Pelvic and Back Pain in Pregnancy: Reading the Evidence Properly

Somewhere around the middle of pregnancy, a lot of women discover that rolling over in bed has become a negotiation. Stairs become a problem. Standing on one leg to get dressed becomes a problem. For some it stays a nuisance; for others it becomes the thing that shapes the day.

It is one of the most common reasons pregnant women come to an acupuncture clinic, alongside morning sickness earlier on.

Acupuncture for pelvic girdle pain has a stronger research base than most people expect, including a large Swedish trial that put it head to head with the standard exercise approach.

What is actually happening in the pelvis?

The pelvis is three bones meeting at three joints: the pubic symphysis at the front and the two sacroiliac joints at the back. In pregnancy these become more mobile. Zita West’s Acupuncture in Pregnancy and Childbirth describes symphysis pubis pain as arising from separation of the joint or swelling within it, with the hormones of pregnancy thought to increase the width of the symphysis.

That extra movement changes how load transfers through the pelvis. The muscles have to work differently, the joints get irritated, and everyday movements that involve standing on one leg or separating the legs become the ones that hurt.

Is it back pain or pelvic girdle pain?

They are frequently lumped together and they behave differently.

Low back pain in pregnancy usually sits in the lumbar spine and feels much like back pain at other times. Pelvic girdle pain sits lower: across the back of the pelvis, over one or both sacroiliac joints, in the groin, or over the pubic bone, sometimes running into the inner thighs. West notes that it can initially be mistaken for a urinary tract infection, which is worth knowing because the two need very different responses.

Pelvic girdle pain is typically provoked by rolling in bed, climbing stairs, walking any distance, standing on one leg, and getting in and out of a car. Many women have both.

What have the trials found?

In 2005 the BMJ published a single-blind randomised trial of 386 pregnant women with pelvic girdle pain, comparing standard treatment alone with standard treatment plus acupuncture or plus stabilising exercises. The acupuncture group had the greater reduction in pain, and a blinded examiner rated their pelvic girdle pain as most improved. The authors concluded that acupuncture and stabilising exercises were efficient complements to standard treatment, with acupuncture superior to the exercises.

The same research group then tested it against a non-penetrating sham.

In that double-blinded trial of 115 women, both groups reported substantial pain relief, and the women receiving real acupuncture did better on two things that matter enormously in pregnancy: more of them returned to regular work, and they scored better on disability. That pattern recurs through this literature. Function improves, and function is what lets a woman keep living her life.

A network meta-analysis published in 2025, covering eight trials and 864 participants, found real acupuncture ahead of both sham and standard care on remission rate and on quality-of-life scores.

The Cochrane review of interventions for back and pelvic pain in pregnancy, covering 34 trials and 5,121 women, found that acupuncture improved pelvic pain more than usual prenatal care, alongside its support for exercise.

A pragmatic French trial of 199 women across five maternity hospitals, published in PLOS ONE in 2019, found a higher proportion of days with pain rated 4 or less out of 10 in the acupuncture group, 61 per cent against 48 per cent, and lower overall costs to the health system and employers.

In short: women in these trials got better, with less pain and, in the best-controlled work, a clear advantage on function, work and quality of life.

What does official guidance say?

In Australia, a 2018 review in Australian Journal of General Practice noted that women receiving acupuncture in addition to standard treatment have reported reduced morning and evening pain and improved functional outcomes.

How Chinese medicine approaches it

Traditionally, low back pain in pregnancy is read through Kidney deficiency, the Kidneys being associated with the lower back and with the reserves drawn on during pregnancy. West directs treatment at the underlying weakness: tonifying BL-23 and KI-3 where the picture is Kidney deficiency, BL-20 and SP-3 where Spleen weakness predominates, and notes BL-23 as useful in chronic backache generally. Where pain is acute and fixed, the reading shifts toward stagnation of qi and blood, and local and channel points are used with the woman positioned side-lying and supported.

In the clinic this mostly translates into a quieter, gentler treatment than people expect, with position and comfort dictating a good deal of what is possible.

Is it safe in pregnancy?

This is the question we are asked most.

The safety substudy attached to that 386-woman Swedish trial looked at 1,414 acupuncture treatments given between 12 and 31 weeks. There were no serious adverse events. Minor complaints occurred in roughly five per cent of treatments, most often needle pain, along with drowsiness and headache, and the authors reported no observable severe adverse influence on the pregnancy, the mother, the delivery or the baby.

On the traditional list of points said to be contraindicated in pregnancy, a review in Acupuncture in Medicine gathered the available evidence: across trials in which several hundred women received thousands of treatments including those points, rates of preterm birth and stillbirth matched untreated comparison groups, observational data on nearly 6,000 pregnant women showed comparable miscarriage and preterm labour rates, and no reliable evidence was found that acupuncture can induce miscarriage. The author’s conclusion was that these findings are reassuring and support individualised assessment of risk and benefit.

