Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial

Abstract

Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.

Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals . 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC).

Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS).

Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.

Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).

Conclusions: Acupuncture does not reduce women's experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated. These findings were obtained in a context with free access to other forms of pain relief.

Trial registration: ClinicalTrials.gov: NCT01197950.

Figure 1

Flow chart of the study participants. MA = Manual acupuncture, EA = Electro-acupuncture, SC = Standard Care, ITT = Intention to treat, PP = Per protocol.

Figure 2

Mean pain scores on a visual analogue scale (VAS) from time point 1 (baseline) to 15 (450 minutes). MA = manual acupuncture, EA = electro-acupuncture, SC = standard care, n = number of valid observations at each time interval. After time interval 6, n < 41 in MA and EA. After time interval 8, n < 41 in SC. The model with interaction was used to identify time intervals when the three groups differed in pain scores on VAS.