A Summary of a Cochrane Review: Acupuncture for Induction of Labor

Nancy Santesso, RD, MLIScorresponding author

Abstract

Review authors in the Cochrane Collaboration conducted a review of the effects of acupuncture to induce labor. After searching for all relevant studies, they found 14 studies with 2220 pregnant women who were overdue or needed to be induced. The findings of the review are summarized below.

Key Words: Pregnancy, acupuncture, induction, complications

INTRODUCTION

Review authors in the Cochrane Collaboration conducted a review of the effects of acupuncture to induce labor. After searching for all relevant studies, they found 14 studies with 2220 pregnant women who were overdue or needed to be induced. The findings of the review are summarized below.

INDUCTION OF LABOR AND ACUPUNCTURE

Some pregnant women may need to have their labor started artificially (induced), such as when they are overdue. These women are assessed by their doctor and those at risk are usually given drugs or hormones to induce labor. It is hoped when women are induced that they will deliver vaginally within 24 hours (not by Cesarean section, c-section) and that they will be well. There should also be no distress for the baby. Researchers are also testing whether acupuncture could be used to induce labor. It is not clear how acupuncture could work, but fine needles are placed into the body at specific places which are thought to affect labor.

WHAT DOES THE RESEARCH SAY?

There are 14 studies that tested the effects of acupuncture to induce labor. The pregnant women in the studies were assessed as needing to be induced, but they were at low risk of serious complications. Some women received acupuncture and other women received fake acupuncture (and sometimes their usual care) and then they were compared.

The evidence from the research was low to very low quality. “Very low quality” evidence means we are still uncertain about what will happen. “Low quality” means we think something may happen, “moderate quality” means it probably will happen, and “high quality” means it will happen.

The studies show that acupuncture may have little or no effect on whether the woman avoids a c-section. It is uncertain whether acupuncture increases or decreases serious complications for the mother or the baby. There was no information from the studies about whether women had a vaginal delivery within 24 hours.

Overall, the studies had flaws and were small and did not collect the most important information. In the studies, acupuncture was provided at different acupuncture points, with different methods (using manual or electrical stimulation), and different number of times. So the best way to provide acupuncture is not clear. The authors suggest that larger and well-done studies should be carried out and should measure the effects of acupuncture that are important to women (such as vaginal delivery within 24 hours).

Table

Summary of Findings

What Was Measured Without Acupuncture With Acupuncture Quality of the Evidencea What Happens
Had a caesarean section (6 studies, 654 women) 20 women had a c-section 1 less woman had a c-section (from 6 fewer to 6 more)b ⊕⊕⊝⊝ low Acupuncture may have little or no effect on how many women have a c-section
Serious complications for mother (1 study, 364 women) 1 study reported that no serious complications occurred with or without acupuncture ⊕⊝⊝⊝very low It is uncertain whether complications increase or decrease
Serious complications for baby (1 study, 364 women) 1 baby had seizures 1 baby had seizures ⊕⊝⊝⊝very low It is uncertain whether complications increase or decrease
Had a vaginal delivery within 24 hours (no studies) Not measured in the studies
Hyperstimulation of uterus with changes in fetal heart rate (no studies) Not measured in the studies
aDetails about the quality of the evidence:

Evidence was low quality due to the risk of bias in the studies and there were few women in the studies.

Evidence was very low quality due to risk of bias and there were very few women in the studies, especially since the complications are rare.

bThe numbers in the brackets show the range in which the actual effect could be. This effect is based on a relative risk of 0.95 (95% confidence interval, 0.69 to 1.30).

WHERE DOES THIS INFORMATION COME FROM?

This summary is based on a Cochrane systematic review: Smith CA, Crowther CA, Grant SJ. Acupuncture for induction of labor. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002962.

The Cochrane Collaboration is an independent global network of people who publish Cochrane systematic reviews. Many of the people are volunteers who write reviews by pulling together scientific studies to answer healthcare questions. These reviews may answer questions about whether, for example, certain vitamins work in diabetes. The Cochrane Complementary and Alternative Medicine Field promotes Cochrane systematic reviews which cover complementary and alternative medicine in many conditions and diseases. For more information, please visit http://www.compmed.umm.edu/cochrane/.

Acknowledgments

This article was prepared on behalf of the Cochrane Complementary and Alternative Medicine Field with funding from the US National Center for Complementary and Alternative Medicine (NCCAM) of the US National Institutes of Health (grant number R24 AT001293). This Summary of Findings column series in Global Advances in Health and Medicine was conceived and is coordinated and edited by Dr Eric Manheimer, the administrator and methodologist of the Cochrane Complementary Medicine Field.

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