastfeeding, followed by mixed
breastfeeding. The advantages include a lower risk of gas-
trointestinal infection and a quicker postbirth weight loss for
the mother.3 Moreover, a consistent protective effect of
breastfeeding against obesity in children has also been
demonstrated.4 Although some studies on breastfeeding
have already been performed in Italy, very few have re-
ported the rate of exclusive breastfeeding.5 Of these, the most
breastfeeding rate at the first month, decreasing to 30%–35%
and 8% at the third and sixth month, respectively.6 The most
common cause of a mother not breastfeeding and/or its early
discontinuation is insufficient milk production in response to
the neonate request. Common opinion, supported by several
reports, affirms that insufficient knowledge of the possibility
of consulting primary care teams skilled in helping the mo-
ther face the problems, ‘‘or conflicts,’’ which may arise dur-
ing the first weeks of a newborn’s life is a contributing factor
to discontinuation.7–9 Moreover, to date, to the best of our
knowledge, there are no proven and tested remedies able to
enhance milk supply, even if many alternative treatments
have been proposed (in particular, herbs and massage10).
However, due to the scarce scientific evidence in support of
the use of such remedies and in the light of a lack of sound
pharmacologic treatments for insufficient milk supply, these
remedies are widely proposed.
The aim of this study is to investigate the efficacy of
acupuncture treatment in the maintenance of exclusive
breastfeeding throughout the first 3 months of a newborn’s

1
Mother–Infant Department, University of Modena and Reggio Emilia, Modena, Italy.
2
Service for Acupuncture in Gynecology and Obstetrics, Department of Gynecology and Obstetrics, University of Turin, Turin, Italy.

133
134 NERI ET AL.

life in women with an insufficient milk production. The re-

search hypothesis was that breastfeeding women who are
given both acupuncture and observation might have greater
milk production and maintenance of breastfeeding than
women receiving observation alone.

