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Meta-Analysis
. 2020 Feb 7;2(2):CD009232.
doi: 10.1002/14651858.CD009232.pub2.

Acupuncture or acupressure for pain management during labour

Caroline A Smith  1 , Carmel T Collins  2 , Kate M Levett  1   3 , Mike Armour  1 , Hannah G Dahlen  4 , Aidan L Tan  5 , Bita Mesgarpour  6
Affiliations
Meta-Analysis

Acupuncture or acupressure for pain management during labour

Caroline A Smith et al. Cochrane Database Syst Rev. .

Abstract

Background: Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence about the use of acupuncture and acupressure for pain management in labour. This is an update of a review last published in 2011.

Objectives: To examine the effects of acupuncture and acupressure for pain management in labour.

Search methods: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, (25 February 2019), the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019, Issue 1), MEDLINE (1966 to February 2019), CINAHL (1980 to February 2019), ClinicalTrials.gov (February 2019), the WHO International Clinical Trials Registry Platfory (ICTRP) (February 2019) and reference lists of included studies.

Selection criteria: Published and unpublished randomised controlled trials (RCTs) comparing acupuncture or acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether nulliparous or multiparous, and in spontaneous or induced labour. We included studies reported in abstract form if there was sufficient information to permit assessment of risk of bias. Trials using a cluster-RCT design were eligible for inclusion, but quasi-RCTs or cross-over studies were not.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach.

Main results: We included 28 trials with data reporting on 3960 women. Thirteen trials reported on acupuncture and 15 trials reported on acupressure. No study was at a low risk of bias on all domains. Pain intensity was generally measured on a visual analogue scale (VAS) of 0 to 10 or 0 to 100 with low scores indicating less pain. Acupuncture versus sham acupuncture Acupuncture may make little or no difference to the intensity of pain felt by women when compared with sham acupuncture (mean difference (MD) -4.42, 95% confidence interval (CI) -12.94 to 4.09, 2 trials, 325 women, low-certainty evidence). Acupuncture may increase satisfaction with pain relief compared to sham acupuncture (risk ratio (RR) 2.38, 95% CI 1.78 to 3.19, 1 trial, 150 women, moderate-certainty evidence), and probably reduces the use of pharmacological analgesia (RR 0.75, 95% CI 0.63 to 0.89, 2 trials, 261 women, moderate-certainty evidence). Acupuncture may have no effect on assisted vaginal birth (very low-certainty evidence), and probably little to no effect on caesarean section (low-certainty evidence). Acupuncture compared to usual care We are uncertain if acupuncture reduces pain intensity compared to usual care because the evidence was found to be very low certainty (standardised mean difference (SMD) -1.31, 95% CI -2.14 to -0.49, 4 trials, 495 women, I2 = 93%). Acupuncture may have little to no effect on satisfaction with pain relief (low-certainty evidence). We are uncertain if acupuncture reduces the use of pharmacological analgesia because the evidence was found to be very low certainty (average RR 0.72, 95% CI 0.60 to 0.85, 6 trials, 1059 women, I2 = 70%). Acupuncture probably has little to no effect on assisted vaginal birth (low-certainty evidence) or caesarean section (low-certainty evidence). Acupuncture compared to no treatment One trial compared acupuncture to no treatment. We are uncertain if acupuncture reduces pain intensity (MD -1.16, 95% CI -1.51 to -0.81, 163 women, very low-certainty evidence), assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupuncture compared to sterile water injection We are uncertain if acupuncture has any effect on use of pharmacological analgesia, assisted vaginal birth or caesarean section because the evidence was found to be very low certainty. Acupressure compared to a sham control We are uncertain if acupressure reduces pain intensity in labour (MD -1.93, 95% CI -3.31 to -0.55, 6 trials, 472 women) or assisted vaginal birth because the evidence was found to be very low certainty. Acupressure may have little to no effect on use of pharmacological analgesia (low-certainty evidence). Acupressure probably reduces the caesarean section rate (RR 0.44, 95% CI 0.27 to 0.71, 4 trials, 313 women, moderate-certainty evidence). Acupressure compared to usual care We are uncertain if acupressure reduces pain intensity in labour (SMD -1.07, 95% CI -1.45 to -0.69, 8 trials, 620 women) or increases satisfaction with pain relief (MD 1.05, 95% CI 0.75 to 1.35, 1 trial, 105 women) because the evidence was found to be very low certainty. Acupressure may have little to no effect on caesarean section (low-certainty evidence). Acupressure compared to a combined control Acupressure probably slightly reduces the intensity of pain during labour compared with the combined control (measured on a scale of 0 to 10 with low scores indicating less pain) (SMD -0.42, 95% CI -0.65 to -0.18, 2 trials, 322 women, moderate-certainty evidence). We are uncertain if acupressure has any effect on the use of pharmacological analgesia (RR 0.94, 95% CI 0.71 to 1.25, 1 trial, 212 women), satisfaction with childbirth, assisted vaginal birth or caesarean section because the certainty of the evidence was all very low. No studies were found that reported on sense of control in labour and only one reported on satisfaction with the childbirth experience.

Authors' conclusions: Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need for further high-quality research that include sham controls and comparisons to usual care and report on the outcomes of sense of control in labour, satisfaction with the childbirth experience or satisfaction with pain relief.

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Conflict of interest statement

Carmel Collins: none known.

Hannah Dahlen: none known.

Bita Mesgarpour: none known.

Aidan Tan: none known.

Mike Armour: is an acupuncturist, not currently in clinical practice and until recently was a director of an acupuncture and physiotherapy clinic. As a medical research institute, the National Institute of Complementary Medicine (NICM) receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute. This systematic review was not specifically supported by donor or sponsor funding to NICM.

Caroline Smith: as a medical research institute, the National Institute of Complementary Medicine receives research grants and donations from foundations, universities, government agencies and industry. Sponsors and donors provide untied and tied funding for work to advance the vision and mission of the Institute.

Kate Levett: is employed at The University of Notre Dame, School of Medicine, and as a medical school employee receives research grants and donations from Foundations, Government agencies and industry. Kate Levett offers private acupressure for labour and birth education classes in Sydney Australia; these classes include complementary therapy strategies for pain relief in labour.

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

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Jin 2011 {published data only}
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Okumus 2017 {published data only}
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Pour 2012 {published data only}
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Samadi 2010 {published data only}
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Su 2001 {published data only}
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Torkzahrani 2016 {published data only}
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Wan 2016 {published data only}
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Wan 2018 {published data only}
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Xu 2000 {published data only}
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Zhang 2002 {published data only}
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Zhang 2006 {published data only}
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Ziaei 2006 {published data only}
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References to ongoing studies

Alimoradi 2018 {published data only}
    1. Alimoradi Z, IRCT20180218038789N1. Comparing the effect of auricular point acupressure and body acupressure on the pain score and the active phase duration of first stage of labor. https://en.irct.ir/trial/29707 (first received 4 March 2018).
Ozgoli 2018 {published data only}
    1. Ozgoli G, IRCT20100503003860N34. The effect of pressure on bile duct 21 on labor pain in primiparous women. https://en.irct.ir/trial/29423 (first received 17 April 2018).
Ranjkesh 2018 {published data only}
    1. Ranjkesh F, IRCT20171203037731N1. The effect of LI4, H7 and SP6, neima acupressure on the pain severity and duration of delivery in nulliparous women. https://en.irct.ir/trial/29263 (first received 6 June 2018).

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References to other published versions of this review

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