That does not mean the caution list is ignored here. It means the decision is made case by case, with your stage of pregnancy and your history in front of us, rather than by rote.

Brisbane, heat, and the practical side

Late pregnancy through a Brisbane summer adds its own difficulties. Swelling is worse in the humidity, sleep is broken by heat as much as by pain, and the advice to keep walking becomes harder to follow between about eleven and four. Treatment here tends to work around that: side-lying with support, shorter time on the table, and attention to swelling and sleep alongside the pain itself.

Stairs deserve a mention of their own in this city. A Queenslander with an external staircase is a daily provocation for a sore pelvis, and a few changes in how those stairs are taken, and how loads are carried up them, often matter as much as anything done in the treatment room.

Both clinics are open into the evening on weekdays and on Saturday mornings. Alexandra Hills is on the ground floor with no steps and parking at the door, which is the more comfortable option late in pregnancy; Balmoral serves Bulimba, Hawthorne, Morningside and the inner east.

When to contact your midwife or doctor

These need your midwife or doctor straight away:

• Any vaginal bleeding, or fluid loss
• Reduced or changed fetal movements. Safer Care Victoria’s guidance is clear that you should contact your maternity care provider and not wait until the next day, and that maternal concern overrides any count-based rule
• Regular tightening or cramping that may be labour, before term
• A persistent headache, visual disturbance, upper abdominal pain or sudden swelling, which can indicate pre-eclampsia
• Fever, burning on urination, or pain that came with feeling unwell
• New numbness in the saddle area, leg weakness, or any change in bladder or bowel control, which needs urgent assessment
• Pain following a fall or other significant injury

Pelvic girdle pain does not cause neurological symptoms. Any of those need urgent medical assessment.

What women ask us

Is acupuncture safe while I am pregnant?

The trial evidence summarised above is reassuring, and treatment is adapted to your stage of pregnancy. Tell us your gestation, your history and anything your midwife has flagged.

Will this stop me needing physiotherapy?

They work best together. Exercise, a support belt and acupuncture each do a different job, and in the Swedish trial acupuncture did more for pain than the stabilising exercises alone. We are happy to work with your physiotherapist directly.

Will it bring on labour?

Nothing we do in the second or early third trimester is aimed at that. Preparation for labour is a different conversation, at a different stage, described elsewhere on this site.

Can I lie face down?

No, and you will not be asked to. Treatment is side-lying or supported.

References

Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ. 2005;330(7494):761. doi:10.1136/bmj.38397.507014.E0

Elden H, Fagevik-Olsén M, Ostgaard HC, Stener-Victorin E, Hagberg H. Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG. 2008;115(13):1655-1668. doi:10.1111/j.1471-0528.2008.01904.x

Elden H, Östgaard HC, Fagevik-Olsén M, Ladfors L, Hagberg H. Treatments of pelvic girdle pain in pregnant women: adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complementary and Alternative Medicine. 2008;8:34. doi:10.1186/1472-6882-8-34

Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database of Systematic Reviews. 2015;9:CD001139. doi:10.1002/14651858.CD001139.pub4

Li M, Xiao Z, Tan D, Tang X, Zhao D, Chen Q. Acupuncture for the treatment of pregnancy-related low back pain: a systematic review and network meta-analysis. Journal of Back and Musculoskeletal Rehabilitation. 2025;38(5):960-967. doi:10.1177/10538127241301682

Nicolian S, Butel T, Gambotti L, et al. Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: a randomized controlled trial. PLOS ONE. 2019;14(4):e0214195. doi:10.1371/journal.pone.0214195

Ee CC, Manheimer E, Pirotta MV, White AR. Acupuncture for pelvic and back pain in pregnancy: a systematic review. American Journal of Obstetrics and Gynecology. 2008;198(3):254-259. doi:10.1016/j.ajog.2007.11.008

Carr DJ. The safety of obstetric acupuncture: forbidden points revisited. Acupuncture in Medicine. 2015;33(5):413-419. doi:10.1136/acupmed-2015-010936

Walters C, West S, Nippita TAC. Pelvic girdle pain in pregnancy. Australian Journal of General Practice. 2018;47(7):439-443. doi:10.31128/AJGP-01-18-4467

West Z. Acupuncture in Pregnancy and Childbirth. 2nd ed. Edinburgh: Elsevier; 2008.

Individual responses vary, and an assessment is what determines whether treatment is suitable for you. Dr Francesco Pennisi practises at Balmoral and Alexandra Hills. Phone (07) 3820 2887, or book online.