Acupuncture and Duration of Labor
June 1999; Volume 1: 49-51
By Adriane Fugh-Berman, MD
The effect of acupuncture on duration of labor has been examined in three rather widely spaced studies over the last two decades. Two studies were reported as positive and one reported as negative, but none of these trials was randomized and all have limitations.
The most recent trial on this subject is an Austrian case-control study published in 1998 by Zeisler that tested acupuncture during the four weeks before term.1 In this standardized protocol, each woman received weekly treatments at the same points: Du20 (Bai Hui), He7 (Shen Men), and Pe6 (Nei Guan). The study included 116 primiparas. Participants were required to have "an uneventful pregnancy;" multiple exclusion criteria included diabetes, pregnancy-induced hypertension, breech presentation, and "poor obstetric history."
Only 57 of the original 116 women were included in the final analysis. The exclusion of such a high proportion of women from the final analysis makes interpretation of the results problematic. The authors excluded 27 women admitted to the delivery unit with more than 3 cm cervical dilation; 12 women who did not complete a minimum of four treatments; six women who underwent vacuum extraction, seven women who underwent cesarean, and six women who were induced by prostaglandins. The control group consisted of 63 primiparous women who delivered closest in time to the acupuncture-treated women.
The authors of this study reported that the median duration of the first stage of labor (defined by the authors as the time interval between 3 cm of cervical dilation and complete cervical dilation) was significantly shorter in the acupuncture-treated group (196 minutes vs. 321 minutes in the control group). Median duration of the second stage of labor was identical (57 minutes) in both groups. Significantly more women (66.7%) in the acupuncture-treated group had premature rupture of membranes (PROM) compared to the control group (33.3%). Women in the control group were treated with oxytocin more often during both the first (85% vs. 15%) and second stages of labor (72% vs. 28%) than those in the acupuncture-treated group.
There are a number of problems with this study. There does not appear to be a comparison reported for the two groups in terms of total duration of labor. The biggest problem is that the treatment group was so overselected that it probably bears no resemblance to the control group. Although patients in the acupuncture group who had problems during pregnancy or labor were excluded from analysis, the control group consisted merely of "the nearest primiparous women who delivered before or after the acupuncture-treated women."
In other words, although women who were counted in the final analysis of the acupuncture group had uncomplicated pregnancies and did not undergo vacuum extraction, prostaglandin induction, or cesarean, it does not appear that any of these criteria were applied to the controls. A comparison of women with uncomplicated pregnancies who required few obstetric interventions with a cross-section of obstetrics patients may well result in differences in duration of labor even without an acupuncture intervention.
Although PROM is not considered a problem after 36 weeks, it is a serious problem prior to 36 weeks. The significantly increased frequency of PROM in the acupuncture group is a worrisome adverse effect. If this effect also occurs earlier in pregnancy, acupuncture at these points could precipitate preterm birth and should be avoided.
This study is thinly reported; there are no tables or information on individual subjects presented, only median values and ranges are reported. While the report states that the rate of vacuum extraction did not differ between the treated group and "the average vacuum extraction rate at our department," it is very odd that the comparison was made between the treated and the control group. And although it does not change the results, the fact that the authors apparently miscalculated a simple percentage of those receiving analgesia (13/57 is reported as 47% and 15/63 is reported as 54%) does not inspire confidence in the accuracy of the rest of the statistical analysis.
Two earlier studies on the same subject utilized a different set of acupuncture points than were used in the Zeisler study. The points consisted of stomach 36 (Zusanli), spleen 6 (Sanyinjiao), gallbladder 34 (Yangling-quan), and urinary bladder 62 (Shenmai). Although both studies used the same set of points, the studies found opposite results. A Swedish study by Lyrenas published in 1987 tested the effect of once-weekly acupuncture from the 36th week of pregnancy to delivery in 56 primigravidae.3 The control group consisted of 112 primiparous women who delivered closest in time to the acupuncture-treated women.
Lyrenas analyzed only women who delivered vaginally (93% of the treated group and 96% of the controls). This study found no significant difference in first-stage, second-stage, or total delivery times between the treated and control groups. In fact, second-stage labor exceeded 2.5 hours in significantly more acupuncture-treated women than controls, and significantly fewer acupuncture-treated women delivered within one hour of the second stage.
The German trial reported in 1973 by Kubista found that an average of three acupuncture treatments in the last weeks of normal pregnancy reduced delivery time in primigravidae by 23%, compared to a control group.4 The treatment group was apparently composed of women who were tense and worried near the end of pregnancy. The study was not randomized and the control group was matched to the treatment group exclusively with regard to the number of manual interventions during the second stage of labor.
The best of the studies reviewed above is the negative study by Lyrenas.2 Acupuncture point stimulation has been used for various indications in obstetrics, including prenatal nausea and vomiting and analgesia during labor. There is evidence for its efficacy in nausea and vomiting of pregnancy (see Alternative Therapies in Women’s Health, January 1999, pp. 9-11), but there are no convincing data that acupuncture (at least at these sets of acupuncture points) has a positive effect on duration of labor in term pregnancies.
References
1. Zeisler H, et al. Influence of acupuncture on duration of labor. Gynecol Obstet Invest 1998;46:22-25.
2. Taber's Cyclopedic Medical Dictionary, 18th ed. Philadelphia, PA: FA Davis Co.; 1997.
3. Lyrenas S, et al. Acupuncture before delivery: Effect on labor. Gynecol Obstet Invest 1987;24:217-224.
4. Kubista E, Kucera H. Uber die anwaendung der akupunktur zur geburtsvorbereitung. Z Geburtshilfe Perinatol 1974;178:224-229.
26. Acupuncture point stimulation has been shown to be effective in:
a. decreasing duration of labor.
b. decreasing the incidence of premature rupture of membranes.
c. decreasing cesareans.
d. None of the above.
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