Acupuncture may not help relieve birth pains

A new review published in BJOG states that the available evidence does not show that acupuncture helps diminish pain during labour.

The use of acupuncture to manage pain in labour started in the 1970s but the evidence of its benefits remains unconvincing. However, its use and that of other forms of complementary and alternative medicine (CAM) continue to be popular in pregnancy.
 

Researchers from Korea and the UK undertook a systematic review and meta-analysis of trials of acupuncture use published in 19 electronic databases from around the world. Their study focused on women who received acupuncture alone (mainly: classical acupuncture, electroacupuncture and auricular acupuncture; studies on related forms of acupuncture such as acupressure and moxibustion therapy were excluded) or those receiving acupuncture and a conventional form of analgesia for pain relief in labour.

Ten randomised controlled trials (five from Europe, three from China and two from Iran) were identified as meeting the inclusion criteria and the results were analysed. Researchers note that the heterogeneity of the studies (large variation in the results from one study to another) made interpretation difficult but the results show that there is little convincing evidence that women who had acupuncture experienced less labour pain than those who received no pain relief, a conventional analgesia, a placebo or sham acupuncture.

In the trials which compared acupuncture to women using conventional pain relief, it was observed that the women who received acupuncture required less meperidine (otherwise known as pethidine or Demerol – a synthetic opiate) or other forms of analgesia. A possible explanation for this finding is that the women felt that they were already being treated and therefore did not need another form of pain relief.

Dr Hyangsook Lee, from the Acupuncture and Meridian Science Research Centre, Kyung Hee University, Seoul, Korea; said “In our previous systematic review of three randomised controlled trials (RCTs) in 2004, acupuncture appeared to be a promising analgesic option for women in labour. To update the evidence for or against acupuncture for labour pain management, this time we searched 19 databases and subsequently analysed 10 RCTs involving women receiving acupuncture alone, or as an adjunct to conventional analgesia, for pain relief in labour.

“In this review, acupuncture did not seem to have any impact on other maternal or fetal outcomes, nor was it associated with harm. However, there was no convincing evidence that women receiving acupuncture experience less labour pain than those in the control groups. Acupuncture might reduce the use of other forms of pain relief such as meperidine, but the evidence is limited. To summarise, the current evidence does not appear to recommend the use of acupuncture for labour pain.”

Co-author Professor Edzard Ernst from the Peninsula Medical School, Universities of Exeter and Plymouth, said “Labour is a good subject to study the analgesic effects of acupuncture. Our analyses show that the effects of acupuncture perceived by women are largely due to placebo. Acupuncture has many qualities that maximise placebo effects: it involves touch and is invasive and, psychologically, is attached to the mysticism of the East. Our findings are in keeping with much of the recent research on acupuncture which demonstrates that the more one controls for such confounders, the smaller the effect of acupuncture gets.”

Professor Philip Steer, BJOG editor-in-chief said, “Pain is a very subjective response. Labour pain can be so intense that the woman feels she would do anything to minimise the sensation of pain. Acupuncture is a drug-free approach and that may explain why some women prefer its use during labour. This research has shown that there were no adverse outcomes to mother and baby for those who had acupuncture to control pain during labour.

“This review of previous research into the usefulness of acupuncture in providing pain relief to women during labour shows that in a very small number of cases, acupuncture may be of help (usually for very short periods of time after treatment) and this may be down to a psychological rather than a physiological effect. Generally, the consensus is that the evidence does not support its use. In contrast, there is good evidence showing a benefit from emotional support during labour, so we should concentrate our efforts on making sure that all women have the benefit of one to one care at this crucial time.”

The study: Cho S-H, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02570.x.

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