Acupuncture for treatment of pain in labor

Acupuncture

There is limited data on the use of acupuncture in labor, and at present there is no evidence for recommending this method for routine use.

Moving to more and more exotic methods of relieving pain of childbirth, here is acupuncture. Acupuncture for treatment of pain has been used for thousands of years and is part if traditional Chinese medicine. The principle of acupuncture lies in the belief in the life energy, or Qi (pronounced as “chee”), that flows through channels in the body called meridians. Blockages in the meridians interfere with the normal flow of Qi and cause diseases and symptoms. In order to restore the normal circulation of Qi thin practitioners of Chinese medicine insert needles into various points of the meridians and rotate them, either vigorously or gently, depending on the goal of treatment. Lately, electrical stimulation of needles with the weak electric current has become popular.

There has been quite a bit of research on the use of acupuncture in the treatment of acute and chronic pain, with some studies showing promising results.

The research on the use of acupuncture in labor pain has been summarize in the recent review by Korean researches who, as the result of using very strict selection criteria finally identified three clinical trials of good quality that could be used for making conclusions regarding the efficacy of this method. Altogether 496 patients were studied, 258 received acupuncture and 238 – conventional care.

In one study, the use of other methods of pain relief – pethidine, epidurals, nitrous oxide and water blocks – was reduced by about 20%. Also, majority of patients who received acupuncture stated that they would choose it for their next labor.

In another trial the number of requests for epidurals was almost half of that among those receiving conventional care. However pain, intensity and numbers of requests for pethidine injections and nitrous oxide was similar between the groups. Remarkably, women receiving acupuncture also reported significantly higher degree of relaxation. Women receiving acupuncture also requested less of non-pharmacological modalities of pain relief, such as hot rice bags, TENS or shower.

Finally, placebo-controlled randomized study found that women receiving acupuncture report less pain (as measured by the Visual Analogue Scale) at 30 minutes, 1 and 2 hours after receiving acupuncture and 2 hours after delivery. Number of requests for pethidine injections and epidural was also considerably less. Importantly, women receiving acupuncture required less Oxytocin for the augmentation of labor. In all three trials there were no adverse effects of acupuncture.

The results of the trials above indicate that acupuncture may be useful for relieving pain of childbirth and is not associated with significant complications. On the other hand, its effect in treatment of various painful conditions has been variable, and the effectiveness and repeatability of acupuncture in relieving intensive pain that accompanies childbirth is questionable.

Even if one finds the use of acupuncture in labor promising and lack of complications encouraging it is unlikely to become mainstream method of pain relief in labor wards in the near future. The practice of traditional Chinese medicine is based on concepts and principles that are very different from those used in it Western counterpart, and its practitioners have to undergo training which is completely different from that necessary for practicing conventional medicine. Acupuncture is administered according to the needs of particular patient, according to the specific clinical signs and symptoms. It’s most serious limitation is that it is time consuming and labor intensive (no pun intended). Using acupuncture for pain relief during childbirth requires the presence of a qualified practitioner throughout the duration of labor, which in turn increases cost burden of medical service. Until more evidence in favor of acupuncture in labor is accumulated the use of this method on mass scale is not feasible.

References:
1. Cho S-H, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG 2010;117:907–920.

[top]

-----

Dr. Eugene Smetannikov is a practicing anesthesiologist with the interest in obstetric anesthesia. He is the author of the most comprehensive book on the subject, The Truth About Labor Epidural