Materials and Methods

A total of 90 women, who were referred to the Breast-
feeding Clinic at the Mother–Infant Department of the
Modena University and the Service for Acupuncture at the
Department of Gynecology and Obstetrics of Turin Uni-
versity, due to an insufficient milk supply, were enrolled
in the study. Inclusion criteria were a singleton healthy
pregnancy, birth weight above 2500 g, and neonatal
well-being. Exclusion criteria were maternal and/or fetal
complications during pregnancy (e.g., gestational hyper-
tension, diabetes, or intrauterine growth retardation), birth
weight less than 2500 g, and/or neonatal disease. After
written informed consent was obtained, the cohort was FIG. 1. The acupoints used in the semistructured formula
randomly divided into two groups: acupuncture treat- applied for milk production enhancement.
ment or observation. A centralized telephone randomization
procedure (with a computer-generated random list) was
used. The National Institutional Review Board approved the
study. All points were punctured with 0.3-mm-diameter sterile
According to Traditional Chinese Medicine (TCM)11–13 disposable steel needles (length 52 mm), inserted to a depth
theories, an insufficient milk production could be explained of 10–30 mm and manipulated until the patient reported the
as (1) a deficiency of Qi (vital energy) and Blood, or (2) a characteristic irradiating sensation, said to indicate effective
stagnation of the Liver Qi. needling, commonly known as De Qi.14
The ‘‘even’’ (intermediate) method was always used for
1. Clinical manifestations of the deficiency of Qi and blood needle manipulation. After insertion, the needles were ma-
include a scarce or absent milk production, fatigue, a nipulated by ‘‘raising and thrusting’’ and ‘‘twirling, or ro-
pale complexion, dry skin, and poor appetite. The tating’’ techniques. The depth of insertion during ‘‘raising
breast appears empty and soft with absence of the and thrusting’’ of the needle was intermediate. During
distending sensation. Often, these women experience ‘‘twirling’’ the needle was rotated mainly to the right. The
hemorrhage during delivery, anemia during pregnancy, manipulation was stopped and the needles left in situ for 30
or a condition of constitutional weakness. In this case, minutes without further manual stimulation, once the needle
the aim of the acupuncture treatment is mainly that of sensation had been obtained. In the specific case of SI 1
strengthening the Qi and blood.
2. Clinical manifestations of Liver Qi Stagnation include
depression, sometimes irritability, with scarce milk
production. These women often have a sensation of
distress in the chest and/or abdomen with epigastric
fullness. Their breasts appear swollen and congested.
In this condition, insufficient milk production is due to
impaired ejection, rather than to scarce production.
Such women may report difficulties in relationships
with their partners, or negative feelings about preg-
nancy. In this case, acupuncture treatment is aimed
mainly at the restoration of regular Qi flow.
A thorough anamnesis and a systematic collection of the
symptoms presented by the patients are carried out by the
acupuncturists before deciding upon the TCM diagnosis. To
this aim, a semistructured ‘‘formula’’ acupuncture was used
to standardize the treatment scheme, independently from the
Chinese differential diagnosis. The following acupoints were
treated: SI 1 Shaoze (specific acupoint for milk ejection) and
ST 18 Rugen and CV 17 Shanzhong (local acupoints for breast
stimulation) (Fig. 1). In the presence of Qi and Blood defi-
ciency, ST 36 Zusanli, SP 6 Sanyinjiao and BL 20 Pishu were FIG. 2. The acupoints used in the presence of Qi and Blood
added (Fig. 2). When a diagnosis of Liver Qi Stagnation was deficiency. Asterisk indicates that this acupoint is located in
made, LR 3 Taichong and PC 6 Neiguan were added14 (Fig. 3). the back.
ACUPUNCTURE TREATMENT AND BREASTFEEDING
FIG. 3. The acupoints used in the presence of Liver Qi
stagnation.
Shaoze, no manipulation was applied to the needle after the
insertion. When the acupoint BL 20 Pishu was included in the
treatment scheme (in case of Qi and Blood deficiency), after
the end of the acupuncture session in supine position, the
patients were put in a prone position and the needles were
inserted and left in situ for 5 more minutes, once the needle
sensation had been obtained.
Acupuncture sessions were performed twice weekly for 3
weeks for a total of six sessions, with the same needle ma-
nipulation technique by 2 of the authors (IN and GA), who
are experienced and qualified acupuncturists. The control
group made weekly visits to the clinic and the midwife ob-
served their breastfeeding, giving routine care. Neither the
control nor study group was given any other medical treat-
ment.
At enrollment and after 3 weeks, the midwife adminis-
tered to all women a semistructured clinical assessment of
the breastfeeding quality, which included assessing the
newborn’s growth rate, any need for artificial formula sup-
ply, and an evaluation of the mother’s subjective satisfaction
with breastfeeding.
Moreover, at the third month of the infant’s life, the
midwife conducted a telephone interview to all women to
investigate the continuation of breastfeeding and the even-
tual addition of artificial formula.
Table 1. Socioeconomic and Demographic Features of Women Included
in Observation and Acupuncture Groupsa
Observation group (45 cases)
Maternal age 33.9  4.5
Rate of graduate women 15 (33%)
Rate of employed women 27 (60%)
Diagnosis of Liver Qi stagnation – 10 (24%)
Diagnosis of Liver Qi deficiency – 31 (76%)
a
The differential Chinese diagnosis was also reported.
Data are reported as mean  standard deviation and a p-value lower than 0.05 was considered significant.
NS, not significant.
135
Statistical Analysis
Analysis of variance was applied to evaluate any demo-
graphic variables between the two groups. The w2 analysis
was used for categorical variables. A p-value <0.05 was
considered significant. Since the treatment protocols only
partially differed and shared a common basic acupuncture
scheme, the statistical analysis was performed considering all
the acupuncture-treated patients as a unique group and did
not consider them as divided TCM categories (i.e., deficiency
of Qi and Blood or Liver Qi Stagnation).
