With Comments from Russell H. Greenfield, MD
Source: Nesheim BI, et al. Acupuncture during labor can reduce the use of meperidine: A controlled clinical study. Clin J Pain 2003;19:187-191.
Goal: To evaluate the effectiveness of acupuncture for pain relief during labor for women choosing not to have an epidural.
Design: Prospective, randomized, controlled, unblinded trial.
Subjects: Records from 290 women with active contractions were available for analysis (acupuncture arm [n = 106]; "no acupuncture" [n = 92]; control group matched to "no acupuncture" arm by parity but not offered participation in the study [n = 92]).
Methods: Acupuncture points were selected on the basis of clinical situation (level of anxiety, degree of pain, duration of labor, etc.), and were generally left in place for 10-20 minutes, though duration of treatment varied. Analgesics, including meperidine, were offered upon receiving appropriate patient request. Effectiveness of acupuncture was measured mainly by requirement for the use of meperidine.
Results: Eleven percent of women received meperidine in the acupuncture group, 37% in the "no acupuncture" group, and 29% in the control group. In the acupuncture group, 34% required no additional analgesia at all, compared with 18% in the "no acupuncture" group and 21% in the control group.
Conclusion: The use of meperidine and other analgesics during labor is lowered with acupuncture, and with a high degree of patient satisfaction.
Study strengths: Use of a control group matched to the "no acupuncture" group; statistical significance was maintained even when six missing charts were included in the analysis as a "worst case scenario."
Study weaknesses: The midwife providing acupuncture was also in charge of the patient; patients were enrolled only when one of the midwives was on duty; lack of a placebo control group; lack of blinding; satisfaction with pain relief was not assessed in the "no acupuncture" group.
Of note: Acupuncture was offered by eight midwives, three of whom had taken a 108-hour course at The Norwegian School of Acupuncture, and five who had received 22 hours of training; a relatively small number of points were employed to address specific complaints; of 103 respondents in the acupuncture group, 89 said they would want acupuncture during another labor.
We knew that: Evidence exists that opioids are not effective analgesics for labor pain.
Clinical import: Any means of enhancing pain relief for women during labor, especially for those either declining use of an epidural or not having the option available to them, would be a welcome addition. Difficulties with blinding and placebo acupuncture create challenges with acupuncture analgesia research, but studies such as this one provide a basis for clinical application. That a technique such as acupuncture may relieve labor pain, while also allowing an expectant mother to more fully participate in the birth of her child, is compelling reason to offer the therapy.
What to do with this article: Keep a copy on your computer.
Dr. Greenfield, Medical Director, Carolinas Integrative Health, Carolinas HealthCare System, Charlotte, NC, is Executive Editor of Alternative Medicine Alert.