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

Abstract

BackgroundAcupuncture 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.MethodsA 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.ResultsMean 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).ConclusionsAcupuncture 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 registrationClinicalTrials.gov: NCT01197950.

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

“…We found one meta-analysis of randomized trials published in the Cochrane database in 2011 and 6 randomized trials published since then [91][92][93][94][95][96][97]. Of the 6 trials, only 4 reported oxytocin use [94][95][96][97].…”

“…One trial compared points SP6 and BX2 [94], another looked at several different acupuncture points [96], and a third focused on points T10-L3 and BL32 [95]. None of these three sets of authors found any difference in oxytocin use between the women having electroacupuncture and those with usual management (LE2).…”

“…We found 3 other randomized trials that have appeared since the last meta-analysis; they evaluated electroacupuncture vs usual management [94][95][96]. One trial compared points SP6 and BX2 [94], another looked at several different acupuncture points [96], and a third focused on points T10-L3 and BL32 [95].…”

“…Of the 6 trials, only 4 reported oxytocin use [94][95][96][97]. The meta-analysis by Smith et al included 13 randomized trials including 9 about acupuncture (manual or electroacupuncture) and 4 about acupressure, with both nulliparous and parous women [91].…”

“…We will therefore discuss each article individually. There were 4 randomized trials of acupressure during labor [96][97][98][99]. The interventions and the groups analyzed were different in each study (LE2).…”