Labor Preparation (pre-birth) Acupuncture:
Research on the use of acupuncture to prepare women for labour first appeared in 1974 with a study by Kubista and Kucera. Their research concluded that acupuncture once a week from 37 weeks gestation was successful in reducing the mean labour time of the women treated. They calculated the labour time in two ways. The first was the mean time between a cervical dilation of 3-4 cm and delivery. In the acupuncture group this was 4 hours and 57 minutes compared to five hours and 54 minutes in the control group. The second was the mean subjective time of labour, taken from the onset of regular (10-15 minute) contractions until delivery. The acupuncture group had a labour time of 6 hours and 36 minutes compared to eight hours and 2 minutes in the controls.
In 1998 Zeisler et al.used acupuncture from 36 weeks gestation. This study concluded that acupuncture treatment had a positive effect on the duration of labour by shortening the first stage of labour, defined as the time between 3cm cervical dilation and complete dilation. The acupuncture group had a median duration of 196 minutes compared to the control group time of 321 minutes.
In 2004 there was an observational study (Betts & Lenox) examining the effect of prebirth acupuncture. This involved 169 women receiving prebirth acupuncture who were compared to local population for gestation at onset of labour, incidence of medical induction, length of labour, use of analgesia and type of delivery. In the acupuncture group there was an overall 35% reduction in the number of inductions (for women having their first baby this was a 43% reduction), 31% reduction in the epidural rate. When comparing midwifery only care there was a 32% reduction in emergency caesarean delivery and a 9% increase in normal vaginal births. The conclusion was that prebirth acupuncture appeared to provide some promising therapeutic benefits in assisting women to have normal vaginal births and that a further randomised controlled study is warranted.
Cervical ripening
A randomised controlled trial into the effects of acupuncture on cervical ripening was published by Rabl in 2001.
Summary and conclusion
The objective of this study was to evaluate whether acupuncture at term can influence cervical ripening and thus reduce the need for postdates induction. On their due dates 45 women were randomised into either an acupuncture group (25) or a control group (20). The acupuncture group received acupuncture every two days. The women in both groups were examined every other day for cervical length (measured by vaginal trasonography, cervical mucus and cervical stasis according to Bishop’s score). If women had not delivered after 10 days labour was induced by administering vaginal prostaglandin tablets. The time from the woman’s due date to delivery was an average of 5 days in the acupuncture group compared to 7.9 days in the control group, and labour was medically induced in 20% of women in the acupuncture group compared to 35% in the control group. There were no differences between overall duration of labour or of the first and second stages of labour. The authors concluded that acupuncture at the points Hegu L.I.-4 and Sanyinjiao SP-6 supports cervical ripening and can shorten the time interval between the woman’s expected date of delivery and the actual time of delivery.
Acupuncture to Induce Labour
The research to date does not support that women receiving acupuncture to stimulate contractions improves labour outcomes. In contrast to the use of prebirth acupuncture which aims to prepare a woman’s body for labour, an acupuncture induction aims to stimulate contractions. It may be that stimulating uterine contractions without an individualised approach to address factors such as cervical ripening, the baby’s position, emotional factors, and physical stamina has limited beneficial effects in terms of labour outcomes.
Summary and conclusion
A Cochrane review in 2013 evaluated 14 studies involving 2220 women. The authors reported that while there was some evidence of changes in cervical maturation and the length of labor for women receiving acupuncture, there was no difference in the number of women using an epidural, in the rate of instrumental delivery or Caesarean sections. The authors concluded that further research is required to gaining a greater understanding of the specific components of acupuncture treatment with women who are overdue.
Breech Presentation
Cardini et al (1998) had the following randomised controlled trial published in the Journal of American Association (JAMA). This was the first trial of this kind to be published in the JAMA.
Summary and conclusion
The objective of the study was to evaluate the efficacy and safety of moxibustion to correct breech presentation. It involved 130 women with a breech presentation having their first baby (primigravidas) at 33 weeks gestation receiving moxibustion, while 130 women, also primigravida with a breech presentation received no intervention. Moxibustion was administered for seven days. Women were then assessed and a further seven days of moxibustion treatment given if the baby’s position had not changed. Outcomes were measured in terms of foetal movements, as counted by the mother for one hour each day for one week, and the number of cephalic (head down) presentations both at 35 weeks and at delivery. At 35 weeks gestation 75.4% in the intervention group had changed to cephalic (47.7% in the control). In terms of foetal movement the moxibustion group experienced a greater number of movements. The authors concluded that in prigravidas at 33 weeks moxibustion treatment increased foetal activity and cephalic presentation.
Further research into using moxibustion for breech presentation (van den Burg 2010) has included a mathematical modelling approach to investigate cost effectiveness. With the authors reporting that the use of moxibustion at 33 weeks would be more cost effective than usual care, including external cephalic version. It was interesting that the authors reported that if 16% or more of women offered moxibustion complied, it was more effective and less costly than expectant management.
In a recent study involving 406 women with a breech baby at 33 – 35 weeks, the use of moxibustion plus usual care at the acupuncture point BL 67 point was reported to be more effective than using moxibustion or usual care at another acupuncture point or usual care alone (Vas J et al 2013).
