Is Acupuncture Useful for Labor Induction?

Woman Giving Birth
Image by Travis S. via Flickr

A recent study purports to show that acupuncture does not induce labor.  What it actually showed was that mild stimulation of a specific set of points did not  affect the onset of labor in 125 women who were characterized as “past due,”  at 41 weeks.  The points chosen were the same for all women, half of which got acupuncture with needles and the other half had stimulation of the same points with a blunt needle, described as “fake acupuncture.”  There was little appreciable difference between the two groups, although the acupuncture group which was slightly older ended up with slightly earlier labor and slightly lower birthweights. The headlines proclaimed, “Study: Acupuncture Doesn’t Help Induce Labor.”

Now the study only showed that two treatments of needling a specific set of fairly ineffective points did not appreciably give an advantage at inducing labor when compared to tapping on those points with a blunt needle referred to as a “sham needle.”  Even though most of the women in the acupuncture insertion group did slightly better.

There are several things wrong with this study:

  • All of the women had the same treatment regardless of why their labor was stalled.  The cervix might not be effaced, the baby’s lungs  might not be ready, the woman might be terrified of giving birth.  And the underlying pattern of the woman-  hot, cold, yin or blood deficient, qi deficient- might be very different.   We would not use the same points for women in those conditions.
  • At 41 weeks, not all of the babies would be ready.  Induction is generally better done at 44 weeks plus 4 days.
  • The point set avoided the especially useful lower abdominal and sacral points that are commonly used for inducing labor (but otherwise avoided in pregnancy.)  It included a point at the top of the head which usually brings the energy upward, the opposite of what you want to do when inducing labor.
  • Electrostimulation, which is useful for inducing labor was not used.  All points were identically twirled every 10 minutes, but based on time not qi sensation.
  • Since differential stimulation was not done (which would have been able to change that upward energy of the head point but could have revealed which needles were inserted) the needling was less effective.  Acupuncturists need to elicit a qi sensation, which is the result of the interaction between the energy of the practitioner via the needle and that of the patient. But the need to simplify a double blind study means that true acupuncture is not given.
  • Acupuncture was administered by midwives trained in acupuncture, but it is not clear that they had more than rudimentary acupuncture training.
  • There really was no control group.  Both groups received a form of acupuncture.  I have said this before: It is impossible to do sham acupuncture.  Needles that do not penetrate the skin, or barely touch the surface are used in Japanese acupuncture.  (By using qigong at an acupuncture point, you can affect qi without needles altogether.) There are layers of points that cover much of the body beyond the normal 12 channels:  tendino muscular channels cover broad areas, extraordinary meridians and divergents cover other areas, There are special points and microsystems that will signal the brain without a direct connection.  While some points may be more efficient than others, all do something to affect the body’s balance.  So finding “placebo points” is not useful either.  The best thing to do is to compare acupuncture to no treatment or conventional treatment.
Demi giving birth.
Image via Wikipedia

The acupuncture insertion group in this study actually did slightly better than the non-insertion acupuncture control group:  they gave birth slightly sooner, even though they were slightly older, slightly heavier and more inclined to smoke than the “control” group.  As a result the head circumference was slightly smaller and the birth weight was slightly less in the acupuncture insertion group.  They used fewer epidurals (40% vs 42%)  and fewer instrumental deliveries (40% vs. 41%.)  Labor was about 45 minutes longer, perhaps as a result of the lower intervention rate.  The acupuncture group had greater cervical dilation (1.5 cm vs 1.1 cm), and their babies had slightly better 1 minute Apgar scores (13% vs10%).  Slightly more of them ultimately required pharmaceutical induction however, but acupuncture was not considered a cause since the other group had “sham” treatment.  These differences were considered not statistically significant.

The study authors were aware of shortcomings and suggested that more intensive acupuncture might give better results.  Regarding sham acupuncture, they said” Sham acupuncture may have an effect beyond that of placebo when used to treat pain in nonpregnant women). Such an effect would cause an underestimation of the effect of acupuncture on the induction of labour.”

Another study by Claudia Clivowitz et al shows that giving acupuncture at the point of labor in a hospital setting results in a lower C-section rate.  Other studies have shown some benefit and a couple recent studies showed no statistically significant effect.  But acupuncture is far more useful when given before labor starts rather than coming in at the last minute to induce birth.

The three things that acupuncture does for labor are:

  1. Tonifying and balancing the woman’s physical state, increasing circulation of qi and blood, increasing physical reserves so that she will be in condition for the intense physical activity of giving birth.  Yang may be tonified to help the woman deal with the cold hospital rooms which can chill the uterus.  Qi may need to be tonified for strength and endurance.  Pain relief for lower back or hip pain may be needed to ensure sleep.  This entails multiple treatments to let the woman sleep, digest and eliminate well before the due date.
  2. Making sure the baby is well-positioned and ready for labor.  There are points that help position the baby, that can turn a breech, and that will help the cervix efface. The points that prepare the cervix can induce hormonal production to start labor.
  3. As a medicine that treats body and soul, acupuncture is especially useful to deal with fears and anxiety about giving birth.  Terror can stall labor.  If there is a history of abuse, the stimulation of reproductive organs can trigger memories.  Stories of bad birth experiences are often gratuitously told to pregnant women.  A medical setting can be frightening.  Rather than simply sticking in needles as someone in a study might do, there is an interaction of patient and acupuncturist which may involve stories, reassurance, and the physical moving of Liver qi constraint or Heart agitation with needles.

Acupuncture is not good at stimulating labor before the baby is ready.  In the final weeks of pregnancy, the baby empties its lungs of amniotic fluid in preparation for breathing air.  It moves into proper position, and it physically prepares for the intense experience of coming into the world.  Due dates are approximate and babies do not read calendars.

Labor should never be induced for the convenience of the doctor or the mother, because both mother and child need to be ready.  Induced labor otherwise can cause an increased risk of C-sections.  If the baby is ready, over 41+4 weeks, and labor is not progressing, then a qualified acupuncturist who deals with pregnancy and labor induction should be used.

I suggest that acupuncture preparation for labor should start at 37 weeks, given once weekly.  This is likely to result in a woman being ready to give birth without the need of induction.  When I treat a woman we discuss her physical symptoms, her feelinigs, and I give homework including points to rub or areas for her partner to massage  to better prepare for labor.  Giving birth is one of the most intense experiences in a woman’s life and being well-prepared honors that experience.

(citations in text)

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