Clinical Abstracts: Acupuncture During Labor

Source: Ramnero A, et al. Acupuncture treatment during labor—a randomized controlled trial. Br J Obstet Gynecol 2002;100: 637-644.

Design/Setting/Subjects: Randomized controlled trial of 90 women delivering in a tertiary care hospital in Sweden. Forty-six received an individualized acupuncture treatment during labor by their attending midwives, who had undergone a four-day course in acupuncture for labor pain as a complementary or alternative treatment to conventional analgesia during labor.

Main Outcome Measures: Hourly assessment of pain intensity and degree of relaxation during labor.

Results: Acupuncture treatment during labor reduced the need for epidural analgesia (12% vs. 22%, relative risk [RR] 0.52, 95% confidence interval [CI] 0.30-0.92). Women receiving acupuncture noted better relaxation compared to controls, but there was no difference between groups in assessments of pain intensity or in labor outcomes (including cesarean sections, duration of labor, oxytocin augmentation, or infant outcomes). No adverse effects were seen.

Funding: Grants from Örebro County Council Research Committee and Center for Nursing Science, Örebro University Hospital.

Comments by Adriane Fugh-Berman, MD: In Sweden, almost all women receive prenatal care from and are delivered by midwives. In this study, acupuncture appeared to be a beneficial adjunct to midwivery care. However, no effort was made to sham-control this study, a limitation noted by the authors. An additional limitation is that mean pain scores were used to compare groups (a statistically inappropriate but popular analytic technique). Of note, the midwives who administered acupuncture had undergone a very short course in the technique, and had learned a limited set of points commonly used for labor pain.

Acupuncture during labor is unlikely to become a trend in U.S. hospitals. Relatively few doctors and nurses are trained in acupuncture, and hospitals have been understandably leery of allowing unaffiliated practitioners to perform invasive procedures within the hospital. In this study, it was attending midwives who were performing acupuncture. In the United States, there are training courses in ear acupuncture for substance abuse treatment, but that is the only treatment-limited form of acupuncture training available. It is quite doubtful that quickie acupuncture courses for labor would be accepted in North America.