Acupuncture or Acupressure for Pain Relief during Labor
- What acupuncture and acupressure are
- How acupuncture and acupressure might work to provide pain relief during labor
- What the evidence shows about using acupuncture and acupressure for pain relief during labor
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- Declercq, E. R., Sakala, C., Corry, M. P., et al. (2013). Listening to mothers III: pregnancy and birth. New York (NY): Childbirth Connection; 2013. Click here. Free full text!
- Dong, C., Hu, L. and Liang, F. (2015). Effects of electro-acupuncture on labor pain management. Arch Gynecol Obstet 291:531-536. Click here.
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- Liu, Y, Xu, M., Che, X. (2015). Effect of direct current pulse stimulating acupoints of JiaJi (T10-L3) and Ciliao (BL 32) with Han’s Acupoint Nerve Stimulator on labor pain in women: a randomized controlled clinical study. J Tradit Chin Med; 35(6):620-625. Click here. Free full text!
- Mafetoni, R. R and Shimo, A. K. K. (2016). The effects of acupressure on labor pains during child birth: randomized clinical trial. Rev. Latino-Am. Enfermagem;24:e2738. Click here. Free full text!
- Schlaeger, J. Gabzdyl, E. M., Bussell, J. L, et al. (2017). Acupuncture and Acupressure in Labor. Journal of Midwifery and Women’s Health; 62(1):12-28. Click here.
- Smith, C. A., Collins, C. T., Crowther, C. A., et al. (2011). Acupuncture or acupressure for pain management in labour. Cochrane Database Syst. Rev.(7):CD009232. Click here.
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View the transcript
In today’s video, we’re going to talk about using acupuncture and acupressure for pain relief during labor.
Hi, everyone. My name’s Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth. I’ve been asked to create a video all about using acupuncture and acupressure for pain relief during labor.
Acupuncture has been used for at least 2,000 years in Asia, including China, Korea, and Japan. It is a major part of Traditional Chinese Medicine (TCM), which believes that good health is maintained by a balance of energy in the body. In TCM, acupuncture is a complex intervention, which often includes the provision of needling, a close patient/provider relationship, lifestyle advice, massage, and the use of herbs.
With acupuncture, very fine needles are inserted into different parts of the body and manipulated to correct energy imbalance. In electro-acupuncture, needles are connected to wires that deliver low or high frequencies of electrical currents.
Acupressure is based on the same theory as acupuncture, but instead of using needles, acupressure is delivered in a noninvasive way using fingers, thumbs, knuckles or other tools to put firm pressure on different areas of the body. Sometimes, only a few areas need that firm pressure in order to induce a sense of relaxation or pain relief. Unlike acupuncture, which must be delivered by a licensed provider, acupressure could be used by anyone, such as a midwife in an out-of-hospital birth setting.
How do acupuncture and acupressure work to relieve pain?
Researchers aren’t really sure how acupuncture and acupressure might work to relieve pain. It might work by changing how you perceive pain. Most acupuncture and acupressure points are near the pathways of the nervous system, so it might be that they’re stimulating the nervous system. Another theory is that acupuncture and acupressure work by leading the body to produce endorphins, which are natural, pain-relieving hormones.
Acupuncture and acupressure are considered part of complimentary medicine (CM). Studies have shown that the use of CM has risen worldwide with about half of all women of reproductive age using CM techniques.
What’s the evidence on using acupuncture and acupressure for pain relief during labor?
Smith et al. (2011) Cochrane Review and Meta-Analysis
Well, researchers carried out a Cochrane Review in 2011 where they combined 13 randomized, controlled trials with a total of more than 2,000 participants. Nine of the trials looked at acupuncture and four of them looked at acupressure. Participants were randomly assigned to either receive acupuncture or acupressure or to be in a group that did not receive acupuncture or acupressure. The groups that did not receive acupuncture or acupressure might have received a variety of other treatments, such as sham or fake acupuncture or acupressure, sterile water injections, medications, or nothing. In most of the studies, the mothers were in spontaneous labor at term.
The researchers found that people who were assigned to acupuncture or acupressure reported less intense pain during labor. Compared to people who received a placebo (which was the fake acupuncture treatment), people who received real acupuncture treatment during labor had shorter labors on average, higher levels of satisfaction, and less use of medication. Acupressure was linked with less intense pain, fewer Cesareans, shorter labors, and less anxiety compared to people who received fake or sham acupressure.
Three recent randomized, controlled trials on acupuncture
There have been three more randomized, controlled trials that have come out since the 2011 Cochrane Review.
In 2015, researchers studied the effects of electro-acupuncture on pain during labor. They found that patients who received electro-acupuncture had lower pain scores at 30, 60, and 120 minutes, compared to people who did not receive any electro-acupuncture treatment.
In another study published in 2015, researchers compared electro-acupuncture to IV opioids, epidurals, and no treatment. You could be randomly assigned to one of those four groups. The people assigned to epidurals had the lowest levels of pain, but the longest second stage labors. The epidural group also had side effects, such as maternal itching, difficulty urinating, and newborn breathing problems. The IV opioids group had side effects, such as maternal nausea and vomiting and newborn breathing problems. The researchers concluded that electro-acupuncture relieves pain better than no treatment and has fewer side effects than medication.
In another recent randomized, controlled trial, mothers were randomly assigned to either receive manual and electro-acupuncture, just manual acupuncture, or standard care. Everyone was free to use additional pain relief as they desired. They foud that the people in the combined manual and electro-acupuncture groups and the manual acupuncture groups were less likely to use an epidural than the people who were in the standard care group.
Four recent randomized, controlled trials on acupressure
There have also been four recent randomized, controlled trials on using acupressure for pain relief during labor. All four studies found that people randomly assigned to receive acupressure during labor experienced lower pain scores. The studies that looked at length of labor also found shorter labors.
Some of the common acupressure points that were used in these studies include LI4, which is on the back of the hand, and SP6, which is on the legs. Acupressure was typically provided during a contraction. It’s typically recommended that these points not be used during pregnancy or prior to labor at term, because they can bring on contractions.
In conclusion, there is a need for more high-quality research on acupuncture and acupressure for pain relief during labor. However, placebo-controlled trials have found that both acupuncture and acupressure are helpful for decreasing pain during labor. Studies have found other potential benefits as well, including higher levels of maternal satisfaction, lower use of pain medication, shorter labors, and less anxiety. All seven of the randomized, controlled trials that have come out in the last few years, have found benefits from acupressure or acupuncture.
The main downside to acupuncture and acupressure for pain relief during labor is that it’s not as effective a method for pain relief as an epidural. In one study, about half of the people assigned to acupuncture still asked for an epidural. This means that in that group, about half of the women did not find it satisfactory enough to just use acupuncture. However, the evidence shows that acupuncture or acupressure may be good options for people who want to avoid pain medications or who are unable to receive pain medications during labor.
I hope you found this video helpful. Thanks and bye!
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