Results
No differences were observed between the observation
and acupuncture groups as far as socio-economic and de-
mographic features (Table 1).
Also, the gestational age at delivery (39.1  1.8 versus
38.2  2.8; p ¼ 0.08), the rate of cesarean section (53.8% versus
58.7%: p ¼ 0.4), and the rate of postpartum hemorrhage (13%
versus 11%: p ¼ 0.6) did not differ between the 2 groups.
Three (3) women declined to continue as they refused the
randomization to the nontreatment arm and 1 dropped out
of the treatment group due to lack of compliance toward
acupuncture. Therefore, the final analysis was done on 84
women: 43 in the observation group and 41 in the acu-
puncture group. It was not possible to carry out a separate
analysis of the results according to the TCM categories (i.e.,
deficiency of Qi and Blood or Liver Qi Stagnation), due to the
relatively small cohort and the use of a semistructured for-
mula acupuncture. Only 3 patients in the acupuncture group
reported having had any negative sensations, such as fear of
needle insertion and/or hypotension during treatment.
The rate of exclusive breastfeeding before treatment was
similar in the observation and acupuncture group (51.2%
versus 48.8%; p ¼ 0.7). However, it lowered significantly in
the observation group more than in the acupuncture group
(60% versus 98%; p < 0.03) at 3 weeks postenrollment. In-
deed, at the third month of the infants’ lives, the rate of
exclusive breastfeeding was significantly lower in observa-
tion group than in the acupuncture group (15% versus 35%,
p < 0.03), odds ratio ¼ 3.52 (95% confidence interval 1.10–
11.69) (Table 2).
Conclusions
The present study leads to the conclusion that 3 weeks of
acupuncture treatment were more effective than was obser-
vation alone in maintaining breastfeeding until the third
Acupuncture group (45 cases) p
34.9  4.3 NS
17 (37.7%) NS
25 (55.5%) NS
NS
–
136
Table 2. Breastfeeding Rate at Baseline, After 3 Weeks and 3 Months for Both Groups
Observation (43 cases)
Neonatal age at baseline (days) 31.4  26.7
Breastfeeding at baseline (no.) 22 (51.2%)
Breastfeeding after 3 weeks (no.) 26 (60%)
Breastfeeding after 3 months (no.) 7 (15%)
Data are expressed as mean  standard deviation. P-values lower than 0.05 were considered significant.
month of the newborn’s life. Although several Chinese studies
have reported the effectiveness of acupuncture in enhancing
insufficient milk supply, they are, unfortunately, not easy to
understand, since there is not even an English abstract for
most of them. To the best of our knowledge, the only study
with translated data demonstrated that electro-acupuncture at
the acupoint Shaoze (SI 1) was able not only to increase milk
production, but also to enhance prolactin levels.15
Literature from Western countries is scant on the appli-
cation of acupuncture to support breastfeeding. Indeed, only
one study reported the use of acupuncture to this aim and
demonstrated that the early implementation of treatment
(i.e., from 5 to 7 days postpartum) and a rapid response (i.e.,
within 24 hours from the first application) are positive
prognostic signs. The efficacy of acupuncture treatment in
this study reached 90%.16
Although there are marked individual fluctuations in the
amount of milk secreted, depending on the mother’s general
health status, both the psychologic and familial conditions of
the women during puerperium also have an effect on affect
milk secretion. The most commonly reported reason for a
premature discontinuation of breastfeeding is the (often
groundless) feeling the mother has of not being able to
produce enough milk. A large study performed in Australia
investigated the attitudes toward breastfeeding until the 6th
month of a newborn’s life and reported that most mothers
were not prepared to experience difficulties with breastfeed-
ing. In this study, the most common motivation put forward
by the women for stopping breastfeeding after 2 weeks was
that their baby was unsettled. Such behavior was commonly
interpreted as an expression of an insufficient milk supply,
whereas in reality, the mother’s anxiety was often the most
relevant problem.17 If this point of view is taken into consid-
eration, then it might be one explanation for the positive effect
that was observed after acupuncture on the mothers’ well-
being. Indeed, it has been demonstrated that acupuncture
improves the quality of life of patients being treated.18
Acupuncture effects are mediated by the secretion of
neurotransmitters and opioids, as well as by the stimulation
of the hypothalamus and pituitary glands.19–21 Moreover, it
has been demonstrated that the stimulation of the acupoint
SI 11 Tianzong increases prolactin in women with lactation
insufficiency as it does pituitary prolactin secretion, in both
lactating and nonlactating rats by central catecholamine and
R-aminobutyric acid secretion.22
Although our present study does have methodological
limitations, inasmuch as there was no objective quantification
of milk production, the mothers had no problems with their
babies being weighed both before, and after, breastfeeding.
Moreover, the rates of exclusive breastfeeding at the first
month in the Northern Italy report (48% versus 70%) are higher
NERI ET AL.
Acupuncture (41 cases) p¼
32.7  25 0.82
20 (48.8%) 0.75
40 (98%) 0.03
14 (35%) 0.03
than ours.6 However, this discrepancy might be due to the low
social class of the women participating in the present study.
Furthermore, the high cesarean section rate (which was
the same for both our groups) in our sample might well have
affected the onset of breastfeeding, due to the effects of an-
esthesia.23
Despite the fact that the use of acupuncture to improve
breastfeeding is becoming more widespread, scientific evi-
dence as to its efficacy remains scarce and anecdotal. How-
ever, the encouraging preliminary data obtained in this
study might hopefully stimulate further research, especially
if the lack of pharmacologic remedies for insufficient lacta-
tion is considered.
Disclosure Statement
No competing financial conflicts exist.
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Address correspondence to:
Isabella Neri, MD, PhD
Mother–Infant Department
University of Modena and Reggio Emilia
Via del Pozzo 71
Modena 41100
Italy
E-mail: neri.isabella@unimore.it
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