Women have traditionally been high users of complementary therapies and use of these therapies continues during pregnancy and birthing. While women look to acupuncture and other therapies to support them during this time, traditional maternity services are in a state of change. In Australia, there is an increase in births, a workforce crisis, an increase in birthing in labour ward settings, few opportunities for women to birth at home, increased caesarean sections and an increase in obstetric interventions. The future role of acupuncture in this changed environment will be influenced by the evidence of safety and effectiveness of acupuncture. Research evaluating acupuncture during the antenatal period, labour preparation and birthing is small in quantity, but there are encouraging findings suggesting acupuncture maybe safe and effective. Women have prioritised interventions to manage pregnancy symptoms such as nausea and back pain, and interventions to prepare for labour and manage pain in labour as important. Further acupuncture trials are needed to ensure women have reliable and valid information to inform their decision making. Assessment of safety requires contributions from researchers, practitioners and integration with institutional data collection systems. Research of effectiveness should involve rigorous designs, but with debate about the appropriateness of traditional randomised controlled trial designs to evaluate complex interventions, and the limitations of sham controls, different approaches with mixed research methods should be considered. Exploring new research methods, especially those which explore the woman's experience with acupuncture, are also key to defining a role in the future.