Acupuncture and acupressure for pain management in labour and birth: A critical narrative review of current systematic review evidence☆
Section snippets
Background
Birth is a complex cultural, social and physical event, and evidence suggests that acupuncture and acupressure may be effective for managing pain in labour. The pain experienced in labour is affected by the processing of multiple physiological and psychosocial factors,1, 2 and where labour is proceeding normally, does not reflect an abnormal pathological process. Perceptions of labour pain intensity vary, and interventions used in pain management can have a primary focus of helping women to
Methods
Systematic reviews provide a methodology to appraise, collate and summarise data from individual studies.39 These reviews are key documents in providing an overview for policy makers and clinical decision makers. Where more than one review exists on a topic, and where the results or conclusions may be inconsistent, it is important to compare and contrast the methodology and findings from separate reviews to ascertain the most cohesive evidence possible.39 A search of the MEDLINE, CINAHL,
Efficacy and effectiveness studies
Reviews were examined specifically as to whether they were designed to answer questions of efficacy or effectiveness.25, 26, 28 These trial designs are dependent on the clinical or research question being asked, however the terms are sometimes used interchangeably, and are often misunderstood. Efficacy trials are designed to show the extent to which a specific treatment or component of an intervention is effective under ideal clinical circumstances with patient populations specifically selected.
Results
One Cochrane systematic review and three other systematic reviews were identified from the search and evaluated for effects on labour outcomes.25, 26, 27, 28 They covered the CM interventions of acupuncture and acupressure for pain management in labour and birth and included both efficacy and effectiveness studies.
Smith et al.25 in the most recent Cochrane systematic review of acupuncture and acupressure, has examined evidence from RCTs to answer the question of whether acupuncture and
What is the evidence really saying? Are we comparing apples with oranges?
In this review of the evidence, it is important to highlight the different clinical questions as the basis for the reviews themselves, but also the different clinical questions, methods, designs and outcome measures of individual trials included in each review. Table 3 outlines the studies incorporated into the reviews, including: type of therapy; population of women; choice of control groups, treatment protocols used and outcome measures used to assess the research question.
In the four
Treatment intent and capturing the treatment outcome
The question of matching the intent of treatment protocols with study design, as well as the outcome measure used, is useful to consider. Generally, the reviews report that in studies where acupuncture was compared with usual care, often reflecting pragmatic trial designs, broader outcomes of the effect of treatment as a whole were often more apparent. These included reduced requirement for pharmacological analgesia, lower rates of instrumental deliveries and greater relaxation and greater
Discussion
Women are large consumers of CM, and they continue to use it during pregnancy and labour. Evidence from these four systematic reviews of acupuncture and acupressure for labour25, 26, 27, 28 suggests that acupuncture and acupressure techniques show promising point specific effects and more generalised holistic effectiveness in the support and management of pain in labour and birth, and the results are varied.
Acupuncture research to date has largely centred on questions of efficacy for the
Conclusion
Overall, the purpose of these approaches to pain management is not the same, and effectively the combining of these studies into a systematic review seems like ‘comparing apples with oranges’. The benefit of acupuncture may lie largely in the capacity to help women manage labour and avoid pharmacological medication in the context of hospital based maternity care. The point specific and point combination effects for analgesia and anaesthesia and the relative benefits of different forms of
Conflict of interest
Kate Levett is currently completing a PhD which involves the evaluation of CAM therapies for labour and birth. The other authors are also Kate Levett's PhD supervisors. This is a mixed methods study being conducted with the assistance of an Australian Post-Graduate Award. KL and CS are both authors of the Cochrane reviews cited in the text.
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Cited by (47)
The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis
2020, Complementary Therapies in Clinical PracticeCitation Excerpt :LI4 and SP6 were the most commonly used acupoints because of their specific effect of increasing uterine contractions, shortening length of labour and reducing labour pain. This is in agreement with other reviews in this area [48]. The secondary outcomes of this review suggest a shorter duration of labour (first stage and total duration of labour) and a higher level of woman satisfaction with pain relief in acupressure groups.
Perspective: Childbirth education in Australia: Have we lost our way?
2019, Women and BirthLabor Pain Management
2018, Integrative Medicine: Fourth Edition
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Sources of support: Kate Levett is a PhD student supported by an Australian Post-Graduate